Alprazolam (Oral)

Used to treat anxiety and symptoms of panic disorders, Alprazolam is a central nervous depressant. By slowing the nervous system down, feelings of anxiety and panic can be reduced significantly.

Overview

Alprazolam, more commonly known under brand names Xanax, Niravam, and Gabazolamine-05, is a medication used to treat anxiety. Patients suffering from depression-induced anxiety and panic disorders can also benefit from taking Alprazolam.

One of many drugs known as benzodiazepines, Alprazolam affects the brain and nerves. By increasing the production of gamma-aminobutyric acid (GABA), Alprazolam inhibits activity in the brain. As over-activity is commonly associated with anxiety and panic, this inhibiting effect enables the patient to feel calmer and reduces feelings of discomfort.

Due to this, Alprazolam can help to reduce feelings of worry, fear, panic, restlessness, trembling, palpitations and sweating. As these symptoms, along with lightheadedness, insomnia, and dizziness, are associated with anxiety, a reduction in the GABA neurotransmitter can help to minimize these symptoms or get rid of them altogether.

Although a course of Alprazolam can be taken in regular doses, it is not always prescribed in this way. In some instances, physicians may advise patients to take Alprazolam when they feel intense anxiety or when a panic attack is approaching. This reduces the risk of benzodiazepine addition but still provides relief from distressing symptoms.

When dealing with anxiety-related disorders, many patients report that feelings of panic can arise almost instantaneously, without any warning. It's important, therefore, that effective medications provide fast-acting relief from symptoms of anxiety. Fortunately, many patients report that Alprazolam begins to work fairly quickly. When patients are experiencing high levels of anxiety, Alprazolam can, therefore, be used to provide fast relief from symptoms.

For use in chronic anxiety or panic disorder, an extended-release version of Alprazolam may be appropriate. This version of the medication delivers relief from symptoms over a longer period of time and can, therefore, be more effective when anxiety is present constantly or for considerable periods of time.

Conditions Treated

  • Anxiety
  • Depression-induced anxiety
  • Panic disorders

Type of Medicine

  • Benzodiazepine

Side Effects

When taking Alprazolam, patients may experience some unwanted side-effects. Drowsiness and fatigue are among the most common side-effects reported, but others may include:

  • Changes in weight
  • Constipation
  • Memory problems
  • Speech problems
  • Increased saliva production
  • Dizziness
  • Changes to menstrual cycle
  • Weight gain
  • Clumsiness
  • Unsteadiness
  • Decrease in sex drive/ability
  • Slurred speech
  • Difficulty with coordination
  • Diarrhea
  • Trouble concentrating or focusing

Other side-effects may occur when talking Alprazolam but they are less common. They may include:

  • Stomach and abdominal pain
  • Chills
  • Dry mouth
  • Ear congestion
  • Decrease in urination
  • Blurred vision
  • Aches and pains
  • Blistering of the skin
  • Unpleasant taste
  • Increased sensitivity to light
  • Difficulty in seeing at night
  • Dilated pupils
  • Swelling of breast tissue in both males and females
  • Lactation in both males and females
  • Burning or tingling sensation
  • Cough
  • Difficulty in passing urine
  • Unusual feeling of warmth
  • Muscle pain, stiffness or cramping
  • Fainting
  • Headache
  • Hyperventilation
  • Restlessness
  • Inability to move eyes
  • Irregular heartbeat
  • Dark urine
  • Mood changes
  • Loss of bladder control
  • Nasal congestion
  • Joint pain
  • Sense of detachment from self or body
  • Visualizing or hearing things which are not really present
  • Weakness
  • Sluggishness
  • Uncontrolled movements
  • Wheezing
  • Unusually long sleeping patterns

Whilst this is not an exhaustive list of the side-effects which may occur when taking Alprazolam, it should be noted that not all patients experience side-effects. Many patients do not suffer any adverse effects when taking this medication and, in those that do, not all side-effects are typically present. In many cases, side-effects are mild and do not prevent the patient from behaving as they normally would.

If side-effects are particularly severe or present an on-going problem, patients should consult their physician.

In very rare cases, patients may show a decreased level of awareness, ringing or buzzing in the ears, chest pain, a false sense of well-being, lack of emotion, shakiness, sleepwalking, feeling cold, mood changes, suicidal thoughts and/or slowing of mental and physical activity. These side-effects are rarely caused by Alprazolam but, if present, patients should notify their doctor.

Yellowing of the skin or eyes, along with seizures, are rare side-effects but they do warrant immediate medical attention if they occur. If patients begin to experience these side-effects when taking Alprazolam, they should assume it is a medical emergency and seek urgent medical help.

Dosage

For treatment of anxiety:

Available in various strengths, the lowest available dose of Alprazolam is normally 0.25 milligrams (mg). When receiving Alprazolam for anxiety, patients will typically be started on a dose of 0.25mg-0.5mg three times per day. In some instances, doctors may prescribe a lower dose initially. Whilst the dose of Alprazolam can be increased, physicians will not normally prescribe more than a total of 4mg per day when treating anxiety.

When prescribing Alprazolam for older or elderly patients with anxiety, physicians will often start with a dose of 0.25mg two or three times daily and increase the dose if required to do so.

Although children can be prescribed Alprazolam for anxiety, there is no set dose for this type of treatment. The patient's age, weight and the severity of their symptoms will enable their doctor to determine whether Alprazolam is an appropriate treatment and, if so, what dose will be safe yet effective.

For treatment of panic disorders:

Extended-release tablets

When treating panic disorder with Alprazolam, physicians will often use a starting dose 0.5-1mg taken daily. When using this dose of Alprazolam to treat panic disorders, however, the extended-release version of the medication is normally prescribed. This provides patients with relief from symptoms over a longer period of time than when the standard version of Alprazolam is used.

Depending on the effectiveness of a low dose and the patient's symptoms, the dosage of extended-release Alprazolam may be increased by physicians. In most cases, however, 10mg per day is considered to be the maximum dose when treating panic disorders.

Extended-release Alprazolam can be prescribed for children suffering from on-going panic disorders, but the dose must be determined by their physician. Often, a very low starting dose is given and then increased incrementally, as necessary.

Standard tablets

In some situations, physicians may treat panic disorders with standard Alprazolam, rather than the extended-release version. If so, a starting dose of 0.5mg three times daily is normally prescribed for adults. If necessary, this can be increased over time, but the daily maximum dose is normally considered to be 10mg.

If older adults or elderly people are prescribed standard Alprazolam for panic disorders, the starting dose is likely to be 0.25mg two or three times per day. If this dose does not provide relief from symptoms, physicians may choose to increase the dose once the patient has become accustomed to the medication.

If standard Alprazolam is prescribed to children with panic disorders, physicians should determine an appropriate starting dose for the individual patient. Age and weight can have a significant impact on how the medication works, so each patient should be assessed individually and a unique treatment plan used.

Whilst these starting doses are the most common way of taking Alprazolam, patients should always adhere to the doctor's instructions when taking medication. If they are advised to take a higher or lower starting dose by their physician, these instructions should be followed.

If patients miss a dose of Alprazolam, they may be able to take the missed dose in some instances. If they realize that they have missed a dose relatively quickly, for example, they should take the missed dose and continue with their usual medication schedule. If they forget to take a tablet or capsule, however, and it is almost time for the next dose of Alprazolam, the missed dose should be skipped altogether. Double doses of Alprazolam should not be taken as this could change the way the medication affects the patient.

If a dose of Alprazolam has been missed and you're unsure how to proceed with taking your medication, you should seek advice from your physician or a qualified pharmacist.

Standard alprazolam is available in various formats. Most commonly, it is prescribed in capsule or tablet format. When taking Alprazolam capsules, the capsule should be swallowed whole and should not be crushed or opened. Similarly, Alprazolam tablets should not be crushed prior to taking them.

Alprazolam is also available as an oral solution and as an orally-disintegrating tablet. When taking an orally-disintegrating tablet, it's important to leave the tablet in the packaging until you are ready to take it. In addition to this, you should always ensure that your hands are dry when handling the medication or the tablets may begin to disintegrate before they're placed in your mouth.

When the patient is ready to take the medication, an orally-disintegrating tablet should be taken from the packet and placed on the tongue. It should melt relatively quickly and can then be swallowed. In most cases, orally-disintegrating tablets should not be swallowed with water. Instead, they can simply be swallowed with saliva once they have melted.

When taking Alprazolam in oral solution form, the liquid should be measured prior to taking a dose. An oral syringe, medicine cup or measuring spoon can be used to measure the correct dose. Following this, the patient can simply swallow the solution.

Drug Interactions

When more than one drug is taken, it can affect the way that the medication is absorbed and, as a result, the medicine can affect the patient differently. Due to this, some medications should not be taken at the same time.

It's extremely important, therefore, that patients inform their doctor if they are taking any other medications, regardless of what condition they've been prescribed for. Similarly, patients should inform their doctor if they are taking any over-the-counter medications, vitamins, supplements or herbal preparations.

In most instances, the following medications should not be taking in conjunction with Alprazolam:

  • Delavirdine
  • Indinavir
  • Itraconazole
  • Ketoconazole
  • Flumazenil

If you are currently taking these medications, your doctor may prescribe an alternative to Alprazolam or change your existing prescription to an alternative medication.

The following medicines are not usually prescribed at the same time as Alprazolam but, in some cases, it may be acceptable for them to be taken at the same time:

  • Boceprevir
  • Amobarbital
  • Butalbital
  • Alfentanil
  • Morphine
  • Bromopride
  • Voriconazole
  • Butabarbital
  • Anileridine
  • Digoxin
  • Carbamazepine
  • Carbinoxamine
  • Carisoprodol
  • Ceritinib
  • Chloral Hydrate
  • Chlorzoxazone
  • Clarithromycin
  • Thiopental
  • Dantrolene
  • Conivaptan
  • Codeine
  • Dasabuvir
  • Ethchlorvynol
  • Dihydrocodeine
  • Fospropofol
  • Doxylamine
  • Eliglustat
  • Butorphanol
  • Fentanyl
  • Levorphanol
  • Fluconazole
  • Domperidone
  • Meprobamate
  • Meperidine
  • Idelalisib
  • Flibanserin
  • Meclizine
  • Hydromorphone
  • Mephenesin
  • Mephobarbital
  • Hydrocone
  • Metaxalone
  • Morphine Sulfate Liposome
  • Methocarbamol
  • Oxymorphone
  • Mirtazapine
  • Bromazepam
  • Methadone
  • xycodone
  • Methohexital
  • Pentazocine
  • Pentobarbital
  • Periciazine
  • Sodium Oxybate
  • Remifentanil
  • Primidone
  • Propofol
  • Propoxyphene
  • Piperaquine
  • Secobarbital
  • Phenobarbital
  • Sufentanil
  • Tapentadol
  • Cobicistat
  • Zolpidem
  • Buprenorphine
  • Tramadol

If the patient is taking any of the above medications, their physician may provide specific instructions regarding when the medicine should be taken in relation to their dose of Alprazolam. In addition to this, their dosage of both medications may be altered to account for any interactions the drugs may have.

The following drugs and supplements could cause increased side-effects to occur. Whilst this doesn't necessarily prevent them from being used in conjunction with Alprazolam, doctors may offer additional medication in order to minimize the potential side-effects. Alternatively, doses may be altered or medications changed so that potential side-effects are reduced. These drugs include:

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

When taking Alprazolam, or any prescription medication, it's important that patients follow their physician's instructions carefully. If your doctor prescribes any of the above medications, as well as Alprazolam, it is because the benefits of the treatment regime are considered to be of significant value.

By providing doctors with a thorough medical history, patients can ensure that their physician will provide the most effective combination of medications for them. Similarly, this information can help to ensure that a safe combination of medication can be provided.

Warnings

Although most patients tolerate Alprazolam well, there are some conditions which may prevent patients from taking this medication. If patients suffer from any of the following, they should notify their physician prior to starting a course of Alprazolam:

As with all medications, allergic reactions to Alprazolam have been noted in rare cases. Before taking the medication, patients should inform their physician of any existing allergies. This should include allergies to foods, preservatives, dyes and even animals.

If symptoms of an allergic reaction occur when taking Alprazolam, urgent medical attention must be sought. These symptoms may include difficulty breathing, facial swelling, rapid heartbeat and/or collapse. As serious allergies are potentially life-threatening, an allergic reaction should always be treated as a medical emergency.

Although pregnant women can be prescribed Alprazolam, the medication is considered to be a category D risk in these circumstances. This means that some fetal harm has been associated with taking this medication when pregnant. Despite this, the benefits of taking Alprazolam for a serious condition may outweigh the potential risks, even in pregnant patients.

Due to this, pregnant patients should discuss the benefits of using Alprazolam with their physician in detail.

Patients who are breastfeeding or nursing a child should not take Alprazolam. The medication can be passed on to the child via breast milk and has been shown to have harmful effects in some cases. As a result, Alprazolam is not an appropriate medication for this class of patient and an alternative medication should be sought.

Although elderly and geriatric patients can take Alprazolam, it's important that their starting dose is lowered from the standard dosage regimen. Side-effects, such as dizziness, clumsiness, and unsteadiness, are more likely to occur in older patients. By reducing the starting dose of Alprazolam, physicians can help to reduce the likelihood of these symptoms occurring and also reduce the chances of subsequent injuries occurring as a result of a fall.

When taking Alprazolam, certain substances should be avoided. The use of alcohol and/or tobacco, for example, is not recommended when taking this medication. Patients should discuss this with their physician if they plan to consume alcohol or smoke tobacco whilst taking Alprazolam. In addition to this, patients should avoid consuming grapefruit juice whilst taking Alprazolam.

It is common for Alprazolam to make patients feel drowsy, fatigued and/or dizzy. Due to this, patients should not drive a vehicle or operate heavy machinery until they are familiar with how the medication affects them.

Although effective in the treatment of anxiety and panic disorders, benzodiazepines have been associated with addiction problems in some patients. Due to this, patients should be monitored whilst taking this medication and remain on the lowest dose possible. If patients feel that they are becoming dependent on the medication, they should seek help from their physician.

Storage

When storing Alprazolam, it's essential that patients find a suitable and secure location to keep their medications. If you have children in your home, for example, you may want to use a cupboard in a high location and add extra locks or child resistant catches so that your medication can't be accessed by anyone else. Similarly, if you have pets in your home, your medications should be kept well out of reach so that they cannot be accessed.

Alprazolam should be stored in a closed container at average room temperature. The medication shouldn't be frozen or placed in a very cold environment. In addition to this, Alprazolam should be kept out of direct sunlight, in a dry environment.

If patients are prescribed orally-disintegrating Alprazolam, it is vital that the tablets are kept away from moisture and heat. If they become wet or are near to steam, for example, they may begin to disintegrate before you take them.

If patients have tablets remaining once they have finished their treatment, they should be disposed of carefully. Similarly, if you have any medications which are out-of-date, they should be thrown away in a responsible manner. In most cases, pharmacists can provide a suitable method of medication disposal.

Summary

For patients experiencing periods of acute panic or long-term panic disorders, Alprazolam can be an extremely effective medication. Often used in conjunction with other treatments, such as therapy or counseling, Alprazolam can help patients to minimize feelings of anxiety, fear, and nervousness.

Patients with these symptoms may struggle to work, socialize or lead fulfilling lives due to the effects of extreme anxiety and panic disorders. By taking Alprazolam, however, they can benefit from reduced anxiety and begin to take part in everyday activities once again.

As Alprazolam is available in standard format and extended-release, patients with chronic anxiety and periods of panic can benefit from taking this medication. Physicians will determine which type of Alprazolam is most appropriate, depending on the patient's symptoms and clinical presentation.

As with most medications, however, there are a number of side-effects associated with Alprazolam. Similarly, there are some instances in which it may not be a viable medication for patients. Pregnant patients, for example, may wish to avoid the fetal risks associated with Alprazolam and opt for another type of medication.

Most patients, however, feel that the benefits of Alprazolam outweigh any side-effects they experience. If side-effects persist, however, they can often be combatted with additional medication or with a change to the patient's dosage.

With 1 in 4 people estimated to suffer from mental health problems, anxiety and panic disorders are likely to become more common than ever before. Many people report feeling overwhelmed prior to experiencing episodes of extreme anxiety or stress and this can result in anxiety becoming an issue.

Due to this, it's important that effective medications are available for patients suffering from these symptoms. Whilst the symptoms of anxiety alone are distressing, patients can often begin to fear the anxiety itself and this can lead to a self-perpetuating cycle of panic attacks.

By prescribing Alprazolam, however, physicians can help to reduce instances of anxiety and the fear which goes alongside these episodes. As a result, most patients benefit from increased self-confidence and increased self-esteem when taking this medication. Furthermore, reducing anxiety with Alprazolam can help patients to avoid the physical and emotional problems that on-going anxiety can cause.

With emotional and physical benefits associated with Alprazolam, it can be a viable form of treatment for all types of patients. Providing no risk factors are present, patients generally find Alprazolam to be a beneficial way of treating anxiety, depression-induced anxiety, social anxiety and panic disorders.

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Last Reviewed:
December 10, 2017
Last Updated:
April 04, 2018