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Alprazolam (Oral route)

Pronunciation:

al-PRA-zoe-lam

Brand Names:

  • Gabazolamine-0.5
  • Niravam
  • Xanax
  • Xanax XR
  • Alti-Alprazolam

Dosage Forms:

  • Tablet
  • Tablet, Disintegrating
  • Solution
  • Tablet, Extended Release

Classifications:

Therapeutic—

Antianxiety

Pharmacologic—

Benzodiazepine, Short or Intermediate Acting

Uses of This Medicine:

Alprazolam is used to relieve symptoms of anxiety, including anxiety caused by depression. It is also used to treat panic disorder in some patients.

Alprazolam is a benzodiazepine. Benzodiazepines belong to the group of medicines called central nervous system (CNS) depressants, which are medicines that slow down the nervous system.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of alprazolam in the pediatric population. Safety and efficacy have not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of alprazolam in the elderly. However, severe drowsiness, dizziness, confusion, clumsiness, or unsteadiness are more likely to occur in the elderly, who are usually more sensitive than younger adults to the effects of alprazolam. Elderly patients may require a lower dose to help reduce unwanted effects.

Pregnancy—

Pregnancy CategoryExplanation
All TrimestersDStudies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast-feeding—

Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using this medicine.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Delavirdine
  • Indinavir
  • Itraconazole
  • Ketoconazole

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Alfentanil
  • Amobarbital
  • Anileridine
  • Aprobarbital
  • Boceprevir
  • Butabarbital
  • Butalbital
  • Carbinoxamine
  • Carisoprodol
  • Chloral Hydrate
  • Chlorzoxazone
  • Codeine
  • Dantrolene
  • Digoxin
  • Domperidone
  • Ethchlorvynol
  • Fentanyl
  • Fluconazole
  • Fospropofol
  • Hydrocodone
  • Hydromorphone
  • Levorphanol
  • Meclizine
  • Meperidine
  • Mephenesin
  • Mephobarbital
  • Meprobamate
  • Metaxalone
  • Methocarbamol
  • Methohexital
  • Morphine
  • Morphine Sulfate Liposome
  • Oxycodone
  • Oxymorphone
  • Pentobarbital
  • Phenobarbital
  • Primidone
  • Propoxyphene
  • Remifentanil
  • Secobarbital
  • Sodium Oxybate
  • Sufentanil
  • Tapentadol
  • Thiopental
  • Voriconazole
  • Zolpidem

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Amprenavir
  • Aprepitant
  • Carbamazepine
  • Cimetidine
  • Clarithromycin
  • Desipramine
  • Desogestrel
  • Dienogest
  • Drospirenone
  • Erythromycin
  • Estradiol Cypionate
  • Estradiol Valerate
  • Ethinyl Estradiol
  • Ethynodiol Diacetate
  • Etonogestrel
  • Fluoxetine
  • Fosaprepitant
  • Imipramine
  • Kava
  • Levonorgestrel
  • Medroxyprogesterone Acetate
  • Mestranol
  • Mifepristone
  • Nefazodone
  • Norelgestromin
  • Norethindrone
  • Norgestimate
  • Norgestrel
  • Perampanel
  • Rifapentine
  • Ritonavir
  • Roxithromycin
  • Sertraline
  • St John's Wort
  • Telaprevir
  • Theophylline
  • Troleandomycin

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Depression or
  • Epilepsy or history of seizures or
  • Lung disease—Use with caution. May make these conditions worse.
  • Glaucoma, acute narrow angle—Should not be used in patients with this condition.
  • Kidney disease or
  • Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of This Medicine:

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

Swallow the extended-release tablet whole with a full glass of water. Do not break, crush, or chew it.

If you are using the orally disintegrating tablet, make sure your hands are dry before you handle the tablet. Do not remove the tablets from the bottle until you are ready to take it. Place the tablet immediately on the top of your tongue. It should melt quickly and be swallowed with saliva.

If you are using the oral solution, measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For anxiety:
    • For oral dosage forms (solution, tablets, or orally disintegrating tablets):
      • Adults—At first, 0.25 to 0.5 milligram (mg) three times a day. Your doctor may increase your dose if needed. However, the dose is usually not more than 4 mg a day.
      • Older adults—At first, 0.25 milligram (mg) two or three times a day. Your doctor may increase your dose if needed.
      • Children—Use and dose must be determined by your doctor.
  • For panic disorder:
    • For oral dosage form (extended-release tablets):
      • Adults—At first, 0.5 to 1 milligram (mg) taken in the morning once a day. Your doctor may increase your dose if needed. However, the dose is usually not more than 10 mg a day.
      • Older adults—At first, 0.5 milligram (mg) taken in the morning once a day. Your doctor may increase your dose if needed.
      • Children—Use and dose must be determined by your doctor.
    • For oral dosage forms (solution, tablets, or orally disintegrating tablets):
      • Adults—At first, 0.5 milligram (mg) three times a day. Your doctor may increase your dose if needed. However, the dose is usually not more than 10 mg a day.
      • Older adults—At first, 0.25 milligram (mg) two or three times a day. Your doctor may increase your dose if needed.
      • Children—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

It is very important to protect the orally disintegrating tablets from moisture. Remove and throw away any cotton packaging from the medicine bottle when you first use the medicine.

Precautions While Using This Medicine:

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for any unwanted effects.

Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

Do not take itraconazole (Sporanox®) or ketoconazole (Nizoral®) while you are using this medicine. Using any of them together with this medicine may increase the chance of serious side effects.

If you develop any unusual and strange thoughts or behavior while you are taking alprazolam, be sure to discuss it with your doctor. Some changes that have occurred in people taking this medicine are like those seen in people who drink alcohol and then act in a manner that is not normal. Other changes may be more unusual and extreme, such as confusion, worsening of depression, hallucinations (seeing, hearing, or feeling things that are not there), suicidal thoughts, and unusual excitement, nervousness, or irritability.

Alprazolam may cause some people, especially older persons, to become drowsy, dizzy or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy, or are not alert or able to see well.

Do not stop taking this medicine without checking with your doctor first. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help prevent a worsening of your condition and reduce the possibility of withdrawal symptoms, such as convulsions (seizures), stomach or muscle cramps, sweating, tremors, vomiting, or unusual behavior.

This medicine will add to the effects of alcohol and other central nervous system (CNS) depressants. CNS depressants are medicines that slow down the nervous system, which may cause drowsiness or make you less alert. Some examples of CNS depressants are antihistamines or medicine for hay fever, allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates (used for seizures); muscle relaxants; or anesthetics (numbing medicines), including some dental anesthetics. This effect may last for a few days after you stop taking this medicine. Check with your doctor before taking any of the above while you are using this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
Being forgetful
changes in patterns and rhythms of speech
clumsiness or unsteadiness
difficulty with coordination
discouragement
drowsiness
feeling sad or empty
irritability
lack of appetite
lightheadedness
loss of interest or pleasure
relaxed and calm
shakiness and unsteady walk
sleepiness or unusual drowsiness
slurred speech
tiredness
trouble concentrating
trouble in speaking
trouble performing routine tasks
trouble sleeping
unsteadiness, trembling, or other problems with muscle control or coordination
unusual tiredness or weakness
Less common
Abdominal or stomach pain
blurred vision
body aches or pain
burning, crawling, itching, numbness, prickling, "pins and needles, or tingling feelings
changes in behavior
chills
clay-colored stools
confusion about identity, place, and time
cough
dark urine
decrease in frequency of urination
decrease in urine volume
diarrhea
difficult or labored breathing
difficulty in moving
difficulty in passing urine (dribbling)
difficulty with concentration
dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
dry mouth
ear congestion
environment seems unreal
fainting
fear or nervousness
feeling of unreality
feeling warm
fever
general feeling of discomfort or illness
headache
hyperventilation
inability to move eyes
inability to sit still
increased blinking or spasms of the eyelid
irregular heartbeats
itching
joint pain
lack or loss of self-control
loss of bladder control
loss of coordination
loss of memory
loss of voice
mood or mental changes
muscle aching or cramping
muscle pain or stiffness
muscle weakness
nasal congestion
nausea
need to keep moving
painful urination
problems with memory
rash
restlessness
runny nose
seeing, hearing, or feeling things that are not there
seizures
sense of detachment from self or body
shaking
shivering
shortness of breath
sneezing
sore throat
sticking out of the tongue
sweating
swollen joints
talkativeness
tightness in the chest
trouble in breathing, speaking, or swallowing
trouble with balance
twitching, twisting, or uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
uncontrolled twisting movements of the neck, trunk, arms, or legs
unpleasant breath odor
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
unusual facial expressions
unusually deep sleep
unusually long duration of sleep
vomiting of blood
wheezing
yellow eyes or skin
Rare
Actions that are out of control
attack, assault, or force
chest pain
continuing ringing or buzzing or other unexplained noise in ears
decreased awareness or responsiveness
deep or fast breathing with dizziness
ear pain
false or unusual sense of well-being
fast, irregular, pounding, or racing heartbeat or pulse
feeling jittery
feeling unusually cold
generalized slowing of mental and physical activity
hearing loss
hoarseness
lack of feeling or emotion
loss of control of the legs
loss of strength or energy
nightmares
numbness of the feet, hands, and around mouth
severe sleepiness
shakiness in the legs, arms, hands, or feet
sleep talking
sleeplessness
swelling
talking, feeling, and acting with excitement
thoughts of killing oneself
unable to sleep
uncaring
unusual weak feeling
voice changes
Incidence not known
General tiredness and weakness
light-colored stools
stomach pain, continuing
upper right abdominal pain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
Absent, missed, or irregular menstrual periods
decreased appetite
decreased interest in sexual intercourse
decreased sexual performance or desire abnormal ejaculation
difficulty having a bowel movement (stool)
inability to have or keep an erection
increased appetite
increased in sexual ability, desire, drive, or performance
increased interest in sexual intercourse
increased weight
loss in sexual ability, desire, drive, or performance
stopping of menstrual bleeding
watering of mouth
weight loss
Less common
Abdominal bloating and cramping
blistering, crusting, irritation, itching, or reddening of the skin
change in taste bad unusual or unpleasant (after) taste
cracked, dry, or scaly skin
cramps
double vision
feeling of warmth
heavy bleeding
menstrual changes
pain
pelvic pain
redness of the face, neck, arms, and occasionally, upper chest
seeing double
sudden sweating
unexplained runny nose or sneezing
Rare
Acid or sour stomach
belching
bigger, dilated, or enlarged pupils (black part of eye)
change in color vision
difficulty seeing at night
feeling of constant movement of self or surroundings
feeling of relaxation
heartburn
hives or welts
increased sensitivity of eyes to sunlight
indigestion
redness of skin
runny nose
sensation of spinning
stomach discomfort, upset, or pain
stuffy nose
Incidence not known
Blistering, peeling, or loosening of the skin
red, irritated eyes
red skin lesions, often with a purple center
sores, ulcers, or white spots in the mouth or on the lips
swelling of the breasts or breast soreness in both females and males
unexpected or excess milk flow from breasts

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 11/4/2014

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