Generic Name: Alprazolam
Tablet Strengths: 0.25 mg, 0.5 mg, 1 mg, 2 mg Orally Disintegrating Tablet Strengths: 0.25 mg, 0.5 mg, 1 mg, 2 mg Oral Solution: 1 mg/mL Extended Release Tablet Strengths: 0.5 mg, 1 mg, 2 mg, 3 mg
Brand Names:
- Xanax®
- Tablet Strengths: 0.25 mg, 0.5 mg, 1 mg, 2 mg
- Xanax XR®
- Extended Release Tablet Strengths: 0.5 mg, 1 mg, 2 mg, 3 mg
Please review all FDA black box warnings at the end of this document before using this medication.
What is Alprazolam and What Does It Treat?
Alprazolam is a benzodiazepine used to treat generalized anxiety disorder (GAD) and panic disorder, with or without agoraphobia. These medications are also used for sleep disturbances and alcohol withdrawal.
Generalized Anxiety Disorder (GAD) is characterized by excessive anxiety and persistent worry for at least six months. Symptoms may include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep problems.
Panic Disorder involves unexpected and recurring episodes of intense fear with physical symptoms like chest pain, shortness of breath, heart palpitations, sweating, dizziness, and nausea. Fear of future episodes is also common.
What is Important to Know About Alprazolam?
- Avoid driving or operating machinery until you understand how this medication affects you, as it may cause drowsiness or dizziness.
- Relief from anxiety or insomnia when starting alprazolam can be rapid, taking several days.
- Benzodiazepines, like alprazolam, are typically prescribed for short periods and may lead to emotional and physical dependence (addiction) even when used as directed. Your healthcare provider will determine the appropriate duration of treatment based on your needs.
- Do not abruptly stop taking alprazolam or change your dosage without consulting your healthcare provider, as it may lead to withdrawal symptoms such as trouble sleeping, anxiety, irritability, nausea, tremors, dizziness, blood pressure changes, rapid heart rate, and seizures. Withdrawal reactions can occur when dosage adjustments are made for any reason.
- Combining alprazolam with opioids has led to severe side effects, including slowed or difficult breathing and death. Opioids are used to manage pain and include medications like codeine, oxycodone, morphine, and illegal substances like heroin, which are also present in some cough syrups. Seek medical assistance if you feel dizziness, drowsiness, slow or troubled breathing, or loss of consciousness while taking alprazolam with an opioid.
- Avoid alcohol while taking this medication.
Are There Specific Concerns About Alprazolam and Pregnancy?
Pregnant individuals or those planning pregnancy should inform their healthcare provider for effective medication management. Decisions regarding benzodiazepine use during pregnancy for individuals with anxiety disorders should consider the risk versus benefit. Alprazolam may increase the risk of premature birth and low birth weight, with potential side effects including neonatal withdrawal and “floppy baby syndrome.” Discuss these concerns with your doctor and caregivers.
Caution is advised during breastfeeding, as alprazolam can pass into breast milk.
What to Discuss With Your Healthcare Provider Before Taking Alprazolam:
- Share the symptoms that trouble you most in relation to your condition.
- Inform your healthcare provider if you have thoughts of self-harm or suicide.
- Disclose prior medications taken for your condition, their effectiveness, and any adverse effects.
- If you experience side effects from your medications, discuss them with your healthcare provider. Some side effects may diminish with time, while others may necessitate medication adjustments.
- Share any other psychiatric or medical issues, including obstructive sleep apnea.
- Provide a list of all current medications, including over-the-counter products, herbal supplements, and nutritional supplements, as well as any known medication allergies.
- If you are undergoing non-medication treatments like talk therapy or substance abuse treatment, discuss how these therapies interact with the medication.
- Mention if you are elderly or prone to falling.
- Communicate your pregnancy status, plans, or breastfeeding.
- Indicate if you have liver disease.
- Mention your alcohol or drug use.
How to Take Alprazolam:
- Alprazolam can be taken with or without food. Use it with food if it causes stomach upset.
- It can be taken every day at regular times or on an as-needed (“PRN”) basis, with the number of doses per day typically limited by your healthcare provider.
- Your healthcare provider will determine the appropriate dosage and method of administration based on your response to the medication.
- Orally disintegrating tablets must be kept in their original packaging. Open the package with clean, dry hands before each dose. Do not attempt to store these tablets in a pillbox. Consume them immediately, with or without liquid.
- Extended release tablets should be swallowed whole without chewing, crushing, or splitting.
- Alprazolam liquid should be measured using a dosing spoon or oral syringe, available at your pharmacy.
- If you take the medication daily, use a calendar, pill organizer, alarm, or phone reminder to help you remember to take it. Alternatively, request assistance from a family member or friend to ensure your adherence.
What to Do If You Miss a Dose of Alprazolam:
If you forget a dose of alprazolam, take it as soon as you remember, unless it’s close to your next scheduled dose. Consult your healthcare provider regarding the missed dose. Do not double the next dose or exceed the prescribed amount.
What to Avoid While Taking Alprazolam:
Refrain from consuming alcohol or using illicit drugs while on alprazolam. These substances can diminish the medication’s benefits and amplify its side effects, particularly sedation. Alcohol increases the risk of accidental overdose when combined with alprazolam.
What to Do in Case of Alprazolam Overdose:
In the event of an overdose, contact your doctor or call 911 for urgent medical attention. You can also reach out to the poison control center at 1-800-222-1222.
Overdose symptoms may include confusion, impaired coordination, slow reflexes, coma, and, in severe cases, death.
There is a specific treatment available to reverse the effects of alprazolam, called flumazenil. However, this treatment must be administered via IV at a hospital, and only a doctor can determine if it is necessary.
Possible Side Effects of Alprazolam:
Common side effects include:
- Dizziness, drowsiness, fatigue, or lightheadedness.
- Impaired coordination and reduced ability to concentrate.
These side effects generally improve within the first one to two weeks of alprazolam use. If side effects persist or become troublesome, consult your healthcare provider.
Rare or severe side effects:
- Shortness of breath, difficulty speaking, profound fatigue, dizziness, or loss of consciousness.
- Increased heart rate, headache, memory problems, irritability, and restlessness.
- Some individuals taking benzodiazepines may experience a severe allergic reaction with facial swelling, sometimes even after the first dose.
- People using benzodiazepines for sleep have reported engaging in various activities while asleep or not fully awake, such as sleep-driving, making phone calls, and preparing or eating food, with no memory of these events upon waking.
- Watch for signs of depression, low mood, thoughts of self-harm or suicide, or a lack of interest in life.
Risks of Long-Term Alprazolam Use:
Alprazolam is considered safe and effective when used as directed. However, benzodiazepines may lead to emotional and/or physical dependence (addiction), even when used as prescribed. Physical dependence may develop after two or more weeks of daily use. The risk of withdrawal reactions upon discontinuation is higher with prolonged use.
Medications That May Interact With Alprazolam:
The following medications may increase alprazolam levels and effects:
- Ketoconazole (Nizoral®), itraconazole (Sporanox®), nefazodone (Serzone®), fluvoxamine (Luvox®), and cimetidine (Tagamet®).
The following medications may decrease the levels and effects of alprazolam:
- Carbamazepine (Tegretol®), phenytoin (Dilantin®), and phenobarbital (Luminal®).
Alprazolam should not be taken with other benzodiazepine medications.
Caution should be exercised when combining alprazolam with other medications that cause drowsiness. These may include:
- Antihistamines such as diphenhydramine (Benadryl®).
- Narcotic pain medication such as morphine, oxycodone (OxyContin®), and hydrocodone (Vicodin® and Lortab®).
- Opioid cough medications such as codeine cough syrup.
- Sleep medications such as zolpidem (Ambien®).
- Other anti-anxiety medications, antipsychotic medications, specific anticonvulsant medications, and tricyclic antidepressant medications like amitriptyline.
How Quickly Does Alprazolam Work?
Alprazolam can provide relief from anxiety or insomnia rapidly, over a few days or even within hours of the first dose.
Summary of FDA Black Box Warnings:
The FDA has noted that benzodiazepines, like alprazolam, when used in combination with opioid medications or other sedating drugs, may lead to severe adverse reactions, including slowed or difficult breathing and death.
