Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: alprazolam

BRAND NAME: Xanax, Kanax XR, Niravam

DRUG CLASS AND MECHANISM: Alprazolam is an anti-anxiety medication in the benzodiazepine family, the same family that includes diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan), flurazepam (Dalmane), and others. Alprazolam and other benzodiazepines act by enhancing the effects of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter (a chemical that nerve cells use to communicate with each other) that inhibits activity in the brain. It is believed that excessive activity in the brain may cause anxiety or other psychiatric disorders.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Tablets: 0.25, 0.5, 1, and 2 mg. Tablets ER (extended release): 0.5, 1, 2, and 3 mg. Solution: 1 mg/ml

STORAGE: Alprazolam should be stored at room temperature, 15-30°C (59-86°F).

PRESCRIBED FOR: Alprazolam is used for the treatment of anxiety disorders and panic attacks. Anxiety disorders are characterized by unrealistic worry and apprehension, causing symptoms of restlessness, aches, trembling, shortness of breath, smothering sensation, palpitations, sweating, cold clammy hands, lightheadedness, flushing, exaggerated startle responses, problems concentrating, and insomnia. Panic attacks occur either unexpectedly or in certain situations (for example, driving), and can require higher dosages of alprazolam.

DOSING: Alprazolam may be taken with or without food. The starting dose for treating anxiety is 0.25-0.5 mg 3 times daily using immediate release tablets. The dose may be increased every 3-4 days to a maximum dose of 4 mg daily. The starting dose for treating panic attacks is 0.5 mg 3 times daily. Doses can be increased every 3-4 days but by no more than 1 mg daily. The effective dose for preventing panic attacks may be as high as 6 mg daily.

DRUG INTERACTIONS: Ketoconazole (Nizoral), itraconazole (Sporanox), nefazodone (Serzone), cimetidine (Tagamet), and fluvoxamine (Luvox) increase the blood concentration of alprazolam and therefore may increase the side effects of alprazolam.

Alprazolam interacts with alcohol and medications (for example, alcohol, barbiturates, and narcotics) by exaggerating their slowing of activity in the brain and sedation.

PREGNANCY: Benzodiazepines, such as alprazolam, can cause fetal abnormalities and should not be used in pregnancy or in nursing mothers.

NURSING MOTHERS: Alprazolam is excreted in breast milk and can affect nursing infants. Therefore, it should not be used by women who are nursing.

SIDE EFFECTS: The most frequent side effects of alprazolam taken at lower doses are drowsiness or lightheadedness, which probably reflect the normal actions of the drug. Side effects of higher dosages (those used for panic attacks) include fatigue, memory problems, speech problems, constipation, and changes in appetite with resultant changes in weight.

Alprazolam can lead to addiction (dependency), especially at high dosages over prolonged periods of time. Abrupt discontinuation of the alprazolam after prolonged use can lead to symptoms of withdrawal such as insomnia, headaches, nausea, vomiting, lightheadedness, sweating, anxiety, and fatigue. Seizures can occur in more severe cases of withdrawal. Consequently, patients on alprazolam for extended periods of time should slowly taper the medication under a doctor's supervision rather than abruptly stopping the medication.

From the Doctors at MedicineNet.com

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