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Alprazolam

Generic name: alprazolam (al PRAY zoe lam)
Brand name: Xanax, Xanax XR, Niravam
Dosage forms: oral concentrate (1 mg/mL); oral tablet (0.25 mg; 0.5 mg; 1 mg; 2 mg); oral tablet, disintegrating (0.25 mg; 0.5 mg; 1 mg; 2 mg); oral tablet, extended release (0.5 mg; 1 mg; 2 mg; 3 mg)
Drug class: Benzodiazepines

Medically reviewed by Sophia Entringer, PharmD. Last updated on Feb 2, 2021.

What is alprazolam?

Alprazolam is a benzodiazepine (ben-zoe-dye-AZE-eh-peen). It is thought that it works by enhancing the activity of certain neurotransmitters in the brain.

Alprazolam is used to treat anxiety disorders, panic disorders, and anxiety caused by depression.

It is dangerous to purchase alprazolam on the Internet or outside the United States. The sale and distribution of medicines outside the U.S. does not comply with safe-use regulations of the Food and Drug Administration (FDA). These medications may contain dangerous ingredients, or may not be distributed by a licensed pharmacy.

Warnings

Alprazolam can slow or stop your breathing, especially if you have recently used an opioid medication, alcohol, or other drugs that can slow your breathing.

You should not use alprazolam if you have narrow-angle glaucoma, if you also take itraconazole or ketoconazole, or if you are allergic to alprazolam or similar medicines (Valium, Ativan, Tranxene, and others).

Do not use alprazolam if you are pregnant. This medicine can cause birth defects or life-threatening withdrawal symptoms in a newborn.

Alprazolam may be habit-forming and should be used only by the person for whom it was prescribed. Keep the medication in a secure place where others cannot get to it. Misuse can cause addiction, overdose, or death.

Fatal side effects can occur if you take alprazolam with alcohol, opioid medicine, or other drugs that cause drowsiness or slow your breathing.

Before taking this medicine

You should not take alprazolam if:

To make sure this medicine is safe for you, tell your doctor if you have ever had:

Tell your doctor if you are pregnant or plan to become pregnant. Alprazolam may harm an unborn baby. Avoid taking this medicine during the first trimester of pregnancy.

If you use alprazolam while you are pregnant, your baby could become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on habit-forming medicine may need medical treatment for several weeks.

You should not breastfeed while using this medicine.

Alprazolam is not approved for use by anyone younger than 18 years old.

How should I take alprazolam?

ake alprazolam exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides. Your doctor may occasionally change your dose. Never use alprazolam in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to use more of this medicine.

Never share this medicine with another person, especially someone with a history of drug abuse or addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medication in a place where others cannot get to it. Selling or giving away this medicine is against the law.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

Swallow the extended-release tablet whole and do not crush, chew, or break it.

Do not swallow the orally disintegrating tablet whole. Allow it to dissolve in your mouth without chewing.

Alprazolam is usually taken for no longer than 4 months to treat anxiety disorder, and for no longer than 10 weeks to treat panic disorder. Follow your doctor's dosing instructions very carefully.

Call your doctor if your symptoms do not improve, or if they get worse.

If you use this medicine long-term, you may need frequent medical tests.

Do not stop using this medicine suddenly, or you could have unpleasant withdrawal symptoms. Follow your doctor's instructions about tapering your dose.

Store at room temperature away from moisture, heat, and light. Keep track of your medicine. You should be aware if anyone is using it improperly or without a prescription.

Throw away any alprazolam liquid not used within 90 days.

Dosing information

Usual Adult Dose for Anxiety:

Immediate-release tablets/orally disintegrating tablets (ODT): 0.25 to 0.5 mg orally administered 3 times a day
-Maximum dose: 4 mg/day

Usual Adult Dose for Panic Disorder:

Immediate-release tablets/ODTs: 0.5 mg orally administered 3 times a day
-Maximum dose: 10 mg/day

Extended-release tablets:
-Initial dose: 0.5 to 1 mg orally once a day
-Maintenance dose: 3 to 6 mg orally per day, preferably in the morning
-Maximum dose: 10 mg/day

Comments:
-The lowest possible effective dose should be administered and the need for continued treatment reassessed frequently.
-Dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage.
-The daily dosage may be decreased by no more than 0.5 mg every 3 days; however, some patients may require an even slower dosage reduction.
-The dose of extended-release tablets may be increased at intervals of 3 to 4 days in increments of no more than 1 mg per day.
-The times of administration should be distributed as evenly as possible throughout the waking hours.

Usual Geriatric Dose for Anxiety:

Elderly or debilitated patients:
Immediate-release tablets/ODTs: 0.25 mg orally administered 2 or 3 times a day.

Usual Geriatric Dose for Panic Disorder:

Elderly or debilitated patients:
Immediate-release tablets/ODTs:
-Initial dose: 0.25 mg orally administered 2 or 3 times a day

Extended-release tablets:
-Initial dose: 0.5 mg orally once a day

Comments:
-If side effects develop, the dose may be lowered.
-The lowest possible effective dose should be administered and the need for continued treatment reassessed frequently.
-Dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of alprazolam can be fatal.

Overdose symptoms may include extreme drowsiness, confusion, muscle weakness, loss of balance or coordination, feeling light-headed, and fainting.

What to avoid

Avoid drinking alcohol. Dangerous side effects or death could occur.

Avoid driving or hazardous activity until you know how alprazolam will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Grapefruit may interact with alprazolam and lead to unwanted side effects. Avoid the use of grapefruit products.

Alprazolam side effects

Get emergency medical help if you have signs of an allergic reaction to alprazolam: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Alprazolam can slow or stop your breathing, especially if you have recently used an opioid medication, alcohol, or other drugs that can slow your breathing. A person caring for you should seek emergency medical attention if you have weak or shallow breathing, if you are hard to wake up, or if you stop breathing.

Call your doctor at once if you have:

  • weak or shallow breathing;

  • a light-headed feeling, like you might pass out;

  • a seizure;

  • hallucinations, risk-taking behavior;

  • increased energy, decreased need for sleep;

  • racing thoughts, being agitated or talkative;

  • double vision; or

  • jaundice (yellowing of the skin or eyes).

The sedative effects of alprazolam may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury.

Common alprazolam side effects may include:

  • drowsiness; or

  • feeling light-headed.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect alprazolam?

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.

Taking alprazolam with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, prescription cough medicine, or medicine for depression or seizures.

Many drugs can interact with alprazolam. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.

Popular FAQ

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Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use alprazolam only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.