alprazolam (Rx)

Brand and Other Names:Xanax, Niravam, more...Xanax XR
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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

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

and alprazolam

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            Contraindicated (2)

            • ketoconazole

              ketoconazole increases levels of alprazolam by decreasing metabolism. Contraindicated.

            • tipranavir

              tipranavir increases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Potential for increased toxicity. Tipranavir is used with ritonavir (boosted therapy) which is a potent CYP3A4 inhibitor.

            Serious - Use Alternative (32)

            • abametapir

              abametapir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

            • apalutamide

              apalutamide will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen, alprazolam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • calcium/magnesium/potassium/sodium oxybates

              alprazolam, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • carbamazepine

              carbamazepine will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • chloramphenicol

              chloramphenicol will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • cimetidine

              cimetidine will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • clarithromycin

              clarithromycin will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • cobicistat

              cobicistat will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • erythromycin base

              erythromycin base will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • erythromycin lactobionate

              erythromycin lactobionate will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • erythromycin stearate

              erythromycin stearate will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • fexinidazole

              fexinidazole will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

            • hydrocodone

              hydrocodone, alprazolam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • idelalisib

              idelalisib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

            • itraconazole

              itraconazole increases levels of alprazolam by decreasing metabolism. Avoid or Use Alternate Drug.

            • ivosidenib

              ivosidenib will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

            • ketoconazole

              ketoconazole will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • lonafarnib

              alprazolam will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

              lonafarnib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

            • lopinavir

              lopinavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • metoclopramide intranasal

              alprazolam, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            • nefazodone

              nefazodone will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • rifabutin

              rifabutin will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • rifampin

              rifampin will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • saquinavir

              saquinavir increases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration. If need to use, decrease alprazolam dose.

            • selinexor

              selinexor, alprazolam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

            • sodium oxybate

              alprazolam, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • St John's Wort

              St John's Wort will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • sufentanil SL

              sufentanil SL, alprazolam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • valerian

              valerian and alprazolam both increase sedation. Avoid or Use Alternate Drug.

            • voxelotor

              voxelotor will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

            Monitor Closely (265)

            • albuterol

              alprazolam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alfentanil

              alprazolam and alfentanil both increase sedation. Use Caution/Monitor.

            • amitriptyline

              alprazolam and amitriptyline both increase sedation. Use Caution/Monitor.

            • amobarbital

              amobarbital will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              amobarbital and alprazolam both increase sedation. Use Caution/Monitor.

            • amoxapine

              alprazolam and amoxapine both increase sedation. Use Caution/Monitor.

            • apomorphine

              alprazolam and apomorphine both increase sedation. Use Caution/Monitor.

            • aprepitant

              aprepitant will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • arformoterol

              alprazolam increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aripiprazole

              alprazolam and aripiprazole both increase sedation. Use Caution/Monitor.

            • armodafinil

              armodafinil will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              alprazolam increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • artemether/lumefantrine

              artemether/lumefantrine will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • atazanavir

              atazanavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • avapritinib

              alprazolam will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • azelastine

              azelastine and alprazolam both increase sedation. Use Caution/Monitor.

            • baclofen

              alprazolam and baclofen both increase sedation. Use Caution/Monitor.

            • belladonna and opium

              alprazolam and belladonna and opium both increase sedation. Use Caution/Monitor.

            • benperidol

              alprazolam and benperidol both increase sedation. Use Caution/Monitor.

            • benzphetamine

              alprazolam increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bosentan

              bosentan will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • brexanolone

              brexanolone, alprazolam. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • brompheniramine

              brompheniramine and alprazolam both increase sedation. Use Caution/Monitor.

            • budesonide

              budesonide will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • buprenorphine

              alprazolam and buprenorphine both increase sedation. Use Caution/Monitor.

            • buprenorphine buccal

              alprazolam and buprenorphine buccal both increase sedation. Use Caution/Monitor.

            • buprenorphine subdermal implant

              alprazolam increases toxicity of buprenorphine subdermal implant by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Studies have shown that the combination of benzodiazepines and buprenorphine altered the usual ceiling effect on buprenorphine-induced respiratory depression, making the respiratory effects of buprenorphine appear similar to those of full opioid agonists. There have been postmarketing reports of coma and death with coadministration of buprenorphine and benzodiazepines. In many, but not all of these cases, buprenorphine was misused by self-injection. If a benzodiazepine must be used for an indication other than seizures, lower the benzodiazepine initial dose and cautiously titrate to clinical response.

            • buprenorphine, long-acting injection

              alprazolam increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

            • butabarbital

              butabarbital will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              butabarbital and alprazolam both increase sedation. Use Caution/Monitor.

            • butalbital

              butalbital will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              butalbital and alprazolam both increase sedation. Use Caution/Monitor.

            • butorphanol

              alprazolam and butorphanol both increase sedation. Use Caution/Monitor.

            • caffeine

              alprazolam increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine and alprazolam both increase sedation. Use Caution/Monitor.

            • carisoprodol

              alprazolam and carisoprodol both increase sedation. Use Caution/Monitor.

            • cenobamate

              cenobamate will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

              cenobamate, alprazolam. Either increases effects of the other by sedation. Use Caution/Monitor.

            • chloral hydrate

              alprazolam and chloral hydrate both increase sedation. Use Caution/Monitor.

            • chlordiazepoxide

              alprazolam and chlordiazepoxide both increase sedation. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine and alprazolam both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              alprazolam and chlorpromazine both increase sedation. Use Caution/Monitor.

            • chlorzoxazone

              alprazolam and chlorzoxazone both increase sedation. Use Caution/Monitor.

            • cinnarizine

              cinnarizine and alprazolam both increase sedation. Use Caution/Monitor.

            • clemastine

              clemastine and alprazolam both increase sedation. Use Caution/Monitor.

            • clobazam

              alprazolam, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

            • clomipramine

              alprazolam and clomipramine both increase sedation. Use Caution/Monitor.

            • clonazepam

              alprazolam and clonazepam both increase sedation. Use Caution/Monitor.

            • clonidine

              clonidine, alprazolam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.

            • clorazepate

              alprazolam and clorazepate both increase sedation. Use Caution/Monitor.

            • clozapine

              alprazolam and clozapine both increase sedation. Use Caution/Monitor.

            • codeine

              alprazolam and codeine both increase sedation. Use Caution/Monitor.

            • conivaptan

              conivaptan will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • cortisone

              cortisone will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • crizotinib

              crizotinib increases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.

            • crofelemer

              crofelemer increases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

            • cyclizine

              cyclizine and alprazolam both increase sedation. Use Caution/Monitor.

            • cyclobenzaprine

              alprazolam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • cyclosporine

              cyclosporine will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine and alprazolam both increase sedation. Use Caution/Monitor.

            • dabrafenib

              dabrafenib will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • dantrolene

              alprazolam and dantrolene both increase sedation. Use Caution/Monitor.

            • darifenacin

              darifenacin will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • darunavir

              darunavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • dasatinib

              dasatinib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • deferasirox

              deferasirox will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • desflurane

              desflurane and alprazolam both increase sedation. Use Caution/Monitor.

            • desipramine

              alprazolam and desipramine both increase sedation. Use Caution/Monitor.

            • deutetrabenazine

              alprazolam and deutetrabenazine both increase sedation. Use Caution/Monitor.

            • dexamethasone

              dexamethasone will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • dexchlorpheniramine

              dexchlorpheniramine and alprazolam both increase sedation. Use Caution/Monitor.

            • dexfenfluramine

              alprazolam increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmedetomidine

              alprazolam and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • dexmethylphenidate

              alprazolam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextroamphetamine

              alprazolam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextromoramide

              alprazolam and dextromoramide both increase sedation. Use Caution/Monitor.

            • DHEA, herbal

              DHEA, herbal will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • diamorphine

              alprazolam and diamorphine both increase sedation. Use Caution/Monitor.

            • diazepam

              alprazolam and diazepam both increase sedation. Use Caution/Monitor.

            • diazepam intranasal

              diazepam intranasal, alprazolam. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

            • diethylpropion

              alprazolam increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • difenoxin hcl

              alprazolam and difenoxin hcl both increase sedation. Use Caution/Monitor.

            • digoxin

              alprazolam increases levels of digoxin by unknown mechanism. Use Caution/Monitor.

            • diltiazem

              diltiazem will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for increased alprazolam side effects including drowsiness or fatigue, nausea, vomiting, diarrhea or constipation.

            • dimenhydrinate

              dimenhydrinate and alprazolam both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine and alprazolam both increase sedation. Use Caution/Monitor.

            • diphenoxylate hcl

              alprazolam and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

            • dipipanone

              alprazolam and dipipanone both increase sedation. Use Caution/Monitor.

            • disulfiram

              disulfiram increases levels of alprazolam by decreasing metabolism. Use Caution/Monitor.

            • dobutamine

              alprazolam increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopamine

              alprazolam increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopexamine

              alprazolam increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dosulepin

              alprazolam and dosulepin both increase sedation. Use Caution/Monitor.

            • doxepin

              alprazolam and doxepin both increase sedation. Use Caution/Monitor.

            • doxylamine

              alprazolam and doxylamine both increase sedation. Use Caution/Monitor.

            • dronedarone

              dronedarone will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • droperidol

              alprazolam and droperidol both increase sedation. Use Caution/Monitor.

            • duvelisib

              duvelisib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. will increase the level or effect of

            • efavirenz

              efavirenz will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • elagolix

              elagolix will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; consider benzodiazepine dose reduction.

            • encorafenib

              encorafenib, alprazolam. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

            • ephedrine

              alprazolam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine

              alprazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine racemic

              alprazolam increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • esketamine intranasal

              esketamine intranasal, alprazolam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

            • eslicarbazepine acetate

              eslicarbazepine acetate will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • estazolam

              alprazolam and estazolam both increase sedation. Use Caution/Monitor.

            • ethanol

              alprazolam and ethanol both increase sedation. Use Caution/Monitor.

            • ethinylestradiol

              ethinylestradiol will increase the level or effect of alprazolam by Mechanism: decreasing metabolism. Use Caution/Monitor. Ethinyl estradiol may inhibit the clearance of benzodiazepines that undergo oxidation, thereby increasing serum concentrations of concomitantly administered benzodiazepines.

            • etomidate

              etomidate and alprazolam both increase sedation. Use Caution/Monitor.

            • etravirine

              etravirine will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • fedratinib

              fedratinib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

            • fenfluramine

              alprazolam increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • finerenone

              alprazolam will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or moderate CYP3A4 inhibitors. Adjust finererone dosage as needed.

            • flibanserin

              alprazolam and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

            • fluconazole

              fluconazole will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • fludrocortisone

              fludrocortisone will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • fluphenazine

              alprazolam and fluphenazine both increase sedation. Use Caution/Monitor.

            • flurazepam

              alprazolam and flurazepam both increase sedation. Use Caution/Monitor.

            • fluvoxamine

              fluvoxamine will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • formoterol

              alprazolam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fosamprenavir

              fosamprenavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • fosphenytoin

              fosphenytoin will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • gabapentin

              gabapentin, alprazolam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • gabapentin enacarbil

              gabapentin enacarbil, alprazolam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • grapefruit

              grapefruit will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • griseofulvin

              griseofulvin will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • haloperidol

              alprazolam and haloperidol both increase sedation. Use Caution/Monitor.

            • hyaluronidase

              hyaluronidase, alprazolam. Other (see comment). Use Caution/Monitor. Comment: Drug combination has been found to be incompatible.

            • hydrocortisone

              hydrocortisone will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • hydromorphone

              alprazolam and hydromorphone both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine and alprazolam both increase sedation. Use Caution/Monitor.

            • iloperidone

              alprazolam and iloperidone both increase sedation. Use Caution/Monitor.

              iloperidone increases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

            • imipramine

              alprazolam and imipramine both increase sedation. Use Caution/Monitor.

            • indinavir

              indinavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • isoniazid

              isoniazid will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • isoproterenol

              alprazolam increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • istradefylline

              istradefylline will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

            • ketamine

              ketamine and alprazolam both increase sedation. Use Caution/Monitor.

            • ketotifen, ophthalmic

              alprazolam and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

            • lapatinib

              lapatinib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • lasmiditan

              lasmiditan, alprazolam. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

            • lemborexant

              alprazolam will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

              lemborexant, alprazolam. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

            • letermovir

              letermovir increases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • levalbuterol

              alprazolam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

              levonorgestrel oral/ethinylestradiol/ferrous bisglycinate will increase the level or effect of alprazolam by decreasing metabolism. Use Caution/Monitor. Ethinyl estradiol may inhibit the clearance of benzodiazepines that undergo oxidation, thereby increasing serum concentrations of concomitantly administered benzodiazepines.

            • levorphanol

              alprazolam and levorphanol both increase sedation. Use Caution/Monitor.

            • lisdexamfetamine

              alprazolam increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lofepramine

              alprazolam and lofepramine both increase sedation. Use Caution/Monitor.

              alprazolam increases levels of lofepramine by decreasing metabolism. Use Caution/Monitor.

            • lofexidine

              alprazolam and lofexidine both increase sedation. Use Caution/Monitor.

            • lomitapide

              alprazolam increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

            • loprazolam

              alprazolam and loprazolam both increase sedation. Use Caution/Monitor.

            • lorazepam

              alprazolam and lorazepam both increase sedation. Use Caution/Monitor.

            • lorlatinib

              lorlatinib will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • lormetazepam

              alprazolam and lormetazepam both increase sedation. Use Caution/Monitor.

            • loxapine

              alprazolam and loxapine both increase sedation. Use Caution/Monitor.

            • loxapine inhaled

              alprazolam and loxapine inhaled both increase sedation. Use Caution/Monitor.

            • lumefantrine

              lumefantrine will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • lurasidone

              lurasidone, alprazolam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

            • maprotiline

              alprazolam and maprotiline both increase sedation. Use Caution/Monitor.

            • marijuana

              marijuana will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              alprazolam and marijuana both increase sedation. Use Caution/Monitor.

            • melatonin

              alprazolam and melatonin both increase sedation. Use Caution/Monitor.

            • meperidine

              alprazolam and meperidine both increase sedation. Use Caution/Monitor.

            • meprobamate

              alprazolam and meprobamate both increase sedation. Use Caution/Monitor.

            • metaproterenol

              alprazolam increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaxalone

              alprazolam and metaxalone both increase sedation. Use Caution/Monitor.

            • methadone

              alprazolam and methadone both increase sedation. Use Caution/Monitor.

            • methamphetamine

              alprazolam increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methocarbamol

              alprazolam and methocarbamol both increase sedation. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              alprazolam increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methylprednisolone

              methylprednisolone will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • metronidazole

              metronidazole will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • miconazole vaginal

              miconazole vaginal will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • midazolam

              alprazolam and midazolam both increase sedation. Use Caution/Monitor.

            • midazolam intranasal

              alprazolam will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

              midazolam intranasal will increase the level or effect of alprazolam by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

            • midodrine

              alprazolam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mifepristone

              mifepristone will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • mirtazapine

              alprazolam and mirtazapine both increase sedation. Use Caution/Monitor.

            • mitotane

              mitotane decreases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

            • modafinil

              modafinil will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              alprazolam increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • morphine

              alprazolam and morphine both increase sedation. Use Caution/Monitor.

            • motherwort

              alprazolam and motherwort both increase sedation. Use Caution/Monitor.

            • moxonidine

              alprazolam and moxonidine both increase sedation. Use Caution/Monitor.

            • nabilone

              alprazolam and nabilone both increase sedation. Use Caution/Monitor.

            • nalbuphine

              alprazolam and nalbuphine both increase sedation. Use Caution/Monitor.

            • nelfinavir

              nelfinavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nevirapine

              nevirapine will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nifedipine

              nifedipine will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nilotinib

              nilotinib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • norepinephrine

              alprazolam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nortriptyline

              alprazolam and nortriptyline both increase sedation. Use Caution/Monitor.

            • olanzapine

              alprazolam and olanzapine both increase sedation. Use Caution/Monitor.

            • oliceridine

              oliceridine, alprazolam. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • ombitasvir/paritaprevir/ritonavir & dasabuvir

              ombitasvir/paritaprevir/ritonavir & dasabuvir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider decreasing alprazolam dose based on clinical response

            • opium tincture

              alprazolam and opium tincture both increase sedation. Use Caution/Monitor.

            • orphenadrine

              alprazolam and orphenadrine both increase sedation. Use Caution/Monitor.

            • oxazepam

              alprazolam and oxazepam both increase sedation. Use Caution/Monitor.

            • oxcarbazepine

              oxcarbazepine will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • oxycodone

              alprazolam and oxycodone both increase sedation. Use Caution/Monitor.

            • oxymorphone

              alprazolam and oxymorphone both increase sedation. Use Caution/Monitor.

            • paliperidone

              alprazolam and paliperidone both increase sedation. Use Caution/Monitor.

            • papaveretum

              alprazolam and papaveretum both increase sedation. Use Caution/Monitor.

            • papaverine

              alprazolam and papaverine both increase sedation. Use Caution/Monitor.

            • pentazocine

              alprazolam and pentazocine both increase sedation. Use Caution/Monitor.

            • pentobarbital

              pentobarbital will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              pentobarbital and alprazolam both increase sedation. Use Caution/Monitor.

            • perampanel

              perampanel and alprazolam both increase sedation. Use Caution/Monitor.

            • perphenazine

              alprazolam and perphenazine both increase sedation. Use Caution/Monitor.

            • phendimetrazine

              alprazolam increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenobarbital

              phenobarbital will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              phenobarbital and alprazolam both increase sedation. Use Caution/Monitor.

            • phentermine

              alprazolam increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine

              alprazolam increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine PO

              alprazolam increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • phenytoin

              phenytoin will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • pholcodine

              alprazolam and pholcodine both increase sedation. Use Caution/Monitor.

            • pimozide

              alprazolam and pimozide both increase sedation. Use Caution/Monitor.

            • pirbuterol

              alprazolam increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • posaconazole

              posaconazole will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • prednisone

              prednisone will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • pregabalin

              pregabalin, alprazolam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • primidone

              primidone will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              primidone and alprazolam both increase sedation. Use Caution/Monitor.

            • prochlorperazine

              alprazolam and prochlorperazine both increase sedation. Use Caution/Monitor.

            • promethazine

              promethazine and alprazolam both increase sedation. Use Caution/Monitor.

            • propofol

              propofol and alprazolam both increase sedation. Use Caution/Monitor.

            • propylhexedrine

              alprazolam increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • protriptyline

              alprazolam and protriptyline both increase sedation. Use Caution/Monitor.

            • quazepam

              alprazolam and quazepam both increase sedation. Use Caution/Monitor.

            • quetiapine

              alprazolam and quetiapine both increase sedation. Use Caution/Monitor.

            • quinupristin/dalfopristin

              quinupristin/dalfopristin will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ramelteon

              alprazolam and ramelteon both increase sedation. Use Caution/Monitor.

            • remimazolam

              remimazolam, alprazolam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

            • ribociclib

              ribociclib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rifapentine

              rifapentine will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • risperidone

              alprazolam and risperidone both increase sedation. Use Caution/Monitor.

            • ritonavir

              ritonavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rucaparib

              rucaparib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

            • rufinamide

              rufinamide will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • salmeterol

              alprazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • scullcap

              alprazolam and scullcap both increase sedation. Use Caution/Monitor.

            • secobarbital

              secobarbital will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              secobarbital and alprazolam both increase sedation. Use Caution/Monitor.

            • sevoflurane

              sevoflurane and alprazolam both increase sedation. Use Caution/Monitor.

            • shepherd's purse

              alprazolam and shepherd's purse both increase sedation. Use Caution/Monitor.

            • sofosbuvir/velpatasvir

              sofosbuvir/velpatasvir increases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Velpatasvir inhibits CYP3A4. Caution if coadministered with drugs with narrow therapeutics indexes.

            • stiripentol

              stiripentol, alprazolam. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

              stiripentol, alprazolam. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

            • sufentanil

              alprazolam and sufentanil both increase sedation. Use Caution/Monitor.

            • suvorexant

              suvorexant and alprazolam both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

            • tapentadol

              alprazolam and tapentadol both increase sedation. Use Caution/Monitor.

            • tazemetostat

              tazemetostat will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              alprazolam will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tecovirimat

              tecovirimat will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

            • teduglutide

              teduglutide increases levels of alprazolam by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.

            • temazepam

              alprazolam and temazepam both increase sedation. Use Caution/Monitor.

            • terbutaline

              alprazolam increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • thioridazine

              alprazolam and thioridazine both increase sedation. Use Caution/Monitor.

            • thiothixene

              alprazolam and thiothixene both increase sedation. Use Caution/Monitor.

            • topiramate

              topiramate will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              alprazolam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

            • tramadol

              alprazolam and tramadol both increase sedation. Use Caution/Monitor.

            • trazodone

              alprazolam and trazodone both increase sedation. Use Caution/Monitor.

            • triazolam

              alprazolam and triazolam both increase sedation. Use Caution/Monitor.

            • triclofos

              alprazolam and triclofos both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              alprazolam and trifluoperazine both increase sedation. Use Caution/Monitor.

            • trimipramine

              alprazolam and trimipramine both increase sedation. Use Caution/Monitor.

            • triprolidine

              triprolidine and alprazolam both increase sedation. Use Caution/Monitor.

            • verapamil

              verapamil will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • voriconazole

              voriconazole will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • xylometazoline

              alprazolam increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • yohimbine

              alprazolam increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • zafirlukast

              zafirlukast will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ziconotide

              alprazolam and ziconotide both increase sedation. Use Caution/Monitor.

            • ziprasidone

              alprazolam and ziprasidone both increase sedation. Use Caution/Monitor.

            • zotepine

              alprazolam and zotepine both increase sedation. Use Caution/Monitor.

            Minor (16)

            • brimonidine

              brimonidine increases effects of alprazolam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • ciprofloxacin

              ciprofloxacin increases levels of alprazolam by decreasing metabolism. Minor/Significance Unknown.

            • esomeprazole

              esomeprazole increases levels of alprazolam by decreasing metabolism. Minor/Significance Unknown.

            • eucalyptus

              alprazolam and eucalyptus both increase sedation. Minor/Significance Unknown.

            • fleroxacin

              fleroxacin increases levels of alprazolam by decreasing metabolism. Minor/Significance Unknown.

            • gemifloxacin

              gemifloxacin increases levels of alprazolam by decreasing metabolism. Minor/Significance Unknown.

            • green tea

              green tea decreases effects of alprazolam by pharmacodynamic antagonism. Minor/Significance Unknown. Caffeine component of green tea may decrease sedative effects of benzodiazepines.

            • levofloxacin

              levofloxacin increases levels of alprazolam by decreasing metabolism. Minor/Significance Unknown.

            • lithium

              alprazolam increases levels of lithium by decreasing renal clearance. Minor/Significance Unknown.

            • moxifloxacin

              moxifloxacin increases levels of alprazolam by decreasing metabolism. Minor/Significance Unknown.

            • ofloxacin

              ofloxacin increases levels of alprazolam by decreasing metabolism. Minor/Significance Unknown.

            • omeprazole

              omeprazole increases levels of alprazolam by decreasing metabolism. Minor/Significance Unknown.

            • rifabutin

              rifabutin decreases levels of alprazolam by increasing metabolism. Minor/Significance Unknown.

            • sage

              alprazolam and sage both increase sedation. Minor/Significance Unknown.

            • vinpocetine

              alprazolam increases effects of vinpocetine by unspecified interaction mechanism. Minor/Significance Unknown. Desirable interaction enhanced memory improvement (based on preliminary trial).

            • zolpidem

              zolpidem, alprazolam. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

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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

            Black Box Warnings

            Risks from concomitant use with opioids

            • Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death
            • Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate
            • Limit dosages and durations to the minimum required
            • Follow patients for signs and symptoms of respiratory depression and sedation
            • Inform patients and caregivers that potentially fatal additive effects may occur if drug is used with opioids and that such drugs should not be used concomitantly unless supervised by a health care provider
            • Prescribers should advise caregivers that they expect to be informed immediately if a patient develops any new findings which are not typical of the patient’s characteristic seizure episode

            Addiction, abuse, and misuse

            • In September 2020, FDA addressed serious risks of benzodiazepine addiction, abuse, and misuse, which can lead to overdose and death
            • Physical dependence can occur when taken steadily for several days to weeks, even as prescribed
            • Stopping abruptly or reducing dosage too quickly can result in withdrawal reactions, including seizures, which can be life-threatening
            • Abuse and misuse of benzodiazepines commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes; before prescribing and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction
            • Assess each patient’s risk prior to prescribing and monitor regularly for the development of these conditions
            • Risks of dependence and withdrawal increase with longer treatment duration and higher daily dose; although injection is indicated only for intermittent use, if used more frequently than recommended, abrupt discontinuation or rapid dosage reduction may precipitate acute withdrawal reactions, including seizures, which can be life-threatening; use gradual taper when discontinuing therapy to reduce withdrawal reactions risk

            Contraindications

            Documented hypersensitivity

            Acute narrow angle glaucoma

            Concomitant use with CYP3A4 inhibitors (itraconazole, ketoconazole)

            Cautions

            Anterograde amnesia reported with benzodiazepine use

            Use caution in elderly patients

            Use caution in debilitated patients

            Use caution in severe respiratory depression; if signs and symptoms of respiratory depression, hypoventilation, or apnea occur, discontinue

            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

            Benzodiazepines expose users to risks of abuse, misuse, and addiction, which can lead to overdose or death; abuse and misuse of benzodiazepines often (but not always) involve use of doses greater than the maximum recommended dosage and commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes, including respiratory depression, overdose, or death

            Use of drug, particularly in patients at elevated risk of abuse, necessitates counseling about risks and proper use of drug along with monitoring for signs and symptoms of abuse, misuse, and addiction; do not exceed recommended dosing frequency

            Avoid or minimize concomitant use of CNS depressants and other substances associated with abuse, misuse, and addiction (eg, opioid analgesics, stimulants); advise patients on proper disposal of unused drug; if a substance use disorder is suspected, evaluate patient and institute (or refer them for) early treatment, as appropriate

            For patients treated more frequently than recommended, use a gradual taper to discontinue therapy (a patient-specific plan should be used to taper the dose), to reduce risk of withdrawal reactions

            Patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages, and those who have had longer durations of use

            In some cases, benzodiazepine users have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months; symptoms may include heightened sensory perception, impaired concentration, dysosmia, clouded sensorium, paresthesias, muscle cramps, muscle twitch, diarrhea, blurred vision, appetite decrease, and weight loss

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            Pregnancy & Lactation

            Pregnancy

            There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to drug during pregnancy; healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Other Psychiatric Medications at 1-866-961-2388 or visiting online at https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/othermedications/.

            Neonates born to mothers using benzodiazepines during later stages of pregnancy reported to experience symptoms of sedation and neonatal withdrawal; overall available data from published observational studies of pregnant women exposed to drug have not established a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes

            Benzodiazepines cross the placenta and may produce respiratory depression and sedation in neonates; monitor neonates exposed to benzodiazepines during pregnancy and labor for signs of sedation, respiratory depression, withdrawal, and feeding problems and manage accordingly

            Lactation

            Limited data from published literature reports the presence of the drug in human breast milk; there are reports of sedation and withdrawal symptoms in breastfed neonates and infants exposed to alprazolam; effects of alprazolam on lactation are unknown

            Because of potential for serious adverse reactions, including sedation and withdrawal symptoms in breastfed neonates and infants, advise patients that breastfeeding is not recommended during treatment

            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

            BRAND FORM. UNIT PRICE PILL IMAGE
            Xanax XR oral
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            Xanax XR oral
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            1 mg tablet
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            Alprazolam Intensol oral
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            1 mg/mL liquid
            alprazolam oral
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            1 mg tablet
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            Xanax oral
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            0.5 mg tablet
            Xanax oral
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            0.25 mg tablet
            Xanax oral
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            1 mg tablet
            Xanax oral
            -
            2 mg tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            alprazolam oral

            ALPRAZOLAM CONCENTRATE SOLUTION - ORAL

            (al-PRA-zoe-lam)

            COMMON BRAND NAME(S): Alprazolam Intensol

            WARNING: Alprazolam has a risk for abuse and addiction, which can lead to overdose and death. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems (especially opioid medications such as codeine, hydrocodone) may cause very serious side effects, including death. To lower your risk, your doctor should have you take the smallest dose of alprazolam that works, and take it for the shortest possible time. Be sure you know how to take alprazolam and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.Suddenly stopping this medication may cause serious (possibly fatal) withdrawal, especially if you have used it for a long time or in high doses. To prevent withdrawal, your doctor may lower your dose slowly. Tell your doctor or pharmacist right away if you have any withdrawal symptoms such as headaches, trouble sleeping, restlessness, hallucinations/confusion, depression, nausea, or seizures. Withdrawal symptoms may sometimes last weeks to months.

            USES: Alprazolam is used to treat anxiety and panic disorders. It belongs to a class of medications called benzodiazepines which act on the brain and nerves (central nervous system) to produce a calming effect. It works by enhancing the effects of a certain natural chemical in the body (GABA).

            HOW TO USE: See also Warning section.Read the Medication Guide provided by your pharmacist before you start taking alprazolam and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth as directed by your doctor. Use the dropper provided to carefully measure out the dose and mix it in liquid or soft food (such as applesauce, pudding) just before taking. Dosage is based on your medical condition, age, and response to treatment. Your dose may be gradually increased until the drug starts working well. Follow your doctor's instructions closely to reduce the risk of side effects.Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.Tell your doctor if your condition persists or worsens.

            SIDE EFFECTS: See also Warning section.Drowsiness, dizziness, increased saliva production, or change in sex drive/ability may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.To minimize dizziness and lightheadedness, get up slowly when rising from a seated or lying position.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if any of these unlikely but serious side effects occur: mental/mood changes (such as hallucinations, thoughts of suicide), trouble speaking, loss of coordination, trouble walking, memory problems.Get medical help right away if these rare but very serious side effects occur: yellowing eyes or skin, seizures.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking alprazolam, tell your doctor or pharmacist if you are allergic to it; or to other benzodiazepines (such as diazepam, lorazepam); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: severe lung/breathing problems (such as COPD, sleep apnea), liver disease, kidney disease, personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol), glaucoma.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially loss of coordination and drowsiness. These side effects can increase the risk of falling.During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Discuss the risks and benefits with your doctor. Babies born to mothers who have used this drug late in the last 3 months of pregnancy may develop unusual sleepiness, feeding/breathing difficulties, muscle shakiness, or constant crying. If you notice any unusual symptoms in your newborn, tell the doctor right away.This drug passes into breast milk and may have undesirable effects on a nursing infant. Therefore, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: See also Warning section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: kava, sodium oxybate.Other medications can affect the removal of alprazolam from your body, which may affect how alprazolam works. Examples include azole antifungals (such as itraconazole, ketoconazole), cimetidine, certain anti-depressants (such as fluoxetine, fluvoxamine, nefazodone), drugs to treat HIV (delavirdine, protease inhibitors such as indinavir), macrolide antibiotics (such as erythromycin), rifamycins (such as rifabutin), St. John's wort, drugs used to treat seizures (such as phenytoin), among others.The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if this medication is taken with other products that may also cause drowsiness or breathing problems. Tell your doctor or pharmacist if you are taking other products such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), other drugs for sleep or anxiety (such as diazepam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.Cigarette smoking decreases blood levels of this medication. Tell your doctor if you smoke or if you have recently stopped smoking.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe drowsiness, slowed/reduced reflexes, slowed breathing, loss of consciousness.

            NOTES: Do not share this medication with others. Sharing it is against the law.Laboratory and/or medical tests (such as liver function tests) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised March 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.