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Alprazolam is a benzodiazepine (ben-zoe-dye-AZE-eh-peen). It affects chemicals in the brain that may be unbalanced in people with 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.
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. Misuse of habit-forming medicine can cause addiction, overdose, or death.
Do not drink alcohol while taking alprazolam. This medication can increase the effects of alcohol. This medicine 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.
It is dangerous to purchase alprazolam on the Internet or from vendors outside the United States. Medications distributed from Internet sales may contain dangerous ingredients, or may not be distributed by a licensed pharmacy. The sale and distribution of alprazolam outside the U.S. does not comply with the regulations of the Food and Drug Administration (FDA) for the safe use of this medication.
You should not take alprazolam if you have:
narrow-angle glaucoma;
if you are also taking itraconazole or ketoconazole; 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 this medicine is safe for you, tell your doctor if you have:
seizures or epilepsy;
kidney or liver disease (especially alcoholic liver disease);
asthma or other breathing disorder;
open-angle glaucoma;
a history of depression or suicidal thoughts or behavior;
a history of drug or alcohol addiction; or
if you also use a narcotic (opioid) medication.
Do not use alprazolam if you are pregnant. This medicine can cause birth defects. Your baby could also 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. Tell your doctor if you are pregnant or plan to become pregnant. Use effective birth control to prevent pregnancy while you are taking this medicine.
Alprazolam can pass into breast milk and may harm a nursing baby. You should not breast-feed while you using this medicine before talking to your doctor.
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.
Alprazolam is not FDA approved for use by anyone younger than 18 years old.
Take alprazolam exactly as prescribed by your doctor. Follow all directions on your prescription label. Never use this medicine in larger amounts, or for longer than prescribed. Tell your doctor if the medicine seems to stop working as well in treating your symptoms.
Alprazolam may be habit-forming. Never share this medicine 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.
Misuse of habit-forming medicine can cause addiction, overdose, or death. Selling or giving away this medicine is against the law.
Do not swallow the orally disintegrating tablet whole. Allow it to dissolve in your mouth without chewing.
Do not crush, chew, or break an extended-release tablet. Swallow it whole.
Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.
Call your doctor if this medicine seems to stop working as well in treating your panic or anxiety symptoms.
Do not stop using alprazolam suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using alprazolam.
Store at room temperature away from moisture and heat.
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.
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.
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.
Alprazolam may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Avoid drinking alcohol. Dangerous side effects could occur.
Grapefruit and grapefruit juice may interact with alprazolam and lead to unwanted side effects. Discuss the use of grapefruit products with your doctor.
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.
Call your doctor at once if you have:
depressed mood, thoughts of suicide or hurting yourself;
racing thoughts, increased energy, unusual risk-taking behavior;
confusion, agitation, hostility, hallucinations;
uncontrolled muscle movements, tremor, seizure (convulsions); or
pounding heartbeats or fluttering in your chest.
Common alprazolam side effects may include:
drowsiness, feeling tired;
slurred speech, lack of balance or coordination;
memory problems; or
feeling anxious early in the morning.
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.
Usual Adult Dose 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 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 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 in the treatment of depression have reported an average effective dose of 3 mg orally daily in divided doses
Maximum Dose: Studies in the treatment of depression have reported to have used 4.5 mg orally daily in divided doses as a maximum.
Usual Geriatric Dose 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 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 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.
Taking this medicine with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before taking a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures.
Tell your doctor about all your current medicines and any you start or stop using, especially:
cimetidine;
fluvoxamine;
nefazodone;
phenytoin;
ritonavir or other medicines to treat HIV or AIDS; or
zolpidem;
antifungal medicine - itraconazole, ketoconazole, fluconazole, voriconazole.
This list is not complete. Other drugs may interact with alprazolam, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
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.
Medically reviewed by USARx EDITORIAL TEAM Last updated on 1/1/2020.
Source: Drugs.com Alprazolam Xr (www.drugs.com/alprazolam.html).
Commonly reported side effects of alprazolam include: ataxia, cognitive dysfunction, constipation, depression, difficulty in micturition, drowsiness, dysarthria, fatigue, headache, memory impairment, menstrual disease, nervousness, sedated state, skin rash, tremor, weight gain, weight loss, anxiety, blurred vision, diarrhea, insomnia, decreased libido, increased appetite, irritability, and decreased appetite. Other side effects include: depersonalization, hyperventilation, hypoesthesia, hypotension, paresthesia, sexual disorder, sialorrhea, muscle twitching, and increased libido. See below for a comprehensive list of adverse effects.
Applies to alprazolam: oral solution, oral tablet, oral tablet disintegrating, oral tablet extended release
Oral route (Tablet)
Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing for patients with inadequate treatment options. Limit dosages and durations to the minimum required and follow patients for signs and symptoms of respiratory depression and sedation.
Along with its needed effects, alprazolam 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 while taking alprazolam:
More common
Less common
Rare
Incidence not known
Some side effects of alprazolam 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
Less common
Rare
Incidence not known
Applies to alprazolam: compounding powder, oral concentrate, oral solution, oral tablet, oral tablet disintegrating, oral tablet extended release
Immediate-release formulations: The most commonly reported side effects included drowsiness/sedation, fatigue and tiredness, impaired coordination, memory impairment, and irritability.
Extended-release tablets: The most commonly reported side effects included sedation, tremor, headache, insomnia, and somnolence.
Immediate-release formulations:
Very common (10% or more): Sedation (up to 77%), drowsiness (up to 76.8%), impaired coordination (up to 40.1%), memory impairment (up to 33.1%), dizziness (up to 29.8%), lightheadedness (up to 29.8%), headache (up to 29.2%), cognitive disorder (up to 29%), dysarthria (up to 23.3%), abnormal voluntary movement (up to 17.3%)
Common (1% to 10%): Abnormal coordination, akathisia, ataxia, attention disturbance, balance disorder, hypersomnia, lethargy, paresthesia, somnolence, syncope, tremor, vasomotor disturbances
Uncommon (0.1% to 1%): Amnesia, autonomic manifestations, coordination disorders, intellectual impairment, stimulation
Frequency not reported: Concentration difficulties, convulsions, dystonia, loss of coordination, seizures, sleepiness, slurred speech, taste alterations, transient amnesia, withdrawal seizures
Postmarketing reports: Autonomic nervous system imbalance, psychomotor hyperactivity
Extended-release tablets:
Very common (10% or more): Sedation (up to 45.2%), tremor (up to 28.2%), headache (up to 26.5%), somnolence (up to 23%), memory impairment (up to 15.4%), dysarthria (up to 10.9%)
Common (1% to 10%): Abnormal coordination, ataxia, balance impaired, disturbance in attention, dizziness, dyskinesia, hypersomnia, hypoesthesia, lethargy, mental impairment, paresthesia, vertigo
Uncommon (0.1% to 1%): Amnesia, clumsiness, depressed level of consciousness, hangover, hypotonia, stupor, syncope
Frequency not reported: Stimulation, withdrawal seizures
Immediate-release formulations:
Very common (10% or more): Fatigue and tiredness (up to 49%)
Common (1% to 10%): Feeling warm, tinnitus, weakness
Frequency not reported: Rebound phenomena
Extended-release tablets:
Very common (10% or more): Fatigue (up to 13.9%)
Common (1% to 10%): Malaise, road traffic accident, weakness
Uncommon (0.1% to 1%): Asthenia, ear pain, fall, feeling drunk, feeling hot and cold, feeling jittery, feeling of relaxation, increased energy, loss of control of legs, pyrexia, rigors, sluggishness, tinnitus
Frequency not reported: Paradoxical reactions
Immediate-release formulations:
Very common (10% or more): Irritability (up to 33.1%), insomnia (up to 29.5%), anxiety (up to 19.2%), decreased libido (up to 14%), depression (up to 13.9%), confusional state (up to 10.4%)
Common (1% to 10%): Agitation, change in libido (not specified), confusion, derealization, disinhibition, disorientation, dream abnormalities, fear, increased libido, nervousness, talkativeness
Uncommon (0.1% to 1%): Adverse behavioral effects, altered mood, concentration difficulties, hallucinations
Rare (0.01% to 0.1%): Hypomania, mania, other adverse behavioral effects
Frequency not reported: Abuse, aggressive or hostile behavior, aggressiveness/aggression, anterograde amnesia, delusion, depersonalization, dysphoria/mild dysphoria, hostility, inappropriate behavior, intrusive thoughts, nightmares, physical dependence, primary/secondary major depressive disorders, psychic dependence, psychoses, rage, restlessness, suicide, withdrawal symptoms
Postmarketing reports: Abnormal thinking, anger, libido disorder
Extended-release tablets:
Very common (10% or more): Insomnia (up to 24.2%), nervousness (up to 21.8%), depression (up to 12.1%)
Common (1% to 10%): Agitation, anxiety, confusion, depersonalization, depressed mood, derealization, disorientation, irritability, libido decreased/increased, nightmare, restlessness
Uncommon (0.1% to 1%): Abnormal dreams, aggression, anger, apathy, bradyphrenia, euphoric mood, hallucination, homicidal ideation, hypomania, impulse control, logorrhea, mania, mood swings, psychomotor retardation, sleep talking, suicidal ideation
Frequency not reported: Adverse behavioral effects, aggressive/hostile behavior, hostility, intrusive thoughts, other adverse behavioral effects, sleep disturbances, rage, withdrawal syndrome
Immediate-release formulations:
Very common (10% or more): Decreased salivation (up to 32.8%), constipation (up to 26.2%), nausea (up to 22%), vomiting (up to 22%), diarrhea (up to 20.6%), abdominal distress (up to 18.3%), dry mouth (up to 15%)
Common (1% to 10%): Increased salivation
Uncommon (0.1% to 1%): Gastrointestinal symptoms/various gastrointestinal symptoms
Frequency not reported: Abdominal cramps
Postmarketing reports: Gastrointestinal disorder
Extended-release tablets:
Very common (10% or more): Diarrhea (up to 12.1%), dry mouth (up to 10.2%)
Common (1% to 10%): Abdominal pain, constipation, dyspepsia, nausea, vomiting
Uncommon (0.1% to 1%): Dysphagia, salivary hypersecretion
Postmarketing reports: Gastrointestinal disorder
Immediate-release formulations:
Very common (10% or more): Increased appetite (up to 33%), decreased appetite (up to 28%), weight gain (up to 27%), weight loss (up to 23%)
Frequency not reported: Anorexia
Extended-release tablets:
Common (1% to 10%): Anorexia, appetite decreased/increased, weight decreased/increased
Uncommon (0.1% to 1%): Thirst
Immediate-release formulations:
Very common (10% or more): Tachycardia (up to 15.4%), chest pain (up to 10.6%)
Common (1% to 10%): Edema, hypotension, palpitations
Postmarketing reports: Peripheral edema
Extended-release tablets:
Common (1% to 10%): Chest pain, hot flush, palpitations
Uncommon (0.1% to 1%): Chest tightness, edema, hypotension, sinus tachycardia
Postmarketing reports: Peripheral edema
Immediate-release formulations:
Very common (10% or more): Micturition difficulties (up to 12.2%), menstrual disorders (up to 10.4%)
Common (1% to 10%): Incontinence, sexual dysfunction
Frequency not reported: Menstrual irregularities, urinary retention
Postmarketing reports: Galactorrhea
Extended-release tablets:
Common (1% to 10%): Difficulty in micturition, dysmenorrhea, premenstrual syndrome, sexual dysfunction
Uncommon (0.1% to 1%): Urinary frequency, urinary incontinence
Postmarketing reports: Galactorrhea
Immediate-release formulations:
Very common (10% or more): Sweating (up to 15.1%), rash (up to 11%)
Common (1% to 10%): Dermatitis
Frequency not reported: Pruritus
Postmarketing reports: Photosensitivity reaction, Stevens-Johnson syndrome
Extended-release tablets:
Common (1% to 10%): Pruritus, sweating increased
Uncommon (0.1% to 1%): Clamminess, rash, urticaria
Postmarketing reports: Stevens-Johnson syndrome
Immediate-release formulations:
Very common (10% or more): Nasal congestion (up to 17.4%)
Common (1% to 10%): Hyperventilation, upper respiratory tract infection
Extended-release tablets:
Common (1% to 10%): Allergic rhinitis, dyspnea, hyperventilation, nasal congestion, pharyngolaryngeal pain, upper respiratory tract infections
Uncommon (0.1% to 1%): Choking sensation, dysphonia, epistaxis, rhinorrhea, sleep apnea syndrome
Immediate-release formulations:
Very common (10% or more): Blurred vision (up to 21%)
Rare (0.01% to 0.1%): Increased intraocular pressure
Frequency not reported: Diplopia
Extended-release tablets:
Common (1% to 10%): Blurred vision
Uncommon (0.1% to 1%): Mydriasis, photophobia
Immediate-release formulations:
Common (1% to 10%): Muscle stiffness, muscle tone disorders, muscular cramps, muscular twitching, rigidity
Uncommon (0.1% to 1%): Muscular weakness
Frequency not reported: Musculoskeletal weakness
Extended-release tablets:
Common (1% to 10%): Arthralgia, back pain, muscle cramps, muscle twitching, myalgia, pain in limb
Frequency not reported: Increased muscle spasticity
Immediate-release formulations:
Common (1% to 10%): Infection
Extended-release tablets:
Common (1% to 10%): Influenza
Immediate-release formulations:
Common (1% to 10%): Allergy
Postmarketing reports: Angioedema
Extended-release tablets:
Postmarketing reports: Angioedema
Immediate-release formulations:
Rare (0.01% to 0.1%): Abnormal hepatic function tests, jaundice
Frequency not reported: Elevated bilirubin, elevated hepatic enzymes
Postmarketing reports: Hepatic failure, hepatitis
Extended-release tablets:
Postmarketing reports: Hepatic failure, hepatitis, liver enzyme elevations
Immediate-release formulations:
Postmarketing reports: Gynecomastia, hyperprolactinemia
Extended-release tablets:
Postmarketing reports: Gynecomastia, hyperprolactinemia
Medically reviewed by USARx EDITORIAL TEAM Last updated on 1/1/2020.
Source: Drugs.com Alprazolam Xr (www.drugs.com/alprazolam.html).
August 6, 2020
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