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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