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alprazolam (Rx)Brand and Other Names:Xanax, Niravam, more...Xanax XR

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet: Schedule IV

  • 0.25mg
  • 0.5mg
  • 1mg
  • 2mg

tablet, extended-release: Schedule IV

  • 0.5mg
  • 1mg
  • 2mg
  • 3mg

tablet, orally disintegrating: Schedule IV

  • 0.25mg
  • 0.5mg
  • 1mg
  • 2mg

oral solution: Schedule IV

  • 1mg/mL
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Anxiety

0.25-0.5 mg PO q6-8hr; titrate to effect q3-4Days; not to exceed 4 mg/day

Panic Disorder

Immediate-release

  • 0.5 mg PO q8hr; may increase q3-4Days by ≤1 mg/day
  • Average dose: 5-6 mg/day PO
  • May require up to 10 mg/day PO divided q8hr  

Extended-release

  • 0.5-1 mg PO qDay; may increase q3-4Days by ≤1 mg/day
  • Average dose: 3-6 mg PO qDay

Anxiety Associated With Depression

1-4 mg/day PO divided q8hr

Premenstrual Syndrome (Off-label)

0.25 mg PO q6-12hr; initiate treatment on day 16-18 of menses (not to exceed 3-4 mg/day); taper dose over 2-3 days once menses occurs

Dosing Modifications

Renal impairment

  • Use caution; not studied

Advanced hepatic impairment

  • Immediate-release: Decrease initial dose to 0.25 mg PO q8-12hr; may gradually increase if needed and as tolerated
  • Extended-release: 0.5 mg PO qDay; may increase dose as needed and tolerated

<18 years old: Not recommended

Panic Disorder

Immediate-release: Decrease initial dose to 0.25 mg PO q8-12hr; may gradually increase if necessary and as tolerated; may increase every 3-4 days by ≤1 mg/day to 5-6 mg/day average dose

Extended-release: Start at 0.5 mg PO qDay; may gradually increase if necessary and as tolerated; may increase q3-4Days by ≤1 mg/day to 3-6 mg/day

Anxiety Associated With Depression

Decrease initial dose to 0.25 mg PO q8-12hr; may gradually increase if needed and as tolerated; may increase every 3-4 days by ≤ 1 mg/day to 1-4 mg/day

Maintenance: 1-4 mg/day PO divided q8hr  

Dosing Considerations

Use smallest effective dose to avoid ataxia and oversedation

Elderly especially sensitive to benzodiazepine effects; higher plasma levels exhibited because of reduced clearance

Mean half-life: 16.3 hours in healthy elderly individuals (range: 9-26.9 hr), compared with 11 hours in healthy adults (range: 6.3-15.8 hr)

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Interactions

Interaction Checker

alprazolam and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10% (4 mg dose)

            Drowsiness (41%)

            Depression (10-15%)

            Headache (10-15%)

            Constipation (10-15%)

            Diarrhea (10-15%)

            Dry mouth (10-15%)

            >10% (10 mg dose)

            Drowsiness (77%)

            Impaired coordination (40-50%)

            Increased appetite (30-35%)

            Fatigue (30-35%)

            Memory impairment (30-35%)

            Irritability (30-35%)

            Decreased salivation (30-35%)

            Cognitive disorders (20-30%)

            Insomnia (20-30%)

            Dcreased appetite (20-30%)

            Headache (20-30%)

            Lightheadedness (20-30%)

            Dysarthria (20-30%)

            Diarrhea, constipation, and nausea/vomiting (20-30%)

            Weight change (20-30%)

            Nasal congestion (15-20%)

            Decreased or increased libido (10-15%)

            Menstrual disorder (10-15%)

            Difficult micturition (10-15%)

            1-10% (4 mg dose)

            Tachycardia (5-10%)

            Confusion (5-10%)

            Insomnia (5-10%)

            Nausea/vomiting (5-10%)

            Blurred vision (5-10%)

            Nasal congestion (5-10%)

            Hypotension (1-5%)

            Syncope (1-5%)

            Akathisia (1-5%)

            Dizziness (1-5%)

            Increased salivation (1-5%)

            Nervousness (1-5%)

            Tremor (1-5%)

            Weight change (1-5%)

            1-10% (10 mg dose)

            Increased salivation (5-10%)

            Talkativeness (1-5%)

            Incontinence (1-5%)

            Postmarketing Reports

            Gastrointestinal: Liver enzyme elevations, hepatitis, hepatic failure

            CNS: Hypomania, mania

            Immunologic: Stevens-Johnson syndrome, angioedema, peripheral edema

            Endocrine: Hyperprolactinemia, gynecomastia, galactorrhea

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            Warnings

            Contraindications

            Documented hypersensitivity

            Acute narrow angle glaucoma

            Concomitant use with CYP3A4 inhibitors (itraconazole, ketoconazole)

            Cautions

            Anterograde amnesia reported with benzodiazepine use

            Use with caution in patients with history of drug abuse or acute alcoholism; psychological dependence may occur with prolonged use (>10 days)

            Do not stop treatment abruptly; slowly taper to discontinuation (0.5 mg q3Days)

            Use caution in elderly patients

            Use caution in debilitated patients

            Use caution in severe respiratory depression

            Use caution in patients who recently received other respiratory depressants

            Use caution in patients who are at risk of falls

            May have prolonged effects in obese patients when discontinued; use caution

            Not for us in acute alcohol intoxication

            Use with caution in patients with hepatic or renal impairment

            Myasthenia gravis (allowable in limited circumstances)

            Use caution in cases of respiratory disease (COPD), sleep apnea, renal/hepatic disease, open-angle glaucoma (questionable), depression, suicide ideation, drug abuse

            CNS depressant; may impair ability to perform hazardous tasks

            Paradoxical reactions, including hyperactive or aggressive behavior reported

            Cigarette smoking may decrease alprazolam concentration up to 50%

            Mania and hypomania episodes reported in depressed patients

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            Pregnancy & Lactation

            Pregnancy category: D

            Lactation: Enters breast milk/not recommended

            Minor tranquilizers should be avoided in first trimester of pregnancy due to increased risk of congenital malformations

            Maternal use shortly before delivery is associated with floppy infant syndrome (good and consistent evidence)

            Prenatal benzodiazepine exposure slightly increases oral cleft risk (limited or inconsistent evidence)

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Binds receptors at several sites within the CNS, including the limbic system and reticular formation; effects may be mediated through GABA receptor system; increase in neuronal membrane permeability to chloride ions enhances the inhibitory effects of GABA; the shift in chloride ions causes hyperpolarization (less excitability) and stabilization of the neuronal membrane

            Absorption

            Bioavailability: 90%

            Peak serum time: 1-2 hr (immediate release); 9 hr (extended release); 1.5-2 hr (disintegrating tablet)

            Peak plasma concentration: 8-37 ng/mL (dose dependent)

            Distribution

            Protein bound: 80%

            Vd: 0.9-1.2 L/kg

            Metabolism

            Metabolized by hepatic P-450 enzyme CYP3A4

            Elimination

            Half-life: 11 hr average for immediate release, 13 hr average for extended release, and 13 hr average for disintegrating tablets (adults); 16.3 hr (elderly); 21.8 hr (obesity)

            Excretion: Urine

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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