Medications and Drugs
Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: alprazolam
BRAND NAME: Xanax, Xanax 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.
Reference: FDA Prescribing Information
Last Editorial Review: 1/30/2008
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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