General Advice
General Advice
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* Immediate-release and extended-release tablets are interchangeable on a daily mg-to-mg basis.
* Immediate-release tablets may be administered sublingually to patient who has difficulty swallowing tablets.
* Administer extended-release tablets once daily, preferably in the morning. Have patient swallow whole. Do not crush, chew, divide, or break tablet.
* Solution, oral
* Use calibrated dropper to measure prescribed dose.
* Add prescribed dose to a liquid (eg, juice, water, soda) or semisolid food (eg, applesauce, pudding), stir for a few seconds then immediately administer entire amount of mixture. Do not prepare and store doses for future use.
Storage/Stability
Store immediate-release tablets below 77°F. Store extended-release tablets, orally disintegrating tablets, and oral solution at controlled room temperature (59° to 86°F). Protect orally disintegrating tablets from moisture.
Drug Interactions
Alcohol and other CNS depressants
Produce additive CNS depressant effects.
Cimetidine, disulfiram, oral contraceptives
May increase effects of alprazolam, producing excessive sedation and impaired psychomotor function.
Desipramine, imipramine
Plasma concentrations of these agents may be increased by alprazolam.
Digoxin
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Serum digoxin concentrations may increase.
Drugs that affect salivary flow and stomach pH
May slow dissolution or disintegration, resulting in slowed or decreased Niravam absorption.
Drugs that induce CYP3A4 metabolism (eg, carbamazepine, rifamycins)
May decrease alprazolam plasma levels.
Drugs that inhibit CYP3A4 metabolism (eg, diltiazem, fluoxetine, fluvoxamine, grapefruit juice, isoniazid, macrolide antibiotics [eg, erythromycin], nefazodone, nonnucleoside reverse transcriptase inhibitors [eg, delavirdine, efavirenz], protease inhibitors [eg, indinavir])
May increase alprazolam plasma concentrations.
Itraconazole, ketoconazole
Concurrent use with alprazolam is contraindicated.
Omeprazole
May increase serum levels of alprazolam and enhance alprazolam’s effects.
Theophyllines
May antagonize sedative effects of alprazolam.
Laboratory Test Interactions
None well documented.
Adverse Reactions
Cardiovascular
Tachycardia (15%); hypotension (5%); palpitation (at least 1%).
CNS
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Drowsiness (77%); fatigue/tiredness (49%); sedation (45%); irritability, memory impairment (33%); cognitive disorder (29%); somnolence (23%); light-headedness (21%); decreased libido (14%); depression (12%); dysarthria (11%); confusional state (10%); abnormal coordination (9%); ataxia, mental impairment (7%); disturbed attention, impaired balance, disinhibition (3%); disorientation, paresthesia, dyskinesia, talkativeness, derealization, abnormal dreams, lethargy (2%); anxiety, hypesthesia, hypersomnia, fear, warm feeling (1%); malaise, weakness, headache, dizziness, tremor, irritability, insomnia, nervousness, increased libido, restlessness, agitation, depersonalization, nightmare (at least 1%).
Dermatologic
Rash (11%); increased sweating (at least 1%); Stevens-Johnson syndrome (postmarketing).
EENT
Nasal congestion (17%); allergic rhinitis (1%); vertigo, blurred vision (at least 1%).
GI
Constipation (26%); nausea/vomiting (22%); diarrhea (21%); abdominal distress (18%); dry mouth (15%); increased salivation (6%); dyspepsia, abdominal pain (at least 1%).
Genitourinary
Micturition difficulties (12%); menstrual disorders (10%); dysmenorrhea (4%); sexual dysfunction, PMS, incontinence (2%); gynecomastia (postmarketing).
Hepatic
Increased liver enzymes, hepatitis, hepatic failure (postmarketing).
Metabolic-Nutritional
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Increased appetite (33%); decreased appetite (28%); weight gain (27%); weight loss (23%); edema (5%); anorexia (2%).
Musculoskeletal
Rigidity (4%); arthralgia, myalgia (2%); limb pain (1%); back pain, muscle cramps, muscle twitching (at least 1%).
Respiratory
Upper respiratory tract infection (4%); dyspnea (2%); hyperventilation (at least 1%).
Miscellaneous
Chest pain (at least 1%); hyperprolactinemia (postmarketing).
Precautions
Monitor
Treatment response
Frequently assess patient for response to treatment. Notify health care provider if condition does not appear to be improving or worsens. Ensure therapy is periodically reviewed to determine if it needs to be continued without change or if a dose change (eg, increase, decrease, discontinuation) is indicated.
Panic disorder
The usual starting dose of regular Xanax is 0.5 milligram 3 times a day. This dose can be increased by 1 milligram a day every 3 or 4 days. You may be given a dose from 1 up to a total of 10 milligrams, according to your needs. The typical dose is 5 to 6 milligrams a day.
If you’re taking Xanax XR, the usual starting dose is 0.5 to 1 milligram once a day taken in the morning. Depending on your response, the dose may be gradually increased by no more than 1 milligram every 3 or 4 days. The usual effective dose is 3 to 6 milligrams a day. Some people may need a larger dose to relieve their symptoms. Others, including older adults and those with liver disease or other serious illnesses, may need to use lower doses.
CHILDREN
Safety and effectiveness have not been established in children under 18 years of age.
OLDER ADULTS
The usual starting dose for an anxiety disorder is 0.25 milligram, 2 or 3 times daily. The starting dose of Xanax XR is 0.5 milligrams once a day. This dose may be gradually increased if needed and tolerated.
PATIENTS SWITCHING FROM XANAX TO XANAX XR
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If you’re taking divided doses of Xanax, the doctor will switch you to a once-daily dose of Xanax XR that equals the current amount you’re taking. If your symptoms return after switching, the dose can be increased as needed.
Overdosage
An overdose of Xanax, alone or after combining it with alcohol, can be fatal. If you suspect an overdose, seek medical attention immediately.
* Symptoms of Xanax overdose may include:
Confusion, coma, impaired coordination, sleepiness, slowed reaction time
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Alprazolam
Pronouncation: (al-PRAY-zoe-lam)
Class: Antianxiety, Benzodiazepine
Trade Names:
Alprazolam Intensol
- Oral solution 1 mg/mL
Trade Names:
Xanax
- Tablets 0.25 mg
- Tablets 0.5 mg
- Tablets 1 mg
- Tablets 2 mg
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Trade Names:
Xanax XR
- Tablets, extended-release 0.5 mg
- Tablets, extended-release 1 mg
- Tablets, extended-release 2 mg
- Tablets, extended-release 3 mg
Trade Names:
Niravam
- Orally disintegrating tablets 0.25 mg
- Orally disintegrating tablets 0.5 mg
- Orally disintegrating tablets 1 mg
- Orally disintegrating tablets 2 mg
Apo-Alpraz (Canada)
Apo-Alpraz TS (Canada)
Gen-Alprazolam (Canada)
Novo-Alprazol (Canada)
Nu-Alpraz (Canada)
ratio-Alprazolam (Canada)
Xanax TS (Canada)
Pharmacology
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Potentiates action of GABA, an inhibitory neurotransmitter, resulting in increased neuronal inhibition and CNS depression, especially in limbic system and reticular formation.
Pharmacokinetics
Absorption
Readily absorbed; T max is 1 to 2 h; C max is 8 to 37 ng/mL (0.5 to 3 mg doses).
Distribution
80% protein bound. Crosses the placenta and is excreted in breast milk.
Metabolism
Metabolized in the liver to alpha-hydroxy-alprazolam (activity is approximately 50% that of alprazolam) and a benzophenone derivative (inactive).
Elimination
The t ½ is approximately 16.3 h. Excreted in the urine.
Special Populations
Hepatic Function Impairment
The t ½ is approximately 19.7 h in those with alcoholic liver disease.
Elderly
The t ½ is approximately 16.3 h.
Obese
The t ½ is approximately 21.8 h.
Indications and Usage
Treatment of panic disorders with or without agoraphobia ( Niravam , Xanax , Xanax XR ); management of anxiety disorders or for short-term relief of symptoms of anxiety, including anxiety associated with depression ( Niravam , immediate-release tablets and oral solution).
Unlabeled Uses
Treatment of irritable bowel syndrome, depression, PMS.
Contraindications
Hypersensitivity to other benzodiazepines; acute narrow-angle glaucoma; patients receiving itraconazole or ketoconazole.
Dosage and Administration
Panic Disorder
Initial dose
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PO Immediate-release tablets: 0.5 mg 3 times daily; if needed, increase by max 1 mg/day every 3 to 4 day. May require more than 4 mg/day. Extended-release tablets: start with 0.5 to 1 mg daily (suggested daily dose ranges between 3 and 6 mg).
Anxiety Disorder (Immediate-Release Tablets and Oral Solution)
Adults
PO Immediate-release tablets and oral solution: 0.25 to 0.5 mg 3 times daily (max, 4mg/day in divided doses). Extended-release tablets: Start with 0.5 mg daily and gradually increase if needed (suggested total daily dose range 3 to 6 mg/day).
Elderly/Debilitated Patients
Adults
PO Immediate-release tablets: 0.25 mg 2 to 3 times daily; may increase dose gradually. Extended-release tablets: 0.25 mg 2 to 3 times daily. May increase dose gradually.
Xanax should be used with caution in elderly or weak patients, and in those with lung disease, alcoholic liver disease, or any disorder that could hinder the elimination of the drug.
Possible food and drug interactions when taking Xanax
Xanax may intensify the effect of alcohol. Do not drink alcohol while taking this medication.
Never combine Xanax with Sporanox or Nizoral. These drugs cause a buildup of Xanax in the body.
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If Xanax is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is important to check with your doctor before combining Xanax with the following:
Amiodarone (Cordarone)
Antihistamines such as Benadryl and Tavist
Carbamazepine (Tegretol)
Certain antibiotics such as Biaxin and erythromycin
Certain antidepressant drugs, including Elavil, Norpramin, and Tofranil
Cimetidine (Tagamet)
Cyclosporine (Neoral, Sandimmune)
Digoxin (Lanoxin)
Diltiazem (Cardizem)
Disulfiram (Antabuse)
Ergotamine
Fluoxetine (Prozac)
Fluvoxamine
Grapefruit juice
Isoniazid (Rifamate)
Major tranquilizers such as Mellaril and chlorpromazine
Nefazodone
Nicardipine (Cardene)
Nifedipine (Adalat, Procardia)
Oral contraceptives
Other central nervous system depressants such as Valium and Demerol
Paroxetine (Paxil)
Propoxyphene (Darvon)
Sertraline (Zoloft)
Special information if you are pregnant or breastfeeding
Do not take this medication if you are pregnant or planning to become pregnant. There is an increased risk of respiratory problems and muscular weakness in your baby. Infants may also experience withdrawal symptoms. Xanax may appear in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to stop breastfeeding until your treatment with this medication is finished.
Recommended dosage
ADULTS
Anxiety disorder
The usual starting dose of Xanax is 0.25 to 0.5 milligram taken 3 times a day. The dose may be increased every 3 to 4 days to a maximum daily dose of 4 milligrams, divided into smaller doses.Tags:Buy Cheap Xanax
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Why should Xanax not be prescribed?
If you are sensitive to or have ever had an allergic reaction to Xanax or other tranquilizers, you should not take this medication. Also avoid Xanax while taking the antifungal drugs Sporanox or Nizoral. Make sure that your doctor is aware of any drug reactions that you have experienced.
Do not take this medication if you have been diagnosed with the eye condition called narrow-angle glaucoma.
Anxiety or tension related to everyday stress usually does not require treatment with Xanax. Discuss your symptoms thoroughly with your doctor.
Special warnings about Xanax
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Xanax may cause you to become drowsy or less alert; therefore, driving or operating dangerous machinery or participating in any hazardous activity that requires full mental alertness is not recommended.
If you are being treated for panic disorder, you may need to take a higher dose of Xanax than for anxiety alone. High doses–more than 4 milligrams a day–of this medication taken for long intervals may cause emotional and physical dependence. It is important that your doctor supervise you carefully when you are using this medication.
As with all antianxiety medication, there is a small chance that Xanax could encourage suicidal thoughts or episodes of euphoria known as mania. If you notice any new or unusual symptoms after starting Xanax, call your doctor immediately.
What other drugs will affect Xanax?
Before taking Xanax, tell your doctor if you are using any of the following drugs:
*birth control pills;
*cimetidine (Tagamet);
*diltiazem (Tiazac, Cartia, Cardizem);
*isoniazid (Nydrazid, Rifamate);
*propoxyphene (Darvon, Darvocet);
*seizure medication;
*antibiotics such as fluconazole (Diflucan), itraconazole (Sporanox) or ketoconazole (Nizoral); or
*antidepressants such as fluvoxamine (Luvox), desipramine (Norpramin), or imipramine (Janimine, Tofranil).
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If you are using any of these drugs, you may not be able to use Xanax, or you may need dosage adjustments or special tests during treatment.
There may be other drugs not listed that can affect Xanax. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
Where can I get more information?
* Your pharmacist has information about Xanax written for health professionals that you may read.
What does my medication look like?
Alprazolam is available with a prescription under the brand names Xanax and Niravam. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.
* Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
* Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (’Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.Tags:Alprazolam 2mg com