Updated 5 years ago in Alprazolam. What are the effects of taking Xanax and over-the-counter drugs, such as vitamin C, Caltrate, zinc, and Metamucil? If you have any other questions or concerns, please post back and I will be happy to help you. What should I know regarding pregnancy, nursing and administering Alprazolam to children or the elderly? The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.
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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. 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 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. The ability of Alprazolam to induce human hepatic enzyme systems has not yet 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. Alprazolam was significantly better than placebo at each of the evaluation periods of these 4-week studies as judged by the following psychometric instruments: Support for the effectiveness of Alprazolam in the treatment of panic disorder came from three short-term, placebo-controlled studies up to 10 weeks in patients with diagnoses closely corresponding to DSM-III-R criteria for panic disorder.
A subgroup of patients who were improved on Alprazolam during short-term treatment in one of these trials was continued on an open basis up to 8 months, without apparent loss of benefit. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic. Generalized anxiety disorder is characterized by unrealistic or excessive anxiety and worry apprehensive expectation about two or more life circumstances, for a period of 6 months or longer, during which the person has been bothered more days than not by these concerns.
At least 6 of the following 18 symptoms are often present in these patients: These symptoms must not be secondary to another psychiatric disorder or caused by some organic factor. Anxiety associated with depression is responsive to Alprazolam tablets, USP. Alprazolam tablets, USP are also indicated for the treatment of panic disorder, with or without agoraphobia. Demonstrations of the effectiveness of Alprazolam tablets, USP by systematic clinical study are limited to 4 months duration for anxiety disorder and 4 to 10 weeks duration for panic disorder; however, patients with panic disorder have been treated on an open basis for up to 8 months without apparent loss of benefit.
The physician should periodically reassess the usefulness of the drug for the individual patient. Alprazolam tablets are contraindicated in patients with known sensitivity to this drug or other benzodiazepines. Risks from Concomitant Use with Opioids Concomitant use of benzodiazepines, including Alprazolam, and opioids may result in profound sedation, respiratory depression, coma, and death.
Because of these risks, reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioids alone. If a decision is made to prescribe Alprazolam concomitantly with opioids, prescribe the lowest effective dosages and minimum durations of concomitant use, and follow patients closely for signs and symptoms of respiratory depression and sedation.
In patients already receiving an opioid analgesic, prescribe a lower initial dose of Alprazolam than indicated in the absence of an opioid and titrate based on clinical response. If an opioid is initiated in a patient already taking Alprazolam, prescribe a lower initial dose of the opioid and titrate based upon clinical response. Advise both patients and caregivers about the risks of respiratory depression and sedation when Alprazolam is used with opioids.
Advise patients not to drive or operate heavy machinery until the effects of concomitant use with the opioid have been determined [see Drug Interactions ]. Dependence and Withdrawal Reactions, Including Seizures. Certain adverse clinical events, some life-threatening, are a direct consequence of physical dependence to Alprazolam. Even after relatively short-term use at the doses recommended for the treatment of transient anxiety and anxiety disorder i.
However, in a controlled postmarketing discontinuation study of panic disorder patients, the duration of treatment 3 months compared to 6 months had no effect on the ability of patients to taper to zero dose. Experience in randomized placebo-controlled discontinuation studies of patients with panic disorder showed a high rate of rebound and withdrawal symptoms in patients treated with Alprazolam compared to placebo-treated patients.
Relapse or return of illness was defined as a return of symptoms characteristic of panic disorder primarily panic attacks to levels approximately equal to those seen at baseline before active treatment was initiated. Rebound refers to a return of symptoms of panic disorder to a level substantially greater in frequency, or more severe in intensity than seen at baseline. Withdrawal symptoms were identified as those which were generally not characteristic of panic disorder and which occurred for the first time more frequently during discontinuation than at baseline.
In a controlled clinical trial in which 63 patients were randomized to Alprazolam and where withdrawal symptoms were specifically sought, the following were identified as symptoms of withdrawal: Other symptoms, such as anxiety and insomnia, were frequently seen during discontinuation, but it could not be determined if they were due to return of illness, rebound, or withdrawal. In a controlled postmarketing discontinuation study of panic disorder patients, the duration of treatment 3 months compared to 6 months had no effect on the ability of patients to taper to zero dose.
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 3 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 Alprazolam. In most cases, only a single seizure was reported; however, multiple seizures and status epilepticus were reported as well.
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.
This includes purposeful tapering, but also inadvertent reduction of dose e. For the same reason, patients should be cautioned about the simultaneous ingestion of alcohol and other CNS depressant drugs during treatment with Alprazolam. If Alprazolam is used during pregnancy, or if the patient becomes pregnant while taking this 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. With drugs inhibiting CYP3A to a lesser but still significant degree, Alprazolam should be used only with caution and consideration of appropriate dosage reduction. The coadministration of Alprazolam with these agents is not recommended. Suicide 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. Mania Episodes of hypomania and mania have been reported in association with the use of Alprazolam in patients with depression. Uricosuric Effect 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.
Use in Patients with Concomitant Illness It is recommended that the dosage be limited to the smallest effective dose to preclude the development of ataxia or oversedation which may be a particular problem in elderly or debilitated patients. 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 Alprazolam.
A decreased systemic Alprazolam elimination rate e. For all Users of Alprazolam To assure safe and effective use of benzodiazepines, all patients prescribed Alprazolam should be provided with the following guidance. 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. 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. 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: 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.
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. 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. 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, e.
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 e. In addition to the relatively common i. 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, the dosage should be reduced slowly in keeping with good medical practice. It is suggested that the daily dosage of Alprazolam 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 since market introduction. The majority of these reactions were reported through the medical event voluntary reporting system. Because of the spontaneous nature of the reporting of medical events and the lack of controls, a causal relationship to the use of Alprazolam cannot be readily determined.
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.