Medication and Treatment Reviews

Xanax

Generic Name: Alprazolam

Uses

Xanax, known as alprazolam in the generic form, is a benzodiazepine primarily used for short-term relief of symptoms of anxiety and panic disorders in adults. It may help relieve excessive worry, shortness of breath or heavy perspiration, feelings of edginess, and difficulty sleeping due to anxiety. Alprazolam is also effective for anxiety associated with depression and panic due to agoraphobia, the anxiety disorder that causes patients to fear and avoid places or situations that might trigger panic and make them feel trapped, helpless, or embarrassed. The safety and effectiveness of alprazolam have not been established for adolescents and children under age 18.

How to Use Xanax

Before starting or refilling an alprazolam prescription, read the medication guide included with your pills, as it may be updated with new information.

This guide should not replace a conversation with your doctor, who has a holistic view of your or your child’s medical history, other diagnoses, and other prescriptions. If you have questions, ask your doctor or pharmacist before you begin taking the medication.

Dosage

As with all medications, follow your prescription instructions exactly. Alprazolam is available in two formulations:

  • Alprazolam Tablet: Taken orally one to three times daily with water or another liquid. Tablets are available in 0.25mg, 0.5mg, 1mg, and 2mg doses.
  • Alprazolam XR: Taken once daily in the morning with water or another liquid. Tablets are available in 0.5 mg, 1mg, 2mg, and 3mg doses.

Do not drink alcohol while taking this medication; do not take it after eating a fatty meal.

The maximum dosage is typically 4mg daily for treatment of anxiety disorders. Treatment of panic disorders may require a higher dosage, up to 10mg per day. When taking a higher dosage, you should meet with your doctor regularly to consider dosage reduction. Doctors may recommend starting with a lower dosage for the elderly patients or patients with advanced liver or other debilitating disease who may be particularly sensitive to benzodiazepines.

The optimal dosage varies by patient; it is not determined by age, weight, or height, but rather by how a person metabolizes the medication. Your doctor may increase your dosage by 1mg per day.

When discontinuing treatment, or decreasing dosage, patients should work with a doctor to gradually taper the level of medication by no more than .5mg every three days. Stopping alprazolam suddenly can create withdrawal symptoms, and seizure can occur. Some patients may need to decrease dosage at an even slower rate.

Some patients develop a tolerance to alprazolam. Do not increase the dosage without discussing it with your doctor. Your doctor should periodically reassess if the treatment is still useful. Long-term treatment with alprazolam increases the risk of dependence, and may cause difficulty when terminating treatment. After an extended period without attacks or symptoms, a patient may work with his or her doctor to taper off the medication gradually.

Side Effects

The most common side effects of alprazolam are similar to those associated with Lorazepam and other benzodiazepines, and are as follows: drowsiness, irritability, dizziness, lightheadedness, dry mouth, altered sex drive, and symptoms of dependence/withdrawal with long-term usage.

Other serious side effects include diarrhea, depressive thoughts, loss of appetite, difficulty concentrating, insomnia, abdominal pain, blurred vision, and headache. If you stop taking alprazolam suddenly, a life-threatening seizure can occur.

Taking alprazolam may impair your ability to drive, operate machinery, or perform other potentially dangerous tasks. This side effect usually wears off with time. If side effects are bothersome, or do not go away, talk to your doctor.

Most people taking this medication do not experience any of these side effects.

Disclose to your physician all mental health issues including any family history of suicide, bipolar illness, mania, or depression. Alprazolam may create new or exacerbate existing behavior or mental problems. Panic disorder is often comorbid with major depressive disorders, which can increase risk for suicide. Call your doctor immediately if you or your child experiences new or worsening mental health symptoms including hallucinations or sudden suspicions.

Alprazolam has a weak uricosuric effect, which can sometimes cause acute renal failure. Elderly or debilitated patients with impaired renal, hepatic, or pulmonary function should use caution and be observed closely when taking alprazolam. Seek medical help right away if you experience yellowing eyes or skin, seizures, or signs of an allergic reaction.

Benzodiazepines like alprazolam have a low potential for abuse and addiction among people who have anxiety. It is a “Schedule IV Stimulant,” a designation that the Drug Enforcement Agency uses for drugs with a low potential for abuse. Other Schedule IV drugs include Valium, Ativan, and Ambien. However, long-term treatment in higher dosages with alprazolam increases the risk of dependence, especially for people being treated for panic disorder. Taking the medication exactly as prescribed can reduce potential for abuse.

The above is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.

Precautions and Safety

Store alprazolam in a secure place out of reach of children, and at room temperature. If you are taking the quick-dissolving tablet, keep the tablets in the blister packaging and hard plastic travel case or carton until you are ready to take it.

You should not take alprazolam if you are sensitive to benzodiazepines, or have acute narrow angle glaucoma.

If you are thinking of becoming pregnant, you should not take alprazolam, because there is a high potential for fetal harm, and increased risk of congenital abnormalities – especially when taken during the first trimester. Alprazolam is passed through breastmilk, so it is recommended that mothers do not nurse while taking it.

Interactions

Before taking alprazolam, discuss all other active prescription medications with your doctor.

You should not take alprazolam if you are taking ketoconazole, itraconazole, or other drugs that inhibit metabolism via cytochrome P4503A, including, but not limited, to:

  • Antidepressants including fluoxetine, fluvoamine, and nefazodone
  • Azole antifungals including itraconazole and ketoconazole
  • Cimetidine
  • HIV protease inhibitors
  • Macrolide antibiotics such as erythromycin

These medications can have a dangerous drug interaction. Exercise caution with other psychotropic agents, anticonvulsant drugs, antihistamines, ethanol, digoxin, oral contraceptives, St. John’s wort, seizure medications, imipramine, and desipramine.

Smoking cigarettes can decrease the level of medication in the blood. Tell your doctor if you are a smoker, or recently quit smoking.

Share a list of all vitamin or herbal supplements, and prescription and non-prescription medications you take with the pharmacist when you fill your prescription, especially any drugs that cause drowsiness. Let all doctors and physicians know you are taking alprazolam before having any surgery or laboratory tests. The above is not a complete list of all possible drug interactions.

Sources:

http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/018276s044,021434s006lbl.pdf
http://www.pfizer.com/files/products/material_safety_data/ALPRAZOLAM%20TABLETS.pdf
https://www.pfizermedicalinformation.com/en-us/xanax

2 reviews

  1. I started taking Vyvanse about 3 years ago. It seemed to worsen my anxiety about 2 hours after I took it. I gave it 2 weeks hoping it would wear off. It didn’t but I started taking .5mg Xanax with it each morning. It made all the difference in the world. I am now on 70mg Vyvanse and still take .5mg Xanax. It still works great.

  2. For depression I take Wellbutrin, but that wasn’t enough, so I also take Abilify, which is very expensive. For the anxiety I take half of a tablet of Alprazolam, and for insomnia, a whole tablet. I’ve had insomnia all my life, (except when backpacking – that completely thrashes me and I sleep well), was diagnosed at 50 with inattention ADD, and still, no matter what ADHD med I’m on, have every type of insomnia (early, middle and late night, and early waking) and the only thing that helps is a sleeping pill. I’ve been taking Alprazolam for several years, works like a charm.

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