Alprazolam (Xanax) vs. Sertraline (Zoloft)

• Alprazolam and Sertraline are used to treat anxiety disorders and panic attacks.
• Sertraline is also used to treat depression, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD).
• Brand names for alprazolam include Xanax and Niravam.
• A brand name for sertraline is Zoloft.
• Alprazolam and sertraline belong to different drug classes. Alprazolam is a benzodiazepine and sertraline is a selective serotonin reuptake inhibitor (SSRI) antidepressant.
• Side effects of alprazolam and sertraline that are similar include drowsiness, constipation, weight changes, headache, and dry mouth.
• Side effects of alprazolam that are different from sertraline include fatigue, memory problems, speech problems, and addiction (dependency).
• Side effects of sertraline that are different from alprazolam include nervousness, sleep problems (insomnia), dizziness, nausea, tremor, skin rash, upset stomach, loss of appetite, diarrhea, abnormal ejaculation, decreased sex drive, and increased sweating.
• Withdrawal symptoms such as insomnia, headaches, nausea, vomiting, lightheadedness, sweating, and fatigue may occur if you suddenly stop taking alprazolam or sertraline.

Alprazolam (brand names: Xanax XR, Niravam) is a benzodiazepine class anti-anxiety medication used to treat anxiety disorders and panic attacks. Other benzodiazepines include diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin), and flurazepam (Dalmane). Alprazolam and other benzodiazepines work by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits activity in the brain. It is believed that excessive activity in the brain may result in anxiety or other psychiatric disorders.

Sertraline (brand name: Zoloft) is a selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat depression, obsessive-compulsive disorder (OCD), panic disorder, and post-traumatic stress disorder (PTSD), social anxiety disorder, and premenstrual dysphoric disorder (PMDD). Other SSRIs include fluoxetine (Prozac, Sarafem), paroxetine (Brisdelle, Paxil, Paxil CR, Pexeva), citalopram (Celexa), and fluvoxamine (Luvox CR).

Alprazolam

The most common side effects of Xanax taken at lower doses are:

• Drowsiness
• Fatigue

Other side effects include:

• Memory problems
• Speech problems
• Constipation
• Changes in weight
• Addiction (dependency)
• Headache
• Constipation
• Dry mouth

What are the withdrawal symptoms of Xanax?

Withdrawal Addiction is more likely to occur at high doses given over prolonged periods. Abrupt discontinuation of alprazolam after prolonged use can lead to symptoms of withdrawal such as:

• Insomnia
• Headaches
• Nausea
• Vomiting
• Lightheadedness
• Sweating
• Anxiety
• 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.

Sertraline

WARNING

• As demonstrated in short-term studies, antidepressants increased the risk of suicidal thinking and behavior (suicidality) in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Zoloft or any other antidepressant in a child or adolescent must balance this risk with the clinical need for the antidepressant. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

The most common side effects of Zoloft are:

• Sleepiness
• Nervousness
• Insomnia
• Dizziness
• Nausea
• Tremor
• Skin rash
• Constipation
• Upset stomach
• Loss of appetite
• Headache
• Diarrhea
• Abnormal ejaculation
• Decreased interest in sexual activity
• Dry mouth
• Increase in sweating, known as diaphoresis
• Weight loss

Possible serious side effects of Zoloft include:

• Irregular heartbeats
• Serious allergic reactions
• Worsening of depression
• Serotonin syndrome
• Hyponatremia
• Abnormal bleeding
• Priapism (prolonged erection)
• Decreased liver function
• Suicidality
• Activation of mania in patients with bipolar disorder

Important side effects are irregular heartbeats, allergic reactions and activation of mania in patients with bipolar disorder.

If Zoloft is discontinued abruptly, some patients experience side effects such as:

• Abdominal cramps
• Fatigue
• Nausea
• Vomiting
• Diarrhea
• Headaches
• Lightheadedness
• Dizziness
• Diminished appetite
• Flu-like symptoms
• Sweating
• Chills
• Sleep disturbances
• Memory impairment

A gradual dose reduction of Zoloft is recommended when therapy is discontinued.

Alprazolam

• The starting dose for treating anxiety is 0.25-0.5 mg 3 to 4 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 10 mg daily for some patients. The starting dose when using extended release tablets to treat panic disorder is 0.5 mg once daily and the average dose is 3-6 mg once daily.
• Alprazolam may be taken with or without food.

Sertraline

• The recommended dose of sertraline is 25-200 mg once daily. Treatment of depression, OCD, panic disorder, PTSD, and social anxiety disorder is initiated at 25-50 mg once daily. Doses are increased at weekly intervals until the desired response is seen.
• The recommended dose for PMDD is 50-150 mg every day of the menstrual cycle or for 14 days before menstruation.
• Sertraline may be taken with or without food.

Alprazolam

• Ketoconazole (Nizoral), itraconazole (Sporanox), nefazodone (Serzone), cimetidine (Tagamet), and fluvoxamine (Luvox) increase concentrations in the blood of alprazolam and therefore may increase the side effects of alprazolam.
• Alprazolam interacts with alcohol and medications (for example, barbiturates, and narcotics) that suppress activity in the brain by suppressing activity more and causing sedation.
• Carbamazepine and rifampin reduce the effect of alprazolam by increasing metabolism and elimination of alprazolam in the liver.

Sertraline

All SSRIs, including Zoloft, should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants, for example

• isocarboxazid (Marplan),
• phenelzine (Nardil),
• tranylcypromine (Parnate),
• selegiline (Eldepryl, Emsam, Elazar), and
• procarbazine (Matulane).

Other drugs that inhibit monoamine oxidase include

• linezolid (Zyvox) and
• intravenous methylene blue.

Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. (A period of 14 days without treatment should lapse when switching between Zoloft and MAOIs.) Similar reactions occur when Zoloft is combined with other drugs for example, tryptophan, St. John's wort, meperidine (Demerol, Meperitab), tramadol (ConZip, Synapryn FusePaq, Ultram) that increase serotonin in the brain.

Cimetidine (Cimetidine Acid Reducer, Tagamet HB ) may increase the levels in blood of Zoloft by reducing the elimination of Zoloft by the liver. Increased levels of Zoloft may lead to more side effects.

Zoloft increases the blood level of pimozide (Orap) by 40%. High levels of pimozide can affect electrical conduction in the heart and lead to sudden death. Therefore, patients should not receive treatment with both pimozide and Zoloft.

Through unknown mechanisms, Zoloft may increase the blood thinning action of warfarin (Coumadin, Jantoven). The effect of warfarin should be monitored when Zoloft is started or stopped.

Alprazolam

• Benzodiazepines, such as alprazolam, can cause fetal abnormalities and should not be used in pregnancy.
• Alprazolam is excreted in breast milk and it can affect nursing infants. Therefore, women who are should not take alprazolam while breastfeeding.

Sertraline

• Use of sertraline during the 3rd trimester of pregnancy may lead to adverse effects in the newborn.
• Use of sertraline by nursing mothers has not been adequately evaluated.