XANAX Tablets contain alprazolam which is a triazolo analog of the 1,4 benzodiazepine class of central nervous system -active compounds. If you take one of these drugs with alprazolam, you may have increased drowsiness or other side effects. It can be used for the short-term relief of symptoms of anxiety, or anxiety linked with depression. If this medication has regularly been used for a long time or in high doses, withdrawal symptoms such as seizures can occur if usage is suddenly stopped. Withdrawal symptoms can occur if a benzodiazepine is discontinued suddenly. I take it for nerve pain and panic attacks that do not occur daily. In addition, the 0. Substance Abuse : How to Conquer Xanax Withdrawal Symptoms
However, this medication may sometimes still help human mothers and their babies more than it might cause harm. Tell your doctor if you are breastfeeding or plan to breastfeed. Benzodiazepines are known to be excreted in human milk. Because of the possibility for adverse reactions in nursing infants from alprazolam, a choice should be made whether to stop nursing or to stop use of alprazolam.
Determining the importance of the drug to the mother should be considered. Alprazolam comes in tablet, an orally disintegrating tablet, and in an oral by mouth solution forms and is usually taken 2 to 4 times a day, with or without food. If it bothers your stomach, try taking it with food. Alprazolam also comes as an extended release tablet and is taken once a day, in the morning. Do not chew, split, or crush tablets. It is not necessary to take with liquid.
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not take two doses at one time. Take alprazolam exactly as prescribed by your doctor. Follow the directions on your prescription label carefully. Your doctor will determine the best dose for you. The dosage of alprazolam must be individualized. The dose may be increased to a maximum daily dose of 4 mg, given in divided doses.
The lowest possible effective dose should be used and the need for continued treatment reassessed frequently. The risk of dependence may increase with dose and duration of treatment. 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.
In case of overdose, call your local poison control center at If the victim has collapsed or is not breathing, call local emergency services at Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture not in the bathroom. This medication can cause drowsiness. Do not suddenly stop taking alprazolam without talking to your doctor because you may experience harmful withdrawal symptoms.
Pharmacist Trey Robinson, PharmD summarizes the uses, common side effects, and warnings for the Benzodiazepines class of medications. Common side effects of alprazolam include sleepiness, lightheadedness, tiredness, and coordination problems. Alprazolam can also cause drowsiness. Do not drive or operate heavy machinery until you know how alprazolam affects you. Patient Ratings for Alprazolam. How was your experience with Alprazolam?
First, a little about yourself Male Female. What tips would you provide a friend before taking Alprazolam? How well did Alprazolam work for you? Did you experience many side effects while taking this drug? How likely would you be to recommend Alprazolam to a friend? Alprazolam Cautionary Labels Back to Top. Uses of Alprazolam Back to Top. This medication may be prescribed for other uses.
Alprazolam Brand Names Back to Top. Alprazolam may be found in some form under the following brand names: Niravam Xanax Xanax XR. Alprazolam Drug Class Back to Top. Alprazolam is part of the drug class: Side Effects of Alprazolam Back to Top. Serious side effects have been reported with alprazolam. Common side effects of alprazolam include: Alprazolam Interactions Back to Top. Especially tell your doctor if you take: John's wort This is not a complete list of alprazolam drug interactions.
Alprazolam Precautions Back to Top. Serious side effects have been reported with alprazolam including: 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 XANAX at doses greater than 4 mg daily.
In controlled trials conducted to establish the efficacy of XANAX 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 than 1 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. 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. 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.
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.
NDC Unit dose NDC Bottles of Side effects to XANAX 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 lightheadedness. 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 XANAX in patients with panic disorder. To discontinue treatment in patients taking XANAX, the dosage should be reduced slowly in keeping with good medical practice. Some patients may benefit from an even slower dosage reduction. 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 XANAX 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 XANAX cannot be readily determined.
If XANAX 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.
Patients who receive alprazolam and digoxin should therefore be monitored for signs and symptoms related to digoxin toxicity. The clinical significance of these changes is unknown. Drugs demonstrated to be CYP3A inhibitors of possible clinical significance on the basis of clinical studies involving alprazolam caution is recommended during coadministration with alprazolam.
Drugs and other substances demonstrated to be CYP 3A inhibitors on the basis of clinical studies involving benzodiazepines metabolized similarly to alprazolam or on the basis of in vitro studies with alprazolam or other benzodiazepines caution is recommended during coadministration with alprazolam. Available data from clinical studies of benzodiazepines other than alprazolam suggest a possible drug interaction with alprazolam for the following: 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: Carbamazepine can increase alprazolam metabolism and therefore can decrease plasma levels of alprazolam.
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 XANAX 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 XANAX 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 XANAX. Some patients have experienced considerable difficulty in tapering and discontinuing from XANAX, especially those receiving higher doses for extended periods.
As with all anxiolytics, repeat prescriptions should be limited to those who are under medical supervision. Certain adverse clinical events, some life-threatening, are a direct consequence of physical dependence to XANAX. These include a spectrum of withdrawal symptoms ; the most important is seizure see Drug Abuse And Dependence. Even after relatively shortterm use at the doses recommended for the treatment of transient anxiety and anxiety disorder ie, 0.
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. Because the management of panic disorder often requires the use of average daily doses of XANAX above 4 mg, the risk of dependence among panic disorder patients may be higher than that among those treated for less severe anxiety.
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 XANAX 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 XANAX 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 XANAX.
The medical event voluntary reporting system shows that withdrawal seizures have been reported in association with the discontinuation of XANAX. 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. 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 should be cautioned against engaging in hazardous occupations or activities requiring complete mental alertness such as operating machinery or driving a motor vehicle. For the same reason, patients should be cautioned about the simultaneous ingestion of alcohol and other CNS depressant drugs during treatment with XANAX. Benzodiazepines can potentially cause fetal harm when administered to pregnant women.
If XANAX 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, XANAX 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 CYP 3A 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.