Alprazolam
Generic Name: alprazolam (al PRAY zoe lam)
Brand Names: Niravam, Xanax, Xanax XR
Brand Names: Niravam, Xanax, Xanax XR
Medically reviewed by Sophia Entringer, PharmD. Last updated on Dec 28, 2018.
What is alprazolam?
Alprazolam is a benzodiazepine (ben-zoe-dye-AZE-eh-peen). It affects chemicals in the brain that may be unbalanced in people with anxiety.
Alprazolam is used to treat anxiety disorders, panic disorders, and anxiety caused by depression.
Alprazolam may also be used for purposes not listed in this medication guide.
Important information
You should not use alprazolam if you have narrow-angle glaucoma, if you also take itraconazole or ketoconazole, or if you are allergic to alprazolam or similar medicines (Valium, Ativan, Tranxene, and others).
Do not use alprazolam if you are pregnant. This medicine can cause birth defects or life-threatening withdrawal symptoms in a newborn.
Alprazolam may be habit-forming. Misuse of habit-forming medicine can cause addiction, overdose, or death.
Do not drink alcohol while taking alprazolam. This medication can increase the effects of alcohol. This medicine may be habit-forming and should be used only by the person for whom it was prescribed. Keep the medication in a secure place where others cannot get to it.
Before taking this medicine
It is dangerous to purchase alprazolam on the Internet or from vendors outside the United States. Medications distributed from Internet sales may contain dangerous ingredients, or may not be distributed by a licensed pharmacy. The sale and distribution of alprazolam outside the U.S. does not comply with the regulations of the Food and Drug Administration (FDA) for the safe use of this medication.
You should not take alprazolam if you have:
- narrow-angle glaucoma;
- if you are also taking itraconazole or ketoconazole; or
- if you are allergic to alprazolam or to other benzodiazepines, such as chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax).
To make sure this medicine is safe for you, tell your doctor if you have:
- seizures or epilepsy;
- kidney or liver disease (especially alcoholic liver disease);
- asthma or other breathing disorder;
- open-angle glaucoma;
- a history of depression or suicidal thoughts or behavior;
- a history of drug or alcohol addiction; or
- if you also use a narcotic (opioid) medication.
Do not use alprazolam if you are pregnant. This medicine can cause birth defects. Your baby could also become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on habit-forming medicine may need medical treatment for several weeks. Tell your doctor if you are pregnant or plan to become pregnant. Use effective birth control to prevent pregnancy while you are taking this medicine.
Alprazolam can pass into breast milk and may harm a nursing baby. You should not breast-feed while you using this medicine before talking to your doctor.
The sedative effects of alprazolam may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking alprazolam.
Alprazolam is not FDA approved for use by anyone younger than 18 years old.
How should I take alprazolam?
Take alprazolam exactly as prescribed by your doctor. Follow all directions on your prescription label. Never use this medicine in larger amounts, or for longer than prescribed. Tell your doctor if the medicine seems to stop working as well in treating your symptoms.
Alprazolam may be habit-forming. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.
Misuse of habit-forming medicine can cause addiction, overdose, or death. Selling or giving away this medicine is against the law.
Do not swallow the orally disintegrating tablet whole. Allow it to dissolve in your mouth without chewing.
Do not crush, chew, or break an extended-release tablet. Swallow it whole.
Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.
Call your doctor if this medicine seems to stop working as well in treating your panic or anxiety symptoms.
Do not stop using alprazolam suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using alprazolam.
Store at room temperature away from moisture and heat.
Keep track of the amount of medicine used from each new bottle. Alprazolam is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of alprazolam can be fatal. Overdose symptoms may include extreme drowsiness, confusion, muscle weakness, loss of balance or coordination, feeling light-headed, and fainting.
What should I avoid while taking alprazolam?
Alprazolam may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Avoid drinking alcohol. Dangerous side effects could occur.
Grapefruit and grapefruit juice may interact with alprazolam and lead to unwanted side effects. Discuss the use of grapefruit products with your doctor.
Alprazolam side effects
Get emergency medical help if you have signs of an allergic reaction to alprazolam: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
- depressed mood, thoughts of suicide or hurting yourself;
- racing thoughts, increased energy, unusual risk-taking behavior;
- confusion, agitation, hostility, hallucinations;
- uncontrolled muscle movements, tremor, seizure (convulsions); or
- pounding heartbeats or fluttering in your chest.
Common alprazolam side effects may include:
- drowsiness, feeling tired;
- slurred speech, lack of balance or coordination;
- memory problems; or
- feeling anxious early in the morning.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Alprazolam dosing information
Usual Adult Dose for Anxiety:
Immediate-release tablets, orally disintegrating tablets, oral concentrate:
Initial dose: 0.25 to 0.5 mg orally 3 times a day
This dose may be gradually increased every 3 to 4 days if needed and tolerated.
Maintenance dose: May increase up to maximum daily dose of 4 mg in divided doses
Initial dose: 0.25 to 0.5 mg orally 3 times a day
This dose may be gradually increased every 3 to 4 days if needed and tolerated.
Maintenance dose: May increase up to maximum daily dose of 4 mg in divided doses
Usual Adult Dose for Panic Disorder:
Immediate-release tablets, orally disintegrating tablets:
Initial dose: 0.5 mg orally 3 times a day
This dose may be gradually increased every 3 to 4 days if needed and tolerated.
Maintenance dose: 1 to 10 mg per day in divided doses
Mean dose employed: 5 to 6 mg per day in divided doses
Extended-release tablets:
Initial dose: 0.5 to 1 mg once a day
The daily dose may be gradually increased by no more than 1 mg every 3 to 4 days if needed and tolerated.
Maintenance dose: 1 to 10 mg once a day
Mean dose employed: 3 to 6 mg once a day
Initial dose: 0.5 mg orally 3 times a day
This dose may be gradually increased every 3 to 4 days if needed and tolerated.
Maintenance dose: 1 to 10 mg per day in divided doses
Mean dose employed: 5 to 6 mg per day in divided doses
Extended-release tablets:
Initial dose: 0.5 to 1 mg once a day
The daily dose may be gradually increased by no more than 1 mg every 3 to 4 days if needed and tolerated.
Maintenance dose: 1 to 10 mg once a day
Mean dose employed: 3 to 6 mg once a day
Usual Adult Dose for Depression:
Immediate-release tablets, orally disintegrating tablets, oral concentrate:
Initial dose: 0.5 mg orally 3 times a day
The daily dose may be gradually increased by no more than 1 mg every 3 to 4 days.
Average Dose: Studies in the treatment of depression have reported an average effective dose of 3 mg orally daily in divided doses
Maximum Dose: Studies in the treatment of depression have reported to have used 4.5 mg orally daily in divided doses as a maximum.
Initial dose: 0.5 mg orally 3 times a day
The daily dose may be gradually increased by no more than 1 mg every 3 to 4 days.
Average Dose: Studies in the treatment of depression have reported an average effective dose of 3 mg orally daily in divided doses
Maximum Dose: Studies in the treatment of depression have reported to have used 4.5 mg orally daily in divided doses as a maximum.
Usual Geriatric Dose for Anxiety:
Immediate-release tablets, orally disintegrating tablets, oral concentrate:
Initial dose: 0.25 mg orally 2 to 3 times a day in elderly or debilitated patients
This dose may be gradually increased if needed and tolerated.
Because of increased sensitivity to benzodiazepines in elderly patients, alprazolam at daily doses greater than 2 mg meets the Beers criteria as a medication that is potentially inappropriate for use in older adults. Smaller doses may be effective as well as safer. Total daily doses should rarely exceed suggested maximums.
Initial dose: 0.25 mg orally 2 to 3 times a day in elderly or debilitated patients
This dose may be gradually increased if needed and tolerated.
Because of increased sensitivity to benzodiazepines in elderly patients, alprazolam at daily doses greater than 2 mg meets the Beers criteria as a medication that is potentially inappropriate for use in older adults. Smaller doses may be effective as well as safer. Total daily doses should rarely exceed suggested maximums.
Usual Geriatric Dose for Depression:
Immediate-release tablets, orally disintegrating tablets, oral concentrate:
Initial dose: 0.25 mg orally 2 to 3 times a day in elderly or debilitated patients
This dose may be gradually increased if needed and tolerated.
Because of increased sensitivity to benzodiazepines in elderly patients, alprazolam at daily doses greater than 2 mg meets the Beers criteria as a medication that is potentially inappropriate for use in older adults. Smaller doses may be effective as well as safer. Total daily doses should rarely exceed suggested maximums.
Initial dose: 0.25 mg orally 2 to 3 times a day in elderly or debilitated patients
This dose may be gradually increased if needed and tolerated.
Because of increased sensitivity to benzodiazepines in elderly patients, alprazolam at daily doses greater than 2 mg meets the Beers criteria as a medication that is potentially inappropriate for use in older adults. Smaller doses may be effective as well as safer. Total daily doses should rarely exceed suggested maximums.
Usual Geriatric Dose for Panic Disorder:
Immediate-release tablets, orally disintegrating tablets:
Initial dose: 0.25 mg orally 2 to 3 times a day in elderly or debilitated patients
This dose may be gradually increased if needed and tolerated.
Extended-release tablets:
Initial dose: 0.5 mg once a day preferably in the morning
This dose may be gradually increased if needed and tolerated.
Because of increased sensitivity to benzodiazepines in elderly patients, alprazolam at daily doses greater than 2 mg meets the Beers criteria as a medication that is potentially inappropriate for use in older adults. Smaller doses may be effective as well as safer. Total daily doses should rarely exceed suggested maximums.
Initial dose: 0.25 mg orally 2 to 3 times a day in elderly or debilitated patients
This dose may be gradually increased if needed and tolerated.
Extended-release tablets:
Initial dose: 0.5 mg once a day preferably in the morning
This dose may be gradually increased if needed and tolerated.
Because of increased sensitivity to benzodiazepines in elderly patients, alprazolam at daily doses greater than 2 mg meets the Beers criteria as a medication that is potentially inappropriate for use in older adults. Smaller doses may be effective as well as safer. Total daily doses should rarely exceed suggested maximums.
What other drugs will affect alprazolam?
Taking this medicine with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before taking a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures.
Tell your doctor about all your current medicines and any you start or stop using, especially:
- cimetidine;
- fluvoxamine;
- nefazodone;
- phenytoin;
- ritonavir or other medicines to treat HIV or AIDS; or
- zolpidem;
- antifungal medicine - itraconazole, ketoconazole, fluconazole, voriconazole.
This list is not complete. Other drugs may interact with alprazolam, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
Further information
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use alprazolam only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
