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• How does this medication work? What will it do for me?
• How should I use this medication?
• What form(s) does this medication come in?
• Who should NOT take this medication?
• What side effects are possible with this medication?
• Are there any other precautions or warnings for this medication?

What other drugs could interact with this medication?

What is alprazolam?

Alprazolam is a benzodiazepine (ben-zoe-dye-AZE-eh-peen). It is thought that it works by enhancing the activity of certain neurotransmitters in the brain.

Alprazolam is used to treat anxiety disorders, panic disorders, and anxiety caused by depression.

It is dangerous to purchase alprazolam on the Internet or outside the United States. The sale and distribution of medicines outside the U.S. does not comply with safe-use regulations of the Food and Drug Administration (FDA). These medications may contain dangerous ingredients, or may not be distributed by a licensed pharmacy.

 

Warnings

MISUSE OF ALPRAZOLAM CAN CAUSE ADDICTION, OVERDOSE, OR DEATH and should be used only by the person for whom it was prescribed. Keep the medication in a place where others cannot get to it.

Alprazolam can slow or stop your breathing and fatal side effects can occur if you take this medicine with alcohol, opioid medicine, or other drugs that cause drowsiness or slow your breathing.

Do not stop using this medicine without asking your doctor. You may have life-threatening withdrawal symptoms if you stop using the medicine suddenly after long-term use. Some withdrawal symptoms may last up to 12 months or longer.

Get medical help right away if you stop using alprazolam and have symptoms such as: unusual muscle movements, being more active or talkative, sudden and severe changes in mood or behavior, confusion, hallucinations, seizures, or thoughts about suicide. 

How does this medication work? What will it do for me?

Alprazolam belongs to the class of medicines called benzodiazepines. It is used for the short-term symptomatic relief of excessive anxiety. It is also used to treat generalized anxiety disorder and panic disorder. Alprazolam works by slowing down the brain (central nervous system).

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Before taking this medicine

You should not take alprazolam if:

• you also take antifungal medicine such as itraconazole or ketoconazole; or
• you have a history of allergic reaction to any benzodiazepine (alprazolam, lorazepam, diazepam, Ativan, Valium, Versed, Klonopin, and others).

To make sure alprazolam is safe for you, tell your doctor if you have ever had:

• breathing problems;
• drug or alcohol addiction;
• depression, mood problems, or suicidal thoughts or behavior; or
• kidney or liver disease.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful to people to take this medication if their doctor has not prescribed it.

How should I use this medication?

The recommended dose of alprazolam for adults varies depending on its use. The starting dose for excessive anxiety is 0.25 mg taken 2 or 3 times a day. This is gradually increased until anxiety is controlled and side effects are minimized. Elderly patients may be started at a lower dose of 0.125 mg taken 2 or 3 times a day. The usual maximum dose is 3 mg daily.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Alprazolam may be habit-forming when taken for long periods of time. If you have been taking this medication regularly for a long period of time (i.e., more than one month), do not stop taking the medication without speaking with your doctor. A gradual reduction in dose is recommended when stopping this medication to avoid withdrawal symptoms.

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It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store at room temperature in a dry place and keep it out of reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

What form(s) does this medication come in?

Who should NOT take this medication?

Do not take this medication if you:

• are allergic to alprazolam or any ingredients of the medication
• are allergic to any other medications belonging to the benzodiazepine class
• have acute narrow-angle glaucoma (alprazolam may be used by people with open-angle glaucoma who are receiving appropriate treatment)
• have myasthenia gravis
• are taking the medications ketoconazole or itraconazole
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Dosing information

Usual Adult Dose for Anxiety:

Immediate-release tablets/orally disintegrating tablets (ODT): 0.25 to 0.5 mg orally administered 3 times a day
-Maximum dose: 4 mg/day

Usual Adult Dose for Panic Disorder:

Immediate-release tablets/ODTs: 0.5 mg orally administered 3 times a day
-Maximum dose: 10 mg/day

Extended-release tablets:
-Initial dose: 0.5 to 1 mg orally once a day
-Maintenance dose: 3 to 6 mg orally per day, preferably in the morning
-Maximum dose: 10 mg/day

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

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The following side effects have been reported by at least 1% of people taking this medication.

Although most of these side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• abnormal thinking (e.g., disorientation, delusions, or loss of sense of reality)
• agitation
• anxiety
• behaviour changes (e.g., aggressive behaviour, bizarre behaviour, decreased inhibition, or outbursts of anger)
• confusion
• increased risk of falls (particularly for seniors)
• loss of recent memory
• signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• slurred speech
• symptoms of mania (e.g., decreased need for sleep, elevated or irritable mood, racing thoughts)
• trouble sleeping
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Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

What other drugs could interact with this medication?

There may be an interaction between alprazolam and any of the following:

• alcohol
• antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• antiseizure medications (e.g., carbamazepine, clobazam, gabapentin, levetiracetam, phenobarbital, phenytoin, primidone, topiramate, valproic acid, zonisamide)
• apalutamide
• aprepitant
• azelastine
• “azole” antifungals (e.g., ketoconazole, itraconazole, fluconazole)
• barbiturates (e.g., butalbital, phenobarbital)
• benzodiazepines (e.g., diazepam, lorazepam)
• calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
• general anesthetics (medications used to put people to sleep before surgery)
• grapefruit juice
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also, tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

What other drugs will affect alprazolam?

Sometimes it is not safe to use certain medicines at the same time. Some drugs can affect your blood levels of other drugs you use, which may increase side effects or make the medicines less effective.

Taking alprazolam with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

Many drugs can interact with alprazolam, and some drugs should not be used at the same time. Tell your doctor about all other medicines you use. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here.