An interaction is when a substance changes the way a drug works. It is not indicated for anxiety disorder. As with all anxiolytics, repeat prescriptions should be limited to those who are under medical supervision. It is important to learn how to cope with everyday stress. Withdrawal symptoms can occur with abrupt discontinuation of Xanax especially in patients on high doses or those who have been on the medication long term. Your child may become lethargic drowsy and lose weight.
In such cases, withdrawal symptoms such as seizures may occur if you suddenly stop using this medication. To prevent withdrawal reactions, your doctor may reduce your dose gradually. Report any withdrawal reactions right away. Though it helps many people, this medication may sometimes cause addiction. Take this medication exactly as prescribed to lower the risk of addiction.
Ask your doctor or pharmacist for more details. When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well. What conditions does Alprazolam treat? If any of these effects persist or worsen, tell your doctor or pharmacist promptly. To minimize dizziness and lightheadedness , get up slowly when rising from a seated or lying position.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor right away if any of these unlikely but serious side effects occur: Get medical help right away if these rare but very seriousyellowing eyes or skin , seizures. A very serious allergic reaction to this drug is rare.
However, get medical help right away if you notice any symptoms of a serious allergic reaction , including: This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. Call your doctor for medical advice about side effects. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at List Alprazolam side effects by likelihood and severity.
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. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. Before using this medication , tell your doctor or pharmacist your medical history, especially of: This drug may make you dizzy or drowsy.
Alcohol or marijuana can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Talk to your doctor if you are using marijuana. Before having surgery, tell your doctor or dentist about all the products you use including prescription drugs , nonprescription drugs, and herbal products.
Older adults may be more sensitive to the side effects of this drug, especially loss of coordination and drowsiness. These side effects can increase the risk of falling. Alprazolam is not recommended for use during pregnancy due to the potential for harm to an unborn baby. Consult your doctor for more details. This drug passes into breast milk and may have undesirable effects on a nursing infant. 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. All three patients recovered without sequelae. Seizures have also been observed in association with dose reduction or discontinuation of XANAX Tablets, the immediate release form of alprazolam.
Five of these cases clearly occurred during abrupt dose reduction, or discontinuation from daily doses of 2 to 10 mg. Three cases occurred in situations where there was not a clear relationship to abrupt dose reduction or discontinuation. In one instance, seizure occurred after discontinuation from a single dose of 1 mg after tapering at a rate of 1 mg every three days from 6 mg daily.
In two other instances, the relationship to taper is indeterminate; in both of these cases the patients had been receiving doses of 3 mg daily prior to seizure. The duration of use in the above 8 cases ranged from 4 to 22 weeks. There have been occasional voluntary reports of patients developing seizures while apparently tapering gradually from XANAX. The medical event voluntary reporting system shows that withdrawal seizures have been reported in association with the discontinuation of XANAX Tablets.
In most cases, only a single seizure was reported; however, multiple seizures and status epilepticus were reported as well. Early morning anxiety and emergence of anxiety symptoms between doses of XANAX Tablets have been reported in patients with panic disorder taking prescribed maintenance doses. These symptoms may reflect the development of tolerance or a time interval between doses which is longer than the duration of clinical action of the administered dose.
In either case, it is presumed that the prescribed dose is not sufficient to maintain plasma levels above those needed to prevent relapse, rebound, or withdrawal symptoms over the entire course of the interdosing interval. Withdrawal reactions may occur when dosage reduction occurs for any reason. This includes purposeful tapering, but also inadvertent reduction of dose eg, the patient forgets, the patient is admitted to a hospital.
Because of its CNS depressant effects, patients receiving XANAX XR should be cautioned against engaging in hazardous occupations or activities requiring complete mental alertness such as operating machinery or driving a motor vehicle. Benzodiazepines can potentially cause fetal harm when administered to pregnant women. If alprazolam is used during pregnancy, or if the patient becomes pregnant while taking this 8 drug, the patient should be apprised of the potential hazard to the fetus.
Because of experience with other members of the benzodiazepine class, alprazolam is assumed to be capable of causing an increased risk of congenital abnormalities when administered to a pregnant woman during the first trimester. Because use of these drugs is rarely a matter of urgency, their use during the first trimester should almost always be avoided. The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered.
Patients should be advised that if they become pregnant during therapy or intend to become pregnant they should communicate with their physicians about the desirability of discontinuing the drug. Drugs that inhibit this metabolic pathway may have a profound effect on the clearance of alprazolam. Consequently, alprazolam should be avoided in patients receiving very potent inhibitors of CYP3A. With drugs inhibiting CYP3A to a lesser but still significant degree, alprazolam should be used only with caution and consideration of appropriate dosage reduction.
Ketoconazole and itraconazole are potent CYP3A inhibitors and have been shown in vivo to increase plasma alprazolam concentrations 3. The coadministration of alprazolam with these agents is not recommended. Drugs demonstrated to be CYP3A inhibitors on the basis of clinical studies involving alprazolam caution and consideration of appropriate alprazolam dose reduction are recommended during coadministration with the following drugs.
Interactions involving HIV protease inhibitors eg, ritonavir and alprazolam are complex and time dependent. Low doses of ritonavir resulted in a large impairment of alprazolam clearance, prolonged its elimination half-life and enhanced clinical effects. However, upon extended exposure to ritonavir, CYP3A induction offset this inhibition.
This interaction will require a dose-adjustment or discontinuation of alprazolam. As with other psychotropic medications, the usual precautions with respect to administration of the drug and size of the prescription are indicated for severely depressed patients or those in whom there is reason to expect concealed suicidal ideation or plans. Panic disorder has been associated with primary and secondary major depressive disorders and increased reports of suicide among untreated patients.
Episodes of hypomania and mania have been reported in association with the use of XANAX Tablets in patients with depression. Alprazolam has a weak uricosuric effect. Although other medications with weak uricosuric effect have been reported to cause acute renal failure , there have been no reported instances of acute renal failure attributable to therapy with alprazolam.
The usual precautions in treating patients with impaired renal, hepatic, or pulmonary function should be observed. There have been rare reports of death in patients with severe pulmonary disease shortly after the initiation of treatment with XANAX Tablets. 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. 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. Safety and effectiveness of alprazolam 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. 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. Animal experiments have suggested that forced diuresis or hemodialysis are probably of little value in treating overdosage. 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 prescribers hould be aware of a risk of seizure in association with flumazenil treatment, particularly in long-term benzodiazepine users and in cyclic antidepressant overdose. XANAX XR may be used in patients with open angle glaucoma who are receiving appropriate therapy, but is contraindicated in patients with acute narrow angle glaucoma.
CNS agents of the 1,4 benzodiazepine class presumably exert their effects by binding at stereospecific receptors at several sites within the central nervous system. Their exact mechanism of action is unknown. Clinically, all benzodiazepines cause a dose-related central nervous system depressant activity varying from mild impairment of task performance to hypnosis. Peak concentrations in the plasma occur in one to two hours following 2 administration. Plasma levels are proportional to the dose given; over the dose range of 0.
Using a specific assay methodology, the mean plasma elimination half-life of alprazolam has been found to be about The slower absorption rate results in a relatively constant concentration that is maintained between 5 and 11 hours after the dosing. Multiple dose studies indicate that the metabolism and elimination of alprazolam are similar for the immediate-release and the extended-release products.
The extent of exposure AUC and elimination half-life t were not affected by eating. Serum albumin accounts for the majority of the binding. Alprazolam is extensively metabolized in humans, primarily by cytochrome P 3A4 CYP3A4 , to two major metabolites in the plasma: A benzophenone derived from alprazolam is also found in humans. Their half-lives appear to be similar to that of alprazolam. The reported relative potencies in benzodiazepine receptor binding experiments and in animal models of induced seizure inhibition are 0.
The benzophenone metabolite is essentially inactive. Alprazolam and its metabolites are excreted primarily in the urine. Changes in the absorption, distribution, metabolism, and excretion of benzodiazepines have been reported in a variety of disease states including alcoholism , impaired hepatic function, and impaired renal function. Changes have also been demonstrated in geriatric patients.
A mean half-life of alprazolam of In patients with alcoholic liver disease the half-life of alprazolam ranged between 5. In an obese group of subjects the half-life of alprazolam ranged between 9. Because of its similarity to other benzodiazepines, it is assumed that alprazolam undergoes transplacental passage and that it is excreted in human milk. Most of the interactions that have been documented with alprazolam are with drugs that inhibit or induce CYP3A4.
Compounds that are potent inhibitors of CYP3A would be expected to increase plasma alprazolam concentrations. Drug products that have been studied in vivo, along with their effect on increasing alprazolam AUC, are as follows: CYP3A inducers would be expected to decrease alprazolam concentrations and this has been observed in vivo. The oral clearance of alprazolam given in a 0.
However, upon extended exposure to ritonavir mg, twice daily , CYP3A induction offset this inhibition. The ability of alprazolam to induce or inhibit human hepatic enzyme systems has not been determined. However, this is not a property of benzodiazepines in general. Further, alprazolam did not affect the prothrombin or plasma warfarin levels in male volunteers administered sodium warfarin orally.