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Why it's used

Alprazolam is used for the management of anxiety disorder or for the short-term relief of symptoms of anxiety. It is a prescription medicine. This medicine works by binding at several sites within the brain and affecting the chemical action to produce a depressive effect on brain activity. This medicine helps by promoting sleep, reducing anxiety and worry. Alprazolam is also used to treat panic disorder with or without fear in open public space (agoraphobia). It is also used for the short-term treatment of anxiety associated with depression.
When not to use
Alprazolam should not be used to treat short-term mild anxiety, such as stress of daily life.
Benzodiazepine
Alprazolam belongs to a class of medicines called Benzodiazepine. Benzodiazepines are a class of drugs used to treat a range of conditions, including anxiety and insomnia. These medicines work by slowing down the activity of the central nervous system by relaxing the muscles and inducing sleep.

How to use

Read the medicine guide provided by your pharmacist, your doctor, or the medicine company. If you have any questions related to Alprazolam, ask your doctor or pharmacist. Use Alprazolam as per the instructions provided by your doctor.
Alprazolam is consumed with or without food.
The typical dose of Alprazolam for adults is 0.25 - 0.5 mg three times a day (not more than 4 mg a day). The maximum dose for adult patients of Alprazolam is 4 mg per day. Although this medicine is useful to people, it may sometimes be habit-forming or cause addiction. You may be at higher risk if you have a substance use disorder, such as an addiction to drugs, or have an existing addiction, such as to alcohol. To reduce your risk of addiction, take this medicine as prescribed.
This medicine is to be used for longer periods of time.
Discuss with your doctor if you develop new symptoms. Discuss with your doctor if memory loss (amnesia), and jaundice. Consult with your doctor before stopping the use of Alprazolam.
Your doctor may prescribe a lower starting dose of this medicine to understand the impact on the body. Please follow your doctor's recommendations. Taking a higher dose of this medicine may increase the risk of side-effects. A lower dose of this medicine may be recommended to reduce the risk of side-effects. Older patients may see an increase in the incidence of side-effects. As a result, a lower dose may be recommended for older patients.
When stopping this medicine, some patients may experience withdrawal symptoms like an increase in the ability to hear, see, or become aware of something through the senses (heightened sensory perception), disturbed focus, dysfunction of the sense of smell (dysosmia), inability to think clearly (clouded sensorium), tingling sensation, muscle cramp, muscle twitch, diarrhea, blurred vision, decreased appetite, weight loss, anxiety, insomnia, headache, muscle pain, tension, restlessness, confusion, irritability, feeling unreal (depersonalisation), hearing disorder (hyperacusis), numbness and tingling on hand or feet, sensitivity to light, noise, or physical contact, hallucination, seizures, mood changes, difficulty sleeping, nausea, vomiting, sweating, stomach cramp, and tremor. You may need to taper (gradually decrease) the dose of this medicine when stopping. The effectiveness of this medicine may diminish when used for long periods of time.
The safety and effectiveness of using Alprazolam in children has not been established. The effect of Alprazolam in the children aged less than 18 years has not been studied.
If using the orally-disintegrating form of this medicine, make sure you do not consume any food or fluid 5 minutes before or after taking this medicine. Before taking the medicine out of the package, wash your hands thoroughly. Place the medicine on the tongue. Make sure you do not chew or swallow the medicine. You do not need to drink water after consuming the medicine. In certain cases, the medicine can taste slightly bitter. Also, ensure that you do not break or split the medicine.
To decrease the possibility of side-effects, you might be recommended to use the extended-release form of this medicine by your doctor. The extended-release medicine helps in maintaining a steady level of the medicine in your body for a longer period of time. Do not crush or chew the medicine, unless indicated on the package or by your doctor.
Avoid consuming alcohol together with Alprazolam. Avoid grapefruit juice while using Alprazolam.
Medicines may be recommended for uses other than those listed in the medicine guide. You should not use Alprazolam for conditions or symptoms for which it was not prescribed. Do not give Alprazolam to other people, even if they have the same conditions or symptoms that you have. The use of this medicine without the advice of a doctor may cause harm.
Follow storage instructions on the product package if available. Store Alprazolam 20 to 25°C (68 to 77°F), away from moisture, and away from light. Store this medicine away from children and pets.

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How to take Alprazolam

Your dose may depend on several personal factors. You should consult with your doctor to find out the dose that is best for you. The dose of Alprazolam depends on the following factors:
  • patient's age
  • patient's health
  • response to treatment

Alprazolam Dosage

Dosage for anxiety disorder

Adult
  • Initial: 0.25 to 0.5 mg three times daily
  • Maximum: 4 mg daily
Older Adults
  • Initial: 0.25 mg two to three times daily

Minimum Age

18 years

Forms

Tablet
Strength: 0.25 mg, 0.5 mg, 1 mg, and 2 mg
Oral Solution
Strength: 1 mg/mL
Extended Release Tablet
Strength: 0.5 mg, 1 mg, 2 mg, and 3 mg
Orally Disintegrating Tablet
Strength: 0.25 mg, 0.5 mg, 1 mg, and 2 mg

Special Instructions

Weak patients and patients with severe liver disease
Starting dose of Alprazolam in weak and severe liver disease patients should be 0.25 mg two to three times daily.

Missed Dose

Take the missed dose as soon as you remember it. Skip the missed dose if its time for the next dose. Do not take a double dose to make up for the dose that you may have missed.

Overdose

What to do if you overdose on Alprazolam?
In case of overdose, pulse rate, respiration, and blood pressure should be monitored. Immediate stomach emptying should be performed. Maintain proper breathing and fluids should be given through the vein. Alprazolam can be removed from the blood by artificial blood purifying technique (dialysis). Flumazenil should be given for the reversal of sleeping effects due to Alprazolam overdose. It should be given with proper monitoring of respiratory insufficiency, re-sedation and other remaining benzodiazepine effects for some period after the treatment. If low blood pressure occurs, it may be treated with blood vessel constriction medicines (vasopressor).
Symptoms of an overdose of Alprazolam
If you use too much of this medicine, it could lead to dangerous levels of the medicine in your body. In such cases, symptoms of an overdose may include:
If you think you have overdosed on Alprazolam, call a poison control center immediately. You can look up the poison control center information from the Poison Center Finder at TabletWise.com.

Precautions while using Alprazolam

Before you use Alprazolam, tell your doctor if you are allergic to it or its ingredients. Your doctor may prescribe an alternative medicine and update your medical records to record this information. Tell your doctor if you are allergic to benzodiazepines.
Before you use Alprazolam, tell your doctor of your medical history including depression, mood problems, suicidal thoughts or behavior, liver or kidney problems, lung disease or breathing problems, mood disorder (borderline personality disorder), violent or aggressive behavior, alcohol or substance abuse, seizures, or brain disorder (epilepsy). The use of this medicine can be possibly fatal in patients with severe lung disease. A decrease in the elimination rate of Alprazolam has been observed in alcoholic liver disease patients.
Avoid the consumption of alcohol with Alprazolam. Drinking alcohol may cause dizziness, severe drowsiness, breathing problems, coma, and possibly fatal.
Alprazolam is not safe for use in pregnant women. If you are pregnant or planning to become pregnant, you should discuss with your doctor the impact this medicine may have on the baby before you start to use this medicine. This medicine can potentially cause harm to the fetus when given to pregnant women. When used during the first trimester of pregnancy, Alprazolam is considered to be capable of producing an increased risk of birth defects including a complete loss of muscle tone (neonatal flaccidity) and respiratory problems in the baby. Consult with your doctor on the use of Alprazolam during breastfeeding. This medicine may pass into breast milk. It can cause lack of energy (lethargy) and weight loss in the baby. So, Alprazolam should not be used while breastfeeding. Consult with your doctor on the use of Alprazolam, if you are trying to conceive.
Alprazolam can make you feel sleepy. Be careful while driving, using machinery, or doing any other activity that needs you to be alert. The consumption of alcohol with Alprazolam can make you feel more sleepy. Alprazolam may cause seizures in some people. Discuss with your doctor if you perform activities where a loss of consciousness may cause you or others harm.
This medicine may increase your sensitivity to sunlight. If this happens, limit your time outdoors and do not tan to prevent sunburns. Cover your skin when you are outdoors or use a sunscreen. In case you get a sunburn, consult with your doctor.
Alprazolam may increase side-effects in older patients. Elderly patients may see an increased risk of loss of body movements, and oversedation.
This medicine may cause psychological dependence when used for a long time.

Alprazolam Side-effects

The following side-effects may commonly occur when using Alprazolam. If any of these side-effects worsen or last for a long time, you should consult with your doctor:
The following side-effects may commonly occur in older patients on the use of Alprazolam. Discuss with your doctor if any of these side-effects last for a long time or are severe:
  • aggressiveness
  • an abnormal condition of mind (psychoses)
  • delusion
  • fall
  • hallucinations
  • inappropriate behavior
  • irritability
  • nervousness
  • nightmares
  • restlessness
  • sedation
  • uncontrollable anger
  • weakness of muscle and skeleton system
The following side-effects may commonly occur in children when using Alprazolam. Discuss with your doctor if any of these side-effects last for a long time or are severe:
  • aggressiveness
  • agitation
  • an abnormal condition of the mind (psychoses)
  • delusion
  • hallucinations
  • inappropriate behaviour
  • irritability
  • nightmares
  • restlessness
  • uncontrollable anger
Rarely, the use of Alprazolam may cause the following side-effects:
  • abnormal thinking
  • abnormally high level of prolactin in the blood (hyperprolactinaemia)
  • aggression
  • anger
  • being hyperactive
  • burning or prickling sensation
  • changes in skin color and temperature (vasomotor disturbances)
  • chest pain
  • decreased salivation
  • difficulties in focus
  • difficulty urinating (micturition difficulties)
  • excessive breathing (hyperventilation)
  • fainting
  • fear
  • feeling unreal (derealization)
  • feeling warm
  • increased appetite
  • increased mental activity (psychomotor hyperactivity)
  • increased pressure in the eye (intraocular pressure increased)
  • increased salivation
  • infection
  • loss of control over urination (incontinence)
  • loss of control senses (disinhibition)
  • menstrual disorder
  • menstrual irregularities
  • mental health disorder (cognitive disorder)
  • mildly elevated mood (hypomania)
  • movement disorder
  • muscle cramp
  • muscle spasm
  • muscle stiffness
  • muscle tone disorder
  • muscle twitching
  • nasal congestion
  • palpitation
  • ringing in the ears (tinnitus)
  • severe itching of the skin
  • short-term memory loss (transient amnesia)
  • slurred speech
  • stiffness of the muscle (rigidity)
  • stomach discomfort (abdominal distress)
  • stomach upset
  • sweating
  • swelling of the feet, ankles, or fingers
  • talkativeness
  • taste changes (alteration)
  • uncontrolled muscle movement (dystonia)
  • unfriendliness (hostility)
  • weakness of muscle or skeleton system
The following severe side-effects may also occur when using Alprazolam:
Your doctor has prescribed Alprazolam because they judge that the benefit is greater than the risk posed by side-effects. Many people using this medicine do not have serious side-effects. This page does not list all possible side-effects of Alprazolam.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Warnings

Use of opioids

Patients using Alprazolam with opioids are at an increased risk. Such patients may have an increased risk of sleepiness, coma, breathing problems, and can be fatal. A lowest effective dose of Alprazolam should be given for the minimum duration of time with opioids. Closely monitor signs and symptoms of breathing problems and sleepiness. It is also advised to patients not to drive or operate heavy machinery.

Dependence and withdrawal reactions

There is a risk of dependence and withdrawal reactions in patients who are using Alprazolam. This may occur in patients with a history of alcohol use or misuse of the drug. Patients using Alprazolam may have a risk of dependence to Alprazolam which can be life-threatening. This medicine also causes withdrawal symptoms including seizures, disturbed focus, abnormal sensation, inability to think clearly or concentrate (clouded sensorium), weight loss, heightened sensory perception, appetite decrease, alteration of the perception of smell (dysosmia), blurred vision, muscle cramps, diarrhea, and muscle twitch. Alprazolam should be discontinued by reducing dosage slowly. The dosage of Alprazolam may be decreased by no more than 0.5 mg every three days.

Memory loss (amnesia)

Patients taking Alprazolam are at an increased risk of memory loss. The patients should take continuous 7 to 8 hours sleep to reduce the risk of memory loss.

Mental and drug-related reactions (psychiatric and paradoxical reactions)

Children and elderly patients are at an increased risk when using this medicine. Such patients may have an increased risk of nervousness, restlessness, irritability, delusion, aggressiveness, violent uncontrollable anger, nightmares, inappropriate behavior, severe mental disorder, and hallucinations. The use of Alprazolam in such patients should be discontinued.

Abnormal functioning of kidneys and liver

Patients with abnormal functioning of kidneys and liver are at an increased risk. Alprazolam should be given with caution in such patients.

Depression or anxiety

Patients with depression or anxiety are at an increased risk when taking this medicine. Such patients may have increased risk of suicide when they take Alprazolam alone. Alprazolam should be given for a short period with caution in patients with symptoms of depression or suicide.

Elderly patients

Elderly patients are at an increased risk when taking this medicine. Such patients may have an increased risk of muscle weakness, severe respiratory insufficiency, and sleepiness. Alprazolam should be given with caution and start with a low dose in such patients.

Patients taking Alprazolam

Patients using Alprazolam may have a risk of withdrawal symptoms including prolonged seizures that can be possibly fatal.

Symptoms occur between dose intervals

Patients using Alprazolam may have a risk of early morning anxiety which may indicate the development of tolerance. The same total daily dose of Alprazolam should be given in divided doses to such patients.

Risk of dose reduction

The reduction of dose in patients using Alprazolam may have a risk of withdrawal reactions. The doses of Alprazolam should be decreased and stopped gradually.

Slow down of body activities (CNS depression)

Alprazolam may cause slow down of body activities due to its brain depressive effect. Patients taking Alprazolam should be cautioned while doing activities which require full mental alertness such as driving a motor vehicle or operating machinery. Such patients also should be cautioned about the simultaneous consumption of alcohol and other brain depressive drugs.

Risk of harm in an unborn baby

Pregnant women taking Alprazolam may have an increased risk of harm to the unborn baby. This medicine may cause birth defects to unborn babies when given to pregnant women in their first trimester. Alprazolam should be avoided in the first 12 weeks of pregnancy. If patients are taking Alprazolam, become pregnant or plan to pregnant during treatment they should consult with their doctor about taking or discontinuing the drug.

Tolerance

The repeated use of Alprazolam for few weeks may cause a decrease in its sleep-inducing effect.

Depression patients

The use of Alprazolam in patients with depression are at increased risk. The use of Alprazolam in patients with depression may cause periods of mild to moderate abnormally elevated mood.

Patients with mental illness

Alprazolam should not be as a primary treatment of mental illness.

Interactions with Alprazolam

When two or more medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a Drug Interaction.
Alprazolam interacts with imipramine and desipramine, which are used to treat depression. An increased amount of imipramine and desipramine in the blood have been reported when used simultaneously with Alprazolam.
There may be an interaction of Alprazolam with other brain depressants (CNS depressants). Alprazolam produces an additive effect when used with other brain depressants (CNS depressants) such as psychotropic medicines, neuroleptics, hypnotics, anti-anxiety drugs, sedatives, antidepressants, narcotic analgesics, anesthetics, anticonvulsants, and antihistamines. The patient should be cautious when using Alprazolam with other brain depressants (CNS depressants).
Alprazolam may interact with opioids, which are used to relieve pain. The use of benzodiazepines and opioids together increases the risk of sedation, breathing insufficiency, coma, and can be possibly fatal because of additive brain depressant (central nervous system depressant) effect. It may also cause an increase in the experience of happiness or excitement which can lead to more mental dependence. If benzodiazepines and opioids are used together, limit the dosage and duration of treatment. Monitor the patients strictly for breathing insufficiency and sedation.
Your doctor's guidelines may need to be followed while taking this medicine along with digoxin, which is used to treat heart failure. When Alprazolam is used with digoxin, increased digoxin amount has been reported in the blood, especially in elderly aged more than 65 years. The patients who receive Alprazolam and digoxin should be monitored for signs and symptoms of increased digoxin levels in the blood.
Special instructions need to be followed while taking this medicine along with liver enzyme (CYP3A) inhibitors. The use of Alprazolam with enzyme CYP3A inhibitors may increase the amount and activity of Alprazolam in the blood. The patients should be cautious while using Alprazolam with cytochrome P450 3A inhibitors, such as fluoxetine, propoxyphene, oral contraceptives, sertraline, diltiazem, or macrolide antibiotics like erythromycin, clarithromycin, and troleandomycin.
Your doctor's guidelines may need to be followed while taking this medicine along with cimetidine, which is used to treat heartburn and stomach ulcers. The use of Alprazolam with cimetidine increases the amount of Alprazolam in the blood. While using Alprazolam with cimetidine, precaution and dose reduction of Alprazolam is recommended.
Special instructions need to be followed while taking this medicine along with nefazodone or fluvoxamine, which are used to treat depression. The use of nefazodone or fluvoxamine with Alprazolam cause a two-time increase in the level of Alprazolam in the blood and a decrease in psychomotor performance. The patients should be cautious while using Alprazolam with nefazodone or fluvoxamine and dose reduction is also recommended.
Alprazolam interacts with azole-type antifungals (for example, ketoconazole, itraconazole), which are used to treat fungal infection. The use of Alprazolam with azole anti-fungals (for example, ketoconazole and itraconazole), decreases the breakdown by cytochrome P450 3A. This causes an increased amount of Alprazolam in the blood. The intake of Alprazolam with ketoconazole, itraconazole, or other azole-type antifungals is not recommended.
There may be an interaction of Alprazolam with HIV protease inhibitors (ritonavir), which are used to treat viral infection. The use of ritonavir with Alprazolam results in decreased Alprazolam elimination from the body and enhanced clinical effects. When HIV protease inhibitors are used with Alprazolam, a dose-adjustment or discontinuation of Alprazolam is needed.
Alprazolam may interact with liver enzyme (CYP3A4) inducers. The inducers of this enzyme may increase the breakdown of Alprazolam.
Alprazolam interacts with isoniazid or paroxetine, which are used to treat infection and depression respectively. While using Alprazolam with isoniazid and paroxetine, caution is recommended.
There may be an interaction of Alprazolam with ergotamine, amiodarone, nicardipine, cyclosporine, and nifedipine, which are used to treat migraine type headache, irregular heartbeat, high blood pressure, to prevent organ rejection and certain types of chest pain respectively. While using Alprazolam with ergotamine, amiodarone, nicardipine, cyclosporine, or nifedipine caution should be taken.
Alprazolam may interact with carbamazepine, which is used to treat seizures. The use of Alprazolam with carbamazepine can increase the breakdown of Alprazolam and thus decrease Alprazolam level in the blood.
This page does not contain all the possible interactions of Alprazolam. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any medicines without the approval of your doctor.

Traveling With Medication

  • Ensure that you carry enough doses of each of your prescription medicines to last the entire trip. The best place to store your medicines is in the carry on baggage. However, while flying, if carrying liquid medicines, make sure you do not go over the limits imposed for carry-on liquids.
  • While traveling overseas, make sure that you can carry each of your prescription medicines legally to your destination country. One way to ensure this is by checking with your destination country's embassy or website.
  • Make sure that you carry each of your medicines in their original packaging, which should typically include your name and address, and the details of the prescribing doctor.
  • If your travel involves crossing time zones, and you are required to take your medicine as per a fixed schedule, make sure that you adjust for the change in time.

Expired Medication

Taking a single dose of expired Alprazolam is unlikely to cause a side-effect. However, please discuss with your doctor or pharmacist, if you feel unwell or sick. An expired medicine may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drug. You are much safer by always keeping a fresh supply of unexpired medicines.

Safe Disposal of Medication

  • If there are disposal instructions on the package, please follow the instructions.
  • If there are medicine take-back programs in your country, you should contact the respective authority to arrange for the disposal of the medicine. For example, in the USA, the Drug Enforcement Administration regularly hosts National Prescription Drug Take-Back events.
  • If there are no take-back programs, mix the medicine with dirt and place them in a sealed plastic bag. Throw the plastic bag in your household trash. Separately, remove all personal information including the prescription label from the medicine packaging and then dispose off the container.
  • If specifically indicated on the medicine package that it needs to be flushed down the toilet when no longer needed, perform the required step.

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