Description and Brand Names

Drug information provided by: Merative, Micromedex®

US Brand Name

1. Gabazolamine-05
2. Niravam
3. Xanax
4. Xanax XR

Canadian Brand Name

1. Alti-ALPRAZolam

Descriptions

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.

This product is available in the following dosage forms:

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

Before Using

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.

Pediatric

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.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of alprazolam in the elderly. However, elderly patients are more likely to have unwanted effects (eg, severe drowsiness, dizziness, confusion, clumsiness, or unsteadiness) and kidney, liver, or lung problems, which may require caution and an adjustment in the dose for patients receiving this medicine.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

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.

• Boceprevir
• Clarithromycin
• Cobicistat
• Conivaptan
• Flumazenil
• Idelalisib
• Indinavir
• Itraconazole
• Ketoconazole
• Lopinavir
• Nefazodone
• Nelfinavir
• Posaconazole
• Saquinavir
• Telaprevir
• Telithromycin
• Voriconazole

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.

• Abametapir
• Acepromazine
• Alfentanil
• Amiodarone
• Amobarbital
• Amprenavir
• Anileridine
• Aprepitant
• Aripiprazole
• Aripiprazole Lauroxil
• Asenapine
• Atazanavir
• Baclofen
• Benperidol
• Benzhydrocodone
• Bromazepam
• Bromopride
• Buprenorphine
• Buspirone
• Butabarbital
• Butalbital
• Butorphanol
• Calcium Oxybate
• Cannabidiol
• Cannabis
• Carbamazepine
• Carbinoxamine
• Carisoprodol
• Carphenazine
• Ceritinib
• Cetirizine
• Chloral Hydrate
• Chlordiazepoxide
• Chlorpromazine
• Chlorzoxazone
• Cimetidine
• Ciprofloxacin
• Clobazam
• Clonazepam
• Clorazepate
• Clozapine
• Codeine
• Crizotinib
• Cyclobenzaprine
• Cyclosporine
• Dantrolene
• Daridorexant
• Darunavir
• Dasabuvir
• Delavirdine
• Dexmedetomidine
• Diacetylmorphine
• Diazepam
• Dichloralphenazone
• Difenoxin
• Digoxin
• Dihydrocodeine
• Diltiazem
• Diphenhydramine
• Diphenoxylate
• Domperidone
• Doxylamine
• Dronedarone
• Droperidol
• Elagolix
• Enflurane
• Erythromycin
• Esketamine
• Estazolam
• Eszopiclone
• Ethchlorvynol
• Ethopropazine
• Ethylmorphine
• Fedratinib
• Fentanyl
• Fexinidazole
• Flibanserin
• Fluconazole
• Flunitrazepam
• Fluphenazine
• Flurazepam
• Fluspirilene
• Fluvoxamine
• Fosamprenavir
• Fosaprepitant
• Fosnetupitant
• Fospropofol
• Gabapentin
• Gabapentin Enacarbil
• Halazepam
• Halothane
• Hexobarbital
• Hydrocodone
• Hydromorphone
• Hydroxyzine
• Imatinib
• Isoflurane
• Ivacaftor
• Ketamine
• Ketazolam
• Ketobemidone
• Lacosamide
• Larotrectinib
• Lemborexant
• Letermovir
• Levocetirizine
• Levoketoconazole
• Levorphanol
• Lofexidine
• Lomitapide
• Lorazepam
• Loxapine
• Magnesium Oxybate
• Mavacamten
• Meclizine
• Melperone
• Meperidine
• Mephenesin
• Mephobarbital
• Meprobamate
• Meptazinol
• Mesoridazine
• Metaxalone
• Methadone
• Methdilazine
• Methocarbamol
• Methohexital
• Methotrexate
• Methotrimeprazine
• Methylene Blue
• Metoclopramide
• Mibefradil
• Midazolam
• Mifepristone
• Mirtazapine
• Molindone
• Moricizine
• Morphine
• Morphine Sulfate Liposome
• Nalbuphine
• Netupitant
• Nicomorphine
• Nilotinib
• Nitrazepam
• Nitrous Oxide
• Olanzapine
• Oliceridine
• Omaveloxolone
• Opium
• Opium Alkaloids
• Orphenadrine
• Oxazepam
• Oxycodone
• Oxymorphone
• Palbociclib
• Papaveretum
• Paregoric
• Pentazocine
• Pentobarbital
• Perampanel
• Perazine
• Periciazine
• Perphenazine
• Phenobarbital
• Pimozide
• Piperacetazine
• Piperaquine
• Pipotiazine
• Piritramide
• Potassium Oxybate
• Prazepam
• Pregabalin
• Primidone
• Prochlorperazine
• Promazine
• Promethazine
• Propofol
• Quazepam
• Quetiapine
• Ramelteon
• Ranitidine
• Ranolazine
• Remifentanil
• Remimazolam
• Remoxipride
• Ritonavir
• Ropeginterferon Alfa-2b-njft
• Scopolamine
• Secobarbital
• Sertindole
• Sodium Oxybate
• Sufentanil
• Sulpiride
• Suvorexant
• Tapentadol
• Temazepam
• Thiethylperazine
• Thiopental
• Thiopropazate
• Thioridazine
• Tilidine
• Tizanidine
• Tolonium Chloride
• Topiramate
• Tramadol
• Trazodone
• Triazolam
• Trifluoperazine
• Trifluperidol
• Triflupromazine
• Trimeprazine
• Verapamil
• Voxelotor
• Zaleplon
• Zolpidem
• Zopiclone
• Zotepine
• Zuranolone

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.

• Fluoxetine
• Kava
• Rifapentine
• Roxithromycin
• Sertraline
• St John's Wort
• 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.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

• Ethanol
• Grapefruit Juice

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:

• Alcohol or drug abuse or dependence, history of or
• Depression, or history of or
• Lung or breathing problems (eg, respiratory depression) or
• Mania, or history of or
• Mental health problems, or history of or
• Seizures, or history of—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

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. If too much of this medicine is used for a long time, it may become habit-forming (causing mental or physical dependence) or cause an overdose.

This medicine should come with a Medication Guide. Read and follow the instructions carefully. Ask your doctor if you have any questions.

Swallow the extended-release tablet or 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 liquid, measure the dose with a marked measuring spoon, oral syringe, or medicine cup.

Do not eat grapefruit or drink grapefruit juice while you are using this medicine.

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) 3 times a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 4 mg per day.
    • Older adults—At first, 0.25 mg 2 or 3 times a day. Your doctor may increase your dose as 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 as needed. However, the dose is usually not more than 10 mg per day.
    • Older adults—At first, 0.5 mg taken in the morning once a day. Your doctor may increase your dose as 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) 3 times a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 10 mg per day.
    • Older adults—At first, 0.25 mg 2 or 3 times a day. Your doctor may increase your dose as 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

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

Tell your doctor if you are pregnant or planning to become pregnant. Using this medicine during the later pregnancy may cause problems in your newborn baby (eg, sedation or withdrawal symptoms). Tell your doctor right away if your baby has an abnormal sleep pattern, diarrhea, feeding problems, a high-pitched cry, irritability, low muscle tone, restlessness, shakiness or tremors, sluggishness, trouble breathing, weight loss, vomiting, or fails to gain weight. 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.

This medicine will add to the effects of alcohol and other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness). 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 or seizure medicines, muscle relaxants, or anesthetics (numbing medicines), including some dental anesthetics. This effect may last for a few days after you stop using this medicine. Check with your doctor before taking any of the above while you are using this medicine.

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 change your dose or stop taking this medicine without checking first with your doctor. 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 including changes in behavior, discouragement, feeling sad or empty, irritability, lack of appetite, loss of interest or pleasure, nausea or vomiting, seeing or hearing things that others do not see or hear, seizures or tremors, stomach or muscle cramps, sweating, thoughts of killing oneself, trouble concentrating, trouble sleeping, unusual movements, responses, or expressions.

This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.

Symptoms of an overdose include: change in consciousness, confusion, dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position, drowsiness, hallucinations, lack of coordination, loss of consciousness, loss of strength or energy, muscle pain or weakness, shakiness and unsteady walk, sleepiness, trouble in speaking, trouble sleeping, unsteadiness, trembling, or other problems with muscle control or coordination, unusual excitement, nervousness, restlessness, or irritability, or unusual weakness. Call your doctor right away if you notice these symptoms.

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

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

1. Being forgetful
2. changes in patterns and rhythms of speech
3. clumsiness or unsteadiness
4. difficulty with coordination
5. discouragement
6. drowsiness
7. feeling sad or empty
8. irritability
9. lack of appetite
10. lightheadedness
11. loss of interest or pleasure
12. relaxed and calm
13. shakiness and unsteady walk
14. sleepiness
15. slurred speech
16. tiredness
17. trouble concentrating
18. trouble performing routine tasks
19. trouble sleeping
20. trouble speaking
21. unsteadiness, trembling, or other problems with muscle control or coordination
22. unusual tiredness or weakness

Less common

1. Blurred vision
2. body aches or pain
3. burning, crawling, itching, numbness, prickling, "pins and needles, or tingling feelings
4. changes in behavior
5. chest tightness
6. chills
7. clay-colored stools
8. confusion about identity, place, and time
9. cough
10. dark urine
11. decrease in frequency of urination
12. decrease in urine volume
13. diarrhea
14. difficult or labored breathing
15. difficulty in passing urine (dribbling)
16. difficulty with concentration
17. difficulty with moving
18. dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
19. dry mouth
20. ear congestion
21. environment seems unreal
22. fainting
23. feeling of unreality
24. feeling warm
25. fever
26. general feeling of discomfort or illness
27. headache
28. inability to move the eyes
29. inability to sit still
30. increased blinking or spasms of the eyelid
31. irregular heartbeats
32. itching or rash
33. joint pain
34. lack or loss of self-control
35. loss of bladder control
36. loss of coordination
37. loss of memory
38. loss of voice
39. mood or mental changes
40. muscle aches, cramps, pain, stiffness, or weakness
41. nausea
42. need to keep moving
43. painful urination
44. problems with memory
45. restlessness
46. runny or stuffy nose
47. seeing, hearing, or feeling things that are not there
48. seizures
49. sense of detachment from self or body
50. shaking
51. shivering
52. sneezing
53. sore throat
54. sticking out of the tongue
55. stomach pain
56. sweating
57. swollen joints
58. talkativeness
59. trouble with balance
60. twitching, twisting, or uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
61. uncontrolled twisting movements of the neck, trunk, arms, or legs
62. unpleasant breath odor
63. unusual dullness or feeling of sluggishness
64. unusual facial expressions
65. unusually deep sleep
66. unusually long duration of sleep
67. vomiting of blood
68. yellow eyes or skin

Rare

1. Actions that are out of control
2. attack, assault, or force
3. chest pain
4. continuing ringing or buzzing or other unexplained noise in the ears
5. decreased awareness or responsiveness
6. deep or fast breathing with dizziness
7. ear pain
8. false or unusual sense of well-being
9. fast, irregular, pounding, or racing heartbeat or pulse
10. feeling jittery
11. feeling unusually cold
12. generalized slowing of mental and physical activity
13. hearing loss
14. hoarseness
15. lack of feeling or emotion
16. loss of control of the legs
17. loss of strength or energy
18. nightmares
19. numbness of the feet, hands, and around mouth
20. severe sleepiness
21. shakiness in the legs, arms, hands, or feet
22. sleep talking
23. swelling
24. talking, feeling, and acting with excitement
25. thoughts of killing oneself
26. uncaring
27. unusual weak feeling
28. voice changes

Incidence not known

1. Light-colored stools
2. upper right abdominal or stomach pain

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

1. Agitation
2. change in consciousness
3. changes in patterns and rhythms of speech
4. confusion
5. lack of coordination
6. loss of consciousness
7. loss of strength or energy
8. shakiness and unsteady walk
9. slurred speech
10. sleepiness or unusual drowsiness
11. talkativeness
12. unsteadiness, trembling, or other problems with muscle control or coordination
13. unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
14. unusual excitement, nervousness, restlessness, or irritability
15. unusual weak feeling

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

1. Absent, missed, or irregular menstrual periods
2. decreased appetite
3. decreased interest in sexual intercourse
4. decreased sexual performance or desire abnormal ejaculation
5. difficulty having a bowel movement (stool)
6. inability to have or keep an erection
7. increased appetite
8. increased in sexual ability, desire, drive, or performance
9. increased interest in sexual intercourse
10. increased weight
11. loss in sexual ability, desire, drive, or performance
12. stopping of menstrual bleeding
13. watering of the mouth
14. weight loss

Less common

1. Blistering, crusting, irritation, itching, or reddening of the skin
2. change in taste bad unusual or unpleasant (after) taste
3. cracked, dry, or scaly skin
4. double vision
5. feeling of warmth
6. heavy bleeding
7. menstrual changes
8. pelvic pain
9. redness of the face, neck, arms, and occasionally, upper chest
10. seeing double
11. stomach bloating and cramping
12. sudden sweating
13. unexplained runny nose or sneezing

Rare

1. Acid or sour stomach
2. belching
3. bigger, dilated, or enlarged pupils (black part of the eye)
4. change in color vision
5. difficulty seeing at night
6. feeling of constant movement of self or surroundings
7. feeling of relaxation
8. heartburn
9. hives or welts
10. increased sensitivity of the eyes to sunlight
11. indigestion
12. redness of the skin
13. sensation of spinning
14. stomach discomfort or upset

Incidence not known

1. Blistering, peeling, or loosening of the skin
2. red, irritated eyes
3. red skin lesions, often with a purple center
4. sores, ulcers, or white spots in the mouth or on the lips
5. swelling of the breasts or breast soreness in both females and males
6. unexpected or excess milk flow from the 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.

Portions of this document last updated: April 01, 2024

Original article: https://www.mayoclinic.org/drugs-supplements/alprazolam-oral-route/precautions/drg-20061040