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What is alprazolam? Alprazolam belongs to a group of drugs called benzodiazepines (ben-zoe-dye-AZE-eh-peens). It works by slowing down the movement of chemicals in the brain that may become unbalanced. This results in a reduction in nervous tension (anxiety). Alprazolam is used to treat anxiety disorders, panic disorders, and anxiety caused by depression. Alprazolam may also be used for purposes not listed in this medication guide. Important information Do not use alprazolam if you are pregnant. It could harm the unborn baby. Do not use this medication if you are allergic to alprazolam or to other benzodiazepines, such as chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax). Slideshow: 12 Things You Should Know About Xanax 12 Things You Should Know About Xanax Before you take alprazolam, tell your doctor if you have asthma or other breathing problems, glaucoma, kidney or liver disease, a history of alcoholism, or a history of depression, suicidal thoughts, or addiction to drugs or alcohol Do not drink alcohol while taking alprazolam. This medication can increase the effects of alcohol. 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. Before taking this medicine It is dangerous to try and purchase alprazolam on the Internet or from vendors outside of the United States. Medications distributed from Internet sales may contain dangerous ingredients, or may not be distributed by a licensed pharmacy. Samples of alprazolam purchased on the Internet have been found to contain haloperidol (Haldol), a potent antipsychotic drug with dangerous side effects. For more information, contact the U.S. Food and Drug Administration (FDA) or visit www.fda.gov/buyonlineguide. You should not take alprazolam if you have: narrow-angle glaucoma; if you are also taking itraconazole (Sporanox) or ketoconazole (Nizoral); or if you are allergic to alprazolam or to other benzodiazepines, such as chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax). To make sure you can safely take alprazolam, tell your doctor if you have any of these other conditions: asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems; glaucoma; kidney or liver disease (especially alcoholic liver disease); a history of depression or suicidal thoughts or behavior; or a history of drug or alcohol addiction. Alprazolam may be habit forming and should be used only by the person for whom it was prescribed. Never share alprazolam with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it. FDA pregnancy category D. Do not use alprazolam if you are pregnant. It could harm the unborn baby. Alprazolam may also cause addiction or withdrawal symptoms in a newborn if the mother takes the medication during pregnancy. Use effective birth control, and tell your doctor if you become pregnant during treatment. Alprazolam can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using this medicine. 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 while you are taking alprazolam. Do not give this medication to anyone under 18 years old. See also: Pregnancy and breastfeeding warnings (in more detail) How should I take alprazolam? Take alprazolam exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time. Measure the liquid form of alprazolam with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one. Do not swallow the orally disintegrating tablets whole. Allow it to dissolve in your mouth without chewing. Contact your doctor if this medicine seems to stop working as well in treating your panic or anxiety symptoms. You may have seizures or withdrawal symptoms when you stop using alprazolam. Ask your doctor how to avoid withdrawal symptoms when you stop using alprazolam. Keep track of the amount of medicine used from each new bottle. Alprazolam is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription. Store at room temperature away from moisture and heat. What happens if I miss a dose? Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. 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 should I avoid? Do not drink alcohol while taking alprazolam. This medication can increase the effects of alcohol. Alprazolam may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Grapefruit and grapefruit juice may interact with alprazolam and lead to unwanted side effects. Discuss the use of grapefruit products with your doctor. Alprazolam side effects Get emergency medical help if you have any of these signs of an allergic reaction to alprazolam: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as: depressed mood, thoughts of suicide or hurting yourself, unusual risk-taking behavior, decreased inhibitions, no fear of danger; confusion, hyperactivity, agitation, hostility, hallucinations; feeling like you might pass out; urinating less than usual or not at all; chest pain, pounding heartbeats or fluttering in your chest; uncontrolled muscle movements, tremor, seizure (convulsions); or jaundice (yellowing of the skin or eyes). Less serious alprazolam side effects may include: drowsiness, dizziness, feeling tired or irritable; blurred vision, headache, memory problems, trouble concentrating; sleep problems (insomnia); swelling in your hands or feet; muscle weakness, lack of balance or coordination, slurred speech; upset stomach, nausea, vomiting, constipation, diarrhea; increased sweating, dry mouth, stuffy nose; or appetite or weight changes, loss of interest in sex. 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. See also: Side effects (in more detail) Alprazolam dosing information Usual Adult Dose of Alprazolam for Anxiety: Immediate-release tablets, orally disintegrating tablets, oral concentrate: Initial dose: 0.25 to 0.5 mg orally 3 times a day This dose may be gradually increased every 3 to 4 days if needed and tolerated. Maintenance dose: May increase up to maximum daily dose of 4 mg in divided doses Usual Adult Dose of Alprazolam for Panic Disorder: Immediate-release tablets, orally disintegrating tablets: Initial dose: 0.5 mg orally 3 times a day This dose may be gradually increased every 3 to 4 days if needed and tolerated. Maintenance dose: 1 to 10 mg per day in divided doses Mean dose employed: 5 to 6 mg per day in divided doses Extended-release tablets: Initial dose: 0.5 to 1 mg once a day The daily dose may be gradually increased by no more than 1 mg every 3 to 4 days if needed and tolerated. Maintenance dose: 1 to 10 mg once a day Mean dose employed: 3 to 6 mg once a day Usual Adult Dose of Alprazolam for Depression: Immediate-release tablets, orally disintegrating tablets, oral concentrate: Initial dose: 0.5 mg orally 3 times a day The daily dose may be gradually increased by no more than 1 mg every 3 to 4 days. Average Dose: Studies on the use of alprazolam for the treatment of depression have reported an average effective dose of 3 mg orally daily in divided doses Maximum Dose: Studies on the use of alprazolam for the treatment of depression have reported to have used 4.5 mg orally daily in divided doses as a maximum. Usual Geriatric Dose of Alprazolam for Anxiety: Immediate-release tablets, orally disintegrating tablets, oral concentrate: Initial dose: 0.25 mg orally 2 to 3 times a day in elderly or debilitated patients This dose may be gradually increased if needed and tolerated. Because of increased sensitivity to benzodiazepines in elderly patients, alprazolam at daily doses greater than 2 mg meets the Beers criteria as a medication that is potentially inappropriate for use in older adults. Smaller doses may be effective as well as safer. Total daily doses should rarely exceed suggested maximums. Usual Geriatric Dose of Alprazolam for Depression: Immediate-release tablets, orally disintegrating tablets, oral concentrate: Initial dose: 0.25 mg orally 2 to 3 times a day in elderly or debilitated patients This dose may be gradually increased if needed and tolerated. Because of increased sensitivity to benzodiazepines in elderly patients, alprazolam at daily doses greater than 2 mg meets the Beers criteria as a medication that is potentially inappropriate for use in older adults. Smaller doses may be effective as well as safer. Total daily doses should rarely exceed suggested maximums. Usual Geriatric Dose of Alprazolam for Panic Disorder: Immediate-release tablets, orally disintegrating tablets: Initial dose: 0.25 mg orally 2 to 3 times a day in elderly or debilitated patients This dose may be gradually increased if needed and tolerated. Extended-release tablets: Initial dose: 0.5 mg once a day preferably in the morning This dose may be gradually increased if needed and tolerated. Because of increased sensitivity to benzodiazepines in elderly patients, alprazolam at daily doses greater than 2 mg meets the Beers criteria as a medication that is potentially inappropriate for use in older adults. Smaller doses may be effective as well as safer. Total daily doses should rarely exceed suggested maximums. What other drugs will affect alprazolam? Before using alprazolam, tell your doctor if you regularly use other medicines that make you sleepy (such as cold or allergy medicine, other sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can add to sleepiness caused by alprazolam. Tell your doctor about all other medicines you use, especially: birth control pills; cimetidine (Tagamet); cyclosporine (Gengraf, Neoral, Sandimmune); dexamethasone (Cortastat, Dexasone, Solurex, DexPak); ergotamine (Cafergot, Ergomar, Migergot); imatinib (Gleevec); isoniazid (for treating tuberculosis); St. John’s wort; an antibiotic such as clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), rifabutin (Mycobutin), rifampin (Rifadin, Rifater, Rifamate), rifapentine (Priftin), or telithromycin (Ketek); antifungal medication such as miconazole (Oravig) or voriconazole (Vfend); an antidepressant such as fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), desipramine (Norpramin), imipramine (Janimine, Tofranil), or nefazodone; a barbiturate such as butabarbital (Butisol), secobarbital (Seconal), pentobarbital (Nembutal), or phenobarbital (Solfoton); heart or blood pressure medication such as amiodarone (Cordarone, Pacerone), diltiazem (Tiazac, Cartia, Cardizem), nicardipine (Cardene), nifedipine (Nifedical, Procardia), or quinidine (Quin-G); HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), efavirenz (Sustiva, Atripla), etravirine (Intelence), indinavir (Crixivan), nelfinavir (Viracept), nevirapine (Viramune), saquinavir (Invirase), or ritonavir (Norvir, Kaletra); or seizure medication such as carbamazepine (Carbatrol, Equetro, Tegretol), felbamate (Felbatol), oxcarbazepine (Trileptal), phenytoin (Dilantin), or primidone (Mysoline). This list is not complete and other drugs may interact with alprazolam. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

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