Xanax is approved for the treatment of anxiety disorder, panic disorder and for anxiety that is associated with depression. I've been dividing 2 mg of Xanax for panic attacks daily. In the small subgroup of individuals who escalate their doses there is usually a history of alcohol or other substance use disorders. Withdrawal symptoms have been described in newborns whose mothers took Xanax during pregnancy. Xanax Pictures Xanax 0. Neuroscientific Basis and Practical Applications. Exercise, food, caffeine, and alcohol should be avoided before bedtime.
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Therefore, breast -feeding while using this drug is not recommended. Consult your doctor before breast-feeding. What should I know regarding pregnancy, nursing and administering Alprazolam to children or the elderly? Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Some products that may interact with this drug include: Other medications can affect the removal of alprazolam from your body, which may affect how alprazolam works. Examples include azole antifungals such as itraconazole , ketoconazole , cimetidine , certain anti-depressants such as fluoxetine , fluvoxamine , nefazodone , drugs to treat HIV delavirdine , protease inhibitors such as indinavir , macrolide antibiotics such as erythromycin , rifamycins such as rifabutin , St.
John's wort, drugs used to treat seizures such as phenytoin , among others. Tell your doctor or pharmacist if you are taking other products such as opioid pain or cough relievers such as codeine, hydrocodone , alcohol, marijuana , other drugs for sleep or anxiety such as diazepam , lorazepam , zolpidem , muscle relaxants such as carisoprodol , cyclobenzaprine , or antihistamines such as cetirizine , diphenhydramine. Check the labels on all your medicines such as allergy or cough -and-cold products because they may contain ingredients that cause drowsiness.
Ask your pharmacist about using those products safely. Cigarette smoking decreases blood levels of this medication. Tell your doctor if you smoke or if you have recently stopped smoking. Does Alprazolam interact with other medications? Should I avoid certain foods while taking Alprazolam? If someone has overdosed and has serious symptoms such as passing out or trouble breathing , call Otherwise, call a poison control center right away. US residents can call their local poison control center at Canada residents can call a provincial poison control center.
Symptoms of overdose may include: Do not share this medication with others. It is against the law. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip themissed dose and resume your usual dosing schedule. Do not double the dose to catch up. Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details. Information last revised September Copyright c First Databank, Inc. Alprazolam Read Reviews Get Prices. How to use Alprazolam Read the Medication Guide provided by your pharmacist before you start taking alprazolam and each time you get a refill. Tell your doctor if your condition persists or worsens.
Related Links What conditions does Alprazolam treat? Side Effects See also Warning section. In the US - Call your doctor for medical advice about side effects. Related Links List Alprazolam side effects by likelihood and severity. Precautions Before taking alprazolam , tell your doctor or pharmacist if you are allergic to it; or to other benzodiazepines such as diazepam , lorazepam ; or if you have any other allergies.
Related Links What should I know regarding pregnancy, nursing and administering Alprazolam to children or the elderly? Interactions See also Warning section. Related Links Does Alprazolam interact with other medications? Overdose If someone has overdosed and has serious symptoms such as passing out or trouble breathing , call Notes Do not share this medication with others.
Missed Dose If you miss a dose, take it as soon as you remember. Storage Store at room temperature away from light and moisture. Show More Show Less. Not recommended for use in pregnancy. Therefore, inform your physician if you are pregnant, if you are planning to have a child, or if you become pregnant while you are taking this medication. Until you experience how this medication affects you, do not drive a car or operate potentially dangerous machinery, etc. Do not increase the dose even if you think the medication "does not work anymore" without consulting your physician.
Do not stop taking this medication abruptly or decrease the dose without consulting your physician, since withdrawal symptoms can occur. In all cases, it is important that your physician help you discontinue this medication in a careful and safe manner to avoid overly extended use of alprazolam tablets. These are generally minor but seizure can occur, especially if you reduce the dose too rapidly or discontinue the medication abruptly.
Seizure can be life-threatening. Laboratory tests are not ordinarily required in otherwise healthy patients. However, when treatment is protracted, periodic blood counts, urinalysis, and blood chemistry analyses are advisable in keeping with good medical practice. Use with Opioids The concomitant use of benzodiazepines and opioids increases the risk of respiratory depression because of actions at different receptor sites in the CNS that control respiration. When benzodiazepines and opioids are combined, the potential for benzodiazepines to significantly worsen opioid-related respiratory depression exists.
Limit dosage and duration of concomitant use of benzodiazepines and opioids, and monitor patients closely for respiratory depression and sedation. Use with Other CNS Depressants If alprazolam tablets are to be combined with other psychotropic agents or anticonvulsant drugs, careful consideration should be given to the pharmacology of the agents to be employed, particularly with compounds which might potentiate the action of benzodiazepines.
The benzodiazepines, including alprazolam, produce additive CNS depressant effects when co-administered with other psychotropic medications, anticonvulsants, antihistaminics, ethanol and other drugs which themselves produce CNS depression. The clinical significance of these changes is unknown. Data from in vitro studies of alprazolam suggest a possible drug interaction with alprazolam for the following: Data from in vitro studies of benzodiazepines other than alprazolam suggest a possible drug interaction for the following: Drugs demonstrated to be inducers of CYP3A Carbamazepine can increase alprazolam metabolism and therefore can decrease plasma levels of alprazolam.
Although interactions between benzodiazepines and commonly employed clinical laboratory tests have occasionally been reported, there is no consistent pattern for a specific drug or specific test. Teratogenic Effects Pregnancy Category D: Nonteratogenic Effects It should be considered that the child born of a mother who is receiving benzodiazepines may be at some risk for withdrawal symptoms from the drug during the postnatal period.
Also, neonatal flaccidity and respiratory problems have been reported in children born of mothers who have been receiving benzodiazepines. Benzodiazepines are known to be excreted in human milk. It should be assumed that alprazolam is as well. Chronic administration of diazepam to nursing mothers has been reported to cause their infants to become lethargic and to lose weight. As a general rule, nursing should not be undertaken by mothers who must use alprazolam tablets. Safety and effectiveness of alprazolam tablets in individuals below 18 years of age have not been established.
The elderly may be more sensitive to the effects of benzodiazepines. They exhibit higher plasma alprazolam concentrations due to reduced clearance of the drug as compared with a younger population receiving the same doses. Side effects to alprazolam tablets, if they occur, are generally observed at the beginning of therapy and usually disappear upon continued medication. In the usual patient, the most frequent side effects are likely to be an extension of the pharmacological activity of alprazolam, eg, drowsiness or light-headedness.
The data cited in the two tables below are estimates of untoward clinical event incidence among patients who participated under the following clinical conditions: These data cannot be used to predict precisely the incidence of untoward events in the course of usual medical practice where patient characteristics, and other factors often differ from those in clinical trials.
These figures cannot be compared with those obtained from other clinical studies involving related drug products and placebo as each group of drug trials are conducted under a different set of conditions. Comparison of the cited figures, however, can provide the prescriber with some basis for estimating the relative contributions of drug and non-drug factors to the untoward event incidence in the population studied. Even this use must be approached cautiously, as a drug may relieve a symptom in one patient but induce it in others.
For example, an anxiolytic drug may relieve dry mouth [a symptom of anxiety] in some subjects but induce it [an untoward event] in others. Additionally, for anxiety disorders the cited figures can provide the prescriber with an indication as to the frequency with which physician intervention eg, increased surveillance, decreased dosage or discontinuation of drug therapy may be necessary because of the untoward clinical event. From the studies cited, it has not been determined whether these symptoms are clearly related to the dose and duration of therapy with alprazolam in patients with panic disorder.
To discontinue treatment in patients taking alprazolam tablets, the dosage should be reduced slowly in keeping with good medical practice. It is suggested that the daily dosage of alprazolam tablets be decreased by no more than 0. Some patients may benefit from an even slower dosage reduction. In a controlled postmarketing discontinuation study of panic disorder patients which compared this recommended taper schedule with a slower taper schedule, no difference was observed between the groups in the proportion of patients who tapered to zero dose; however, the slower schedule was associated with a reduction in symptoms associated with a withdrawal syndrome.
As with all benzodiazepines, paradoxical reactions such as stimulation, increased muscle spasticity, sleep disturbances, hallucinations and other adverse behavioral effects such as agitation, rage, irritability, and aggressive or hostile behavior have been reported rarely. Should any of the above events occur, alprazolam should be discontinued.
Isolated published reports involving small numbers of patients have suggested that patients who have borderline personality disorder, a prior history of violent or aggressive behavior, or alcohol or substance abuse may be at risk for such events. Instances of irritability, hostility, and intrusive thoughts have been reported during discontinuation of alprazolam in patients with posttraumatic stress disorder.
Various adverse drug reactions have been reported in association with the use of alprazolam tablets since market introduction. The majority of these reactions were reported through the medical event voluntary reporting system. The symptoms can range from mild dysphoria and insomnia to a major syndrome that may include abdominal and muscle cramps, vomiting, sweating, tremors and convulsions. Distinguishing between withdrawal emergent signs and symptoms and the recurrence of illness is often difficult in patients undergoing dose reduction.
The long term strategy for treatment of these phenomena will vary with their cause and the therapeutic goal. When necessary, immediate management of withdrawal symptoms requires re-institution of treatment at doses of alprazolam tablets sufficient to suppress symptoms. There have been reports of failure of other benzodiazepines to fully suppress these withdrawal symptoms.
These failures have been attributed to incomplete cross-tolerance but may also reflect the use of an inadequate dosing regimen of the substituted benzodiazepine or the effects of concomitant medications. While it is difficult to distinguish withdrawal and recurrence for certain patients, the time course and the nature of the symptoms may be helpful. A withdrawal syndrome typically includes the occurrence of new symptoms, tends to appear toward the end of taper or shortly after discontinuation, and will decrease with time.
In recurring panic disorder, symptoms similar to those observed before treatment may recur either early or late, and they will persist. While the severity and incidence of withdrawal phenomena appear to be related to dose and duration of treatment, withdrawal symptoms, including seizures, have been reported after only brief therapy with alprazolam tablets at doses within the recommended range for the treatment of anxiety eg, 0.
Signs and symptoms of withdrawal are often more prominent after rapid decrease of dosage or abrupt discontinuance. Patients, especially individuals with a history of seizures or epilepsy, should not be abruptly discontinued from any CNS depressant agent, including alprazolam tablets. Psychological dependence is a risk with all benzodiazepines, including alprazolam tablets. Some patients have experienced considerable difficulty in tapering and discontinuing from alprazolam tablets, especially those receiving higher doses for extended periods.
Addiction-prone individuals should be under careful surveillance when receiving alprazolam tablets. As with all anxiolytics, repeat prescriptions should be limited to those who are under medical supervision. Alprazolam is a controlled substance under the Controlled Substance Act by the Drug Enforcement Administration and alprazolam tablets have been assigned to Schedule IV. Manifestations of alprazolam overdosage include somnolence, confusion, impaired coordination, diminished reflexes and coma.
Death has been reported in association with overdoses of alprazolam by itself, as it has with other benzodiazepines. In addition, fatalities have been reported in patients who have overdosed with a combination of a single benzodiazepine, including alprazolam, and alcohol; alcohol levels seen in some of these patients have been lower than those usually associated with alcohol-induced fatality. Animals could be resuscitated with positive mechanical ventilation and the intravenous infusion of norepinephrine bitartrate.
Animal experiments have suggested that forced diuresis or hemodialysis are probably of little value in treating overdosage. Overdosage reports with alprazolam tablets are limited. As in all cases of drug overdosage, respiration, pulse rate, and blood pressure should be monitored. General supportive measures should be employed, along with immediate gastric lavage. Intravenous fluids should be administered and an adequate airway maintained.
If hypotension occurs, it may be combated by the use of vasopressors. Dialysis is of limited value. As with the management of intentional overdosing with any drug, it should be borne in mind that multiple agents may have been ingested. Flumazenil, a specific benzodiazepine receptor antagonist, is indicated for the complete or partial reversal of the sedative effects of benzodiazepines and may be used in situations when an overdose with a benzodiazepine is known or suspected.
Prior to the administration of flumazenil, necessary measures should be instituted to secure airway, ventilation and intravenous access. Flumazenil is intended as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. Patients treated with flumazenil should be monitored for re-sedation, respiratory depression, and other residual benzodiazepine effects for an appropriate period after treatment. The prescriber should be aware of a risk of seizure in association with flumazenil treatment, particularly in long-term benzodiazepine users and in cyclic antidepressant overdose.
Dosage should be individualized for maximum beneficial effect. In such cases, dosage should be increased cautiously to avoid adverse effects. Treatment for patients with anxiety should be initiated with a dose of 0. The dose may be increased to achieve a maximum therapeutic effect, at intervals of 3 to 4 days, to a maximum daily dose of 4 mg, given in divided doses.
The lowest possible effective dose should be employed and the need for continued treatment reassessed frequently. The risk of dependence may increase with dose and duration of treatment. In all patients, dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage. Although there are no systematically collected data to support a specific discontinuation schedule, it is suggested that the daily dosage be decreased by no more than 0.
Some patients may require an even slower dosage reduction. The successful treatment of many panic disorder patients has required the use of alprazolam at doses greater than 4 mg daily. In controlled trials conducted to establish the efficacy of alprazolam in panic disorder, doses in the range of 1 to 10 mg daily were used. The mean dosage employed was approximately 5 to 6 mg daily.
Occasional patients required as much as 10 mg a day to achieve a successful response. Treatment may be initiated with a dose of 0. Depending on the response, the dose may be increased at intervals of 3 to 4 days in increments of no more than1 mg per day. To lessen the possibility of interdose symptoms, the times of administration should be distributed as evenly as possible throughout the waking hours, that is, on a three or four times per day schedule.
Generally, therapy should be initiated at a low dose to minimize the risk of adverse responses in patients especially sensitive to the drug. Dose should be advanced until an acceptable therapeutic response ie, a substantial reduction in or total elimination of panic attacks is achieved, intolerance occurs, or the maximum recommended dose is attained. Because of the danger of withdrawal, abrupt discontinuation of treatment should be avoided.
The necessary duration of treatment for panic disorder patients responding to alprazolam is unknown. In any case, reduction of dose must be undertaken under close supervision and must be gradual. If significant withdrawal symptoms develop, the previous dosing schedule should be reinstituted and, only after stabilization, should a less rapid schedule of discontinuation be attempted. It is suggested that the dose be reduced by no more than 0.
Some patients may prove resistant to all discontinuation regimens. In elderly patients, in patients with advanced liver disease or in patients with debilitating disease, the usual starting dose is 0. This may be gradually increased if needed and tolerated. The elderly may be especially sensitive to the effects of benzodiazepines. If side effects occur at the recommended starting dose, the dose may be lowered.
Alprazolam Tablets, USP 0. They are supplied as follows: They are supplied as follows:. Dispense in a tight, light-resistant container [see USP]. These lesions did not appear until after 11 months of treatment. What is the most important information I should know about alprazolam tablets? Before you take alprazolam tablets, tell your healthcare provider about all of your medical conditions, including if you: Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
Taking alprazolam tablets with certain other medicines can cause side effects or affect how well alprazolam tablets or the other medicines work. Do not start or stop other medicines without talking to your healthcare provider. See "What is the most important information I should know about alprazolam tablets? The most common side effects of alprazolam include drowsiness and light-headedness. These are not all the possible side effects of alprazolam. Call your doctor for medical advice about side effects.
General information about the safe and effective use of alprazolam tablets. Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation. The structural formula is represented below: Anxiety associated with depression is responsive to alprazolam tablets. Panic Disorder Alprazolam tablets are also indicated for the treatment of panic disorder, with or without agoraphobia.
Dependence and Withdrawal Reactions, Including Seizures Certain adverse clinical events, some life-threatening, are a direct consequence of physical dependence to alprazolam tablets. Status Epilepticus and its Treatment The medical event voluntary reporting system shows that withdrawal seizures have been reported in association with the discontinuation of alprazolam tablets. Interdose Symptoms Early morning anxiety and emergence of anxiety symptoms between doses of alprazolam tablets have been reported in patients with panic disorder taking prescribed maintenance doses of alprazolam tablets.
Risk of Dose Reduction Withdrawal reactions may occur when dosage reduction occurs for any reason. Information for Patients For all users of Alprazolam Tablets To assure safe and effective use of benzodiazepines, all patients prescribed alprazolam tablets should be provided with the following guidance. Inform your physician if you are nursing. Laboratory Tests Laboratory tests are not ordinarily required in otherwise healthy patients.
Drug Interactions Use with Opioids The concomitant use of benzodiazepines and opioids increases the risk of respiratory depression because of actions at different receptor sites in the CNS that control respiration. Labor and Delivery Alprazolam tablets have no established use in labor or delivery. Nursing Mothers Benzodiazepines are known to be excreted in human milk.
Pediatric Use Safety and effectiveness of alprazolam tablets in individuals below 18 years of age have not been established. Geriatric Use The elderly may be more sensitive to the effects of benzodiazepines. Post Introduction Reports Various adverse drug reactions have been reported in association with the use of alprazolam tablets since market introduction. General Treatment of Overdose Overdosage reports with alprazolam tablets are limited.
Anxiety Disorders and Transient Symptoms of Anxiety Treatment for patients with anxiety should be initiated with a dose of 0. Panic Disorder The successful treatment of many panic disorder patients has required the use of alprazolam at doses greater than 4 mg daily. Dose Titration Treatment may be initiated with a dose of 0. Dosing in Special Populations In elderly patients, in patients with advanced liver disease or in patients with debilitating disease, the usual starting dose is 0.
Alprazolam tablets is a benzodiazepine medicine. Taking benzodiazepines with opioid medicines, alcohol, or other central nervous system depressants including street drugs can cause severe drowsiness, breathing problems respiratory depression , coma and death. Alprazolam tablets can make you sleepy or dizzy, and can slow your thinking and motor skills.