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Alprazolam has boxed warnings. Using this drug alongside opioids may cause extreme sedation, life-threatening slow and ineffective breathing, coma, or death.¹
A person can develop a dependency on alprazolam, and ceasing use may result in withdrawal symptoms, including seizures. Some symptoms of withdrawal may be fatal.
Due to its depressive effects on the central nervous system, people taking the drug should avoid situations where a lack of focus or alertness may be dangerous, such as operating heavy equipment or driving. Alcohol use can enhance the drug’s depressive effects, so individuals are advised to avoid consuming alcohol while taking alprazolam.
Alprazolam may cause fetal harm during pregnancy. Therefore, if a person taking alprazolam becomes pregnant, they should seek guidance from their doctor on discontinuing the drug safely.
Certain antifungals can significantly increase the concentration of alprazolam in the blood, and taking these drugs concurrently is contraindicated. The same is true for fluvoxamine and cimetidine, which cause comparable increases in the blood concentration of alprazolam.
Alprazolam is a psychotropic medication prescribed by doctors to treat generalized anxiety disorders and panic disorders.
Alprazolam is the generic name of the better-known brand names Xanax, Xanax XR, and Gabazolamine-05. It belongs to a class of medications called benzodiazepines, which reduce some of the abnormal activity of the central nervous system, helping manage anxiety and panic symptoms.
Alprazolam should be taken with caution. It’s highly addictive, and stopping use is associated with withdrawal symptoms, which may be fatal. In addition, the drug exhibits depressive effects on the central nervous system, which can be dangerous in situations that demand alertness. Alprazolam can cause extreme sedation and life-threatening breathing problems, and the risk is higher when the drug is taken alongside certain medications, including opioids.
Alprazolam is US Food and Drug Administration (FDA)-approved for the treatment of anxiety disorders and panic disorders.
Additionally, doctors often prescribe alprazolam to treat other conditions off-label, meaning the US FDA has yet to approve the use of this drug for the treatment of these specific conditions. Common off-label uses for alprazolam include:
Premenstrual syndrome (PMS)
Agoraphobia (fear of open or public spaces)
Alprazolam is available as a standard tablet, an extended-release tablet, an orally disintegrating tablet, and a liquid solution. The strength varies based on the form.²
Xanax: These standard tablets are available in strengths of 0.25mg, 0.5mg, 1mg, and 2mg.
Xanax XR: The extended-release version of Xanax is available in 0.5mg, 1mg, 2mg, and 3mg tablets.
Orally disintegrating tablets are available in 0.25mg, 0.5mg, 1mg, and 2mg strengths, while the liquid solution (alprazolam intensol) comes in a standard 1mg/mL concentration with a dropper to measure the appropriate dose.
How you take alprazolam will depend on the form you take and your symptoms. Your doctor may adjust your dose based on your response to the drug.²
Standard, immediate-release tablets can be taken with or without food, but taking them with food may help reduce stomach discomfort.
Orally disintegrating tablets are placed onto the tongue (not under), where they eventually dissolve. You should remove these tablets from their packaging immediately before taking them and make sure your hands are dry so the tablet doesn’t start to dissolve in your hands.
Liquid alprazolam comes with a specialized dropper. You’ll draw the prescribed dose into the dropper and mix it into a liquid or semisolid food, which you’ll need to consume right away.
Finally, extended-release tablets are swallowed whole once daily. They must not be crushed or chewed, as each tablet is specifically designed to release the medication slowly over time.
For people taking immediate-release forms, doctors typically prescribe a starting dose of 0.25mg or 0.5mg, taken three times daily. Depending on the person’s response, the doctor may adjust the dosage every three to four days thereafter. The maximum daily dose is 4mg.
People with panic disorders may take alprazolam in the same immediate-release forms available for anxiety disorders; however, the dosages are different, and people with panic disorders can also take the drug in its extended-release form.
For adults with panic disorders taking immediate-release tablets, orally disintegrating tablets, or liquid solution, doctors will typically start with 0.5mg three times daily. Depending on the person’s response to the drug, the doctor may adjust the dosage gradually. On average, people with panic disorders take 5mg to 6mg of alprazolam daily; however, in some cases, a doctor will prescribe a higher daily dose — with a maximum amount of 10mg per day.
Older adults will start with a lower dose of 0.25mg two to three times daily.
Adults taking extended-release tablets for panic disorders will take a single dose daily. The starting dose is typically between 0.5mg and 1mg, and the maintenance dose is between 3mg and 6mg, up to a maximum daily amount of 10mg.
Elderly adults taking extended-release tablets will start with a 0.5mg daily dose.
Due to the high risk of dependence associated with this medication, doctors prescribe the lowest possible effective dose with continuous monitoring and evaluation.
Increasing the dose must be done gradually at intervals of three to four days in increments that don’t exceed 1mg per day.
Patients can feel some of the effects of alprazolam around an hour after taking it.
How fast you’ll see results and how long they’ll last will depend on your particular condition, its severity, and your age, sex, and weight (among other factors). You will notice a calming effect within an hour of taking it, but the overall improvement of your symptoms may take a few days to show after starting alprazolam.
Your body can build tolerance toward alprazolam. In that case, it may take longer to experience the full effects of the drug, and its effects may not last as long.
People who are sensitive to benzodiazepines should not take alprazolam. Additionally, the drug should not be used alongside ketoconazole and itraconazole.¹
Alprazolam should not be taken during pregnancy as it may cause fetal harm.
Like other drugs, alprazolam carries a risk of side effects, which may vary in severity.³
Among the more common side effects of alprazolam are the following:
Drowsiness
Dry mouth
Diarrhea
Nausea
Vomiting
Trouble concentrating
Headache
Irritability
Problems with balance and coordination
Sleeping problems
Fatigue
Changes in libido or sexual performance
Musculoskeletal weakness
Menstrual irregularities
Fast heartbeat or palpitations
Slurred speech
Severe and less common side effects of alprazolam include:
Shortness of breath
Skin rash
Hostility
Depressed moods
Increased risk-taking behavior
Agitation
Thoughts of suicide
Seizures
Uncontrolled muscle movements
You must not drink alcohol while taking alprazolam, as it significantly increases the risk of severe side effects.
There is a tendency to misuse the drug because of the relief it brings. People who misuse it are susceptible to overdose and withdrawal symptoms. Therefore, it’s essential to stay vigilant in monitoring for signs of an overdose.³
Extreme drowsiness
Confusion
Slow reflexes
Problems in motor coordination
Shallow breathing
Slow heart rate
Fainting
Coma
Overdosing on alprazolam could have severe consequences and may be fatal; call 911 immediately if you suspect that you or someone else has overdosed.
If you miss a dose of alprazolam, you should take it when you remember. However, if it’s nearer to your next dose (the time to your next dose is less than the time passed since your missed one), then you should skip the missed dose, take your next dose as planned, and resume your regular schedule.
Never double your dose or take two doses close in time to each other to make up for a missed dose, as this could lead to an overdose which may be fatal.
Allergies to alprazolam are rare, but call 911 if you suspect you may be having an allergic reaction to the drug.
Signs of a drug allergy may include:
Skin rash
Hives
Changes in heart rate (slower or faster)
Swelling in the areas of the face, throat, or tongue
Alprazolam is intended for short-term use. Doctors will prescribe the lowest dose necessary to achieve the desired outcomes with continuous and frequent evaluation of the treatment plan and its effectiveness to prevent overuse of this medication.
There is a possibility of both emotional and physical dependence on alprazolam linked to long-term use. The risk of psychological dependence may increase when taking doses greater than 4mg per day and with longer-term use. Notably, the risk is much higher in those with a history of alcohol or drug abuse. Addiction could develop over time, so it’s essential you follow your doctor’s advice if you’re taking alprazolam.¹ ⁴
Additionally, a person may develop tolerance to the drug with long-term use, reducing the effectiveness and possibly leading to a dangerous loop of elevating the dose to achieve the desired efficacy again, followed by more tolerance and dependence, and so on.
Alprazolam falls into pregnancy category D, according to the US FDA. Use of the drug during pregnancy must be avoided as it is associated with a number of adverse effects. Further, a child born to a mother taking alprazolam may experience withdrawal symptoms during the postnatal period.¹
Serious complications may arise from taking alprazolam while pregnant. The drug increases the risk of premature birth and may cause low birth weight. Other adverse effects on pregnancy include congenital abnormalities, neonatal withdrawal, and "floppy baby syndrome" (poor muscle tone).
You must inform your doctor if you need to take alprazolam and are breastfeeding or planning to breastfeed. Alprazolam can pass from the mother to the baby through the milk and might have adverse effects.
If you’re pregnant or plan to become pregnant, you must inform your physician so they can help you discontinue alprazolam safely.
Taking alprazolam with other drugs may be dangerous. Some medicines that interact with alprazolam include:¹
Opioids: Taken with alprazolam, opioids can increase the risk of respiratory depression (slow, inefficient breathing).
Central nervous system depressants: Alprazolam could worsen the side effects of these medications.
Certain antifungals and other CYP3A inhibitors: Drugs that inhibit CYP3A, including azole antifungals, can increase the concentration of alprazolam in the blood.
Digoxin: When taken with alprazolam, digoxin concentrations may increase in the blood, especially among the elderly.
Some antidepressants: Antidepressants, including fluoxetine, fluvoxamine, and nefazodone, could affect the effectiveness of alprazolam.
St. John's wort, a herb, and compounds found in grapefruit could also interact with alprazolam.
No. Alcohol, like alprazolam, depresses central nervous system activity. Drinking alcohol while you take alprazolam can lead to dangerous (and, in some cases, fatal) side effects.
When you visit your doctor to discuss alprazolam, bring along a list of all medications, herbs, vitamins, and supplements you’re taking. Beyond that, you should let your doctor know if you:
Have any other medical condition including cardiovascular, kidney, liver, lung disease, or others.
Have glaucoma, as it may not be safe to take alprazolam with glaucoma.
Are pregnant, planning, or breastfeeding. Taking alprazolam in these cases could be life-threatening to the baby.
Have had or plan to have surgery (including dental).
Consume alcohol regularly and in large amounts. You must stop drinking alcohol if you are going to take alprazolam.
Use cannabis. Taking this medication with cannabis will make you more drowsy.
Have (or have had) any other mental health issues, including suicidal thoughts or behaviors.
Have ever overused or misused any prescription drug, or if you’ve used street drugs or drugs that were prescribed to someone else.
Regularly engage in activities that demand alertness in your personal or professional life. Your doctor will consider this information when deciding on a dosing schedule.
You should not stop taking alprazolam without the advice of your doctor. Alprazolam must be stopped in a gradual manner which will vary based on how high your current dose is and how long you’ve been taking the drug. Abruptly stopping this medication could lead to serious withdrawal symptoms and could be life-threatening. Withdrawal symptoms may include:⁵
Anxiety
Irritability
Tremors
Changes in blood pressure
Rapid heart rate
Burning or strange sensations in the hands, arms, legs, or feet
Sudden mood changes
Problems with memory or thinking
Uncontrolled muscle movements
Suicidal thoughts
Ringing in the ear
Hallucinations
Prolonged use of the drug may increase physical dependence, which also increases the chances of having more severe and long-lasting withdrawal symptoms. Withdrawal symptoms involving alprazolam are a vital cause of concern. Suddenly stopping this medication can worsen the psychological symptoms for which alprazolam was prescribed and cause some of the above withdrawal symptoms, which may last up to a year before disappearing. You must immediately inform your doctor if you experience withdrawal symptoms upon stopping alprazolam.
The US FDA has approved alprazolam for the treatment of anxiety disorders and panic disorders, granting initial approval in 1981. The extended-release and orally disintegrating forms were approved in 2003 and 2005, respectively.
Researchers compared Xanax to a placebo (a tablet that doesn’t contain any medication) in controlled clinical trials (doses up to 4mg per day) in patients diagnosed with anxiety or anxiety with associated depressive symptoms. Xanax performed significantly better than the placebo for each of the four-week studies when assessed according to the following psychometric instruments:¹
Physician’s Global Impressions, Hamilton Anxiety Rating Scale
Target Symptoms
Patient’s Global Impressions and Self-Rating Symptom Scale
Evidence supporting the effectiveness of Xanax in the treatment of panic disorders comes from three short-term, placebo-controlled studies (up to ten weeks) in patients with diagnoses closely corresponding to the DSM-III-R criteria for panic disorder.¹
The average dose of Xanax was 5mg to 6mg per day in two of the studies. In the third study, the doses were fixed at 2mg and 6mg daily.
Xanax was more effective than the placebo at reducing anxiety symptoms in all three studies when tracking the number of patients who experienced zero panic attacks.
Two of the three studies showed that Xanax was superior to the placebo when considering changes from baseline on the number of panic attacks per week and phobia rating. Some patients who saw improvement with Xanax during short-term treatment continued on an open basis for up to eight months with no apparent loss of benefit.
Here are some of the tips for taking alprazolam:
Properly dispose of any alprazolam liquid you don’t use within 90 days.
Be conscious of the fact that you’ll be less alert after taking alprazolam, and speak with your doctor about timing your doses if necessary.
Never drink alcohol when taking this medication.
If you feel your dose is inadequate, speak with your doctor. Don’t increase your dose without guidance.
Always store alprazolam at room temperature and keep it away from moisture, heat, and light.
Yes, Xanax is the brand name of the generic drug alprazolam.
Your doctor will decide what’s safe for you, but alprazolam should only be used short-term. Long-term use increases the risk of dependency and severe withdrawal symptoms.
Alprazolam can be taken daily during the treatment period. Your doctor will work with you to determine how much you need, how often you’ll take it, and how long your treatment period will last.
Sources
Alprazolam (2022)
Alprazolam | MedlinePlus
Alprazolam (Xanax) | National Alliance on Mental Illness
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Here at HealthMatch, we’ve done our best to ensure that the information provided in this article is helpful, up to date, and, most importantly, accurate.
However, we can’t replace the one-to-one advice of a qualified medical practitioner or outline all of the possible risks associated with this particular drug and your circumstances.
It is therefore important for you to note that the information contained in this article does not constitute professional medical or healthcare advice, diagnosis or recommendation of treatment and is not intended to, nor should be used to, replace professional medical advice. This article may not always be up to date and is not exhaustive of all of the risks and considerations relevant to this particular drug. In no circumstances should this article be relied upon without independent consideration and confirmation by a qualified medical practitioner.
Your doctor will be able to explain all possible uses, dosages, precautions, interactions with other drugs, and other potential adverse effects, and you should always talk to them about any kind of medication you are taking, thinking about taking or wanting to stop taking.
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