Dosing & Uses
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)
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (4)
- cobicistat
cobicistat will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- ketoconazole
ketoconazole increases levels of alprazolam by decreasing metabolism. Contraindicated.
- levoketoconazole
levoketoconazole will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
levoketoconazole 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 (34)
- 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.
benzhydrocodone/acetaminophen and alprazolam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buprenorphine subdermal implant
buprenorphine subdermal implant and alprazolam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine transdermal
buprenorphine transdermal and alprazolam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and alprazolam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- 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.
- ceritinib
ceritinib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- 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.
- 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.
- 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.
- olopatadine intranasal
alprazolam and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- 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 (281)
- acrivastine
acrivastine and alprazolam both increase sedation. Use Caution/Monitor.
- 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.
- amisulpride
amisulpride and alprazolam 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.
- asenapine
asenapine and alprazolam both increase sedation. Use Caution/Monitor.
- asenapine transdermal
asenapine transdermal and alprazolam both increase sedation. Use Caution/Monitor.
- atazanavir
atazanavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- atogepant
alprazolam will increase the level or effect of atogepant 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.
avapritinib and alprazolam both increase sedation. 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.
- belzutifan
belzutifan will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.
- 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.
- brexpiprazole
brexpiprazole and alprazolam both increase sedation. Use Caution/Monitor.
- brimonidine
brimonidine and alprazolam both increase sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and alprazolam both increase 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.
- daridorexant
alprazolam and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- 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.
- difelikefalin
difelikefalin and alprazolam both increase sedation. 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.
- fosaprepitant
fosaprepitant 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.
- ganaxolone
alprazolam and ganaxolone both increase sedation. Use Caution/Monitor.
- 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.
- isavuconazonium sulfate
alprazolam will increase the level or effect of isavuconazonium sulfate 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. - lenacapavir
lenacapavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.
- 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
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.
- nirmatrelvir/ritonavir
nirmatrelvir/ritonavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider lowering alprazolam dosing when coadministered with nirmatrelvir/ritonavir
- 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 (DSC)
ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) 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 (20)
- acetazolamide
acetazolamide will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- anastrozole
anastrozole will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- 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.
- cyclophosphamide
cyclophosphamide will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 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.
- larotrectinib
larotrectinib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- 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.
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
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
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.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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Xanax XR oral - | 3 mg tablet |  | |
| Xanax XR oral - | 2 mg tablet |  | |
| Xanax XR oral - | 1 mg tablet |  | |
| Xanax XR oral - | 0.5 mg tablet |  | |
| Alprazolam Intensol oral - | 1 mg/mL liquid |  | |
| alprazolam oral - | 1 mg tablet |  | |
| alprazolam oral - | 0.5 mg tablet |  | |
| alprazolam oral - | 0.5 mg tablet |  | |
| alprazolam oral - | 0.25 mg tablet |  | |
| alprazolam oral - | 0.25 mg tablet |  | |
| alprazolam oral - | 0.25 mg tablet |  | |
| alprazolam oral - | 0.5 mg tablet |  | |
| alprazolam oral - | 1 mg tablet |  | |
| alprazolam oral - | 0.5 mg tablet |  | |
| alprazolam oral - | 0.5 mg tablet |  | |
| alprazolam oral - | 3 mg tablet |  | |
| alprazolam oral - | 0.5 mg tablet |  | |
| alprazolam oral - | 0.5 mg tablet |  | |
| alprazolam oral - | 0.25 mg tablet |  | |
| alprazolam oral - | 2 mg tablet |  | |
| alprazolam oral - | 2 mg tablet |  | |
| alprazolam oral - | 1 mg tablet |  | |
| alprazolam oral - | 0.25 mg tablet |  | |
| alprazolam oral - | 2 mg tablet |  | |
| alprazolam oral - | 0.5 mg tablet |  | |
| alprazolam oral - | 0.25 mg tablet |  | |
| alprazolam oral - | 2 mg tablet |  | |
| alprazolam oral - | 1 mg tablet |  | |
| alprazolam oral - | 2 mg tablet |  | |
| alprazolam oral - | 1 mg tablet |  | |
| alprazolam oral - | 1 mg tablet |  | |
| alprazolam oral - | 2 mg tablet |  | |
| alprazolam oral - | 1 mg tablet |  | |
| alprazolam oral - | 0.5 mg tablet |  | |
| alprazolam oral - | 0.5 mg tablet |  | |
| alprazolam oral - | 1 mg tablet |  | |
| alprazolam oral - | 2 mg tablet |  | |
| alprazolam oral - | 2 mg tablet |  | |
| alprazolam oral - | 2 mg tablet |  | |
| alprazolam oral - | 0.25 mg tablet |  | |
| alprazolam oral - | 1 mg tablet |  | |
| alprazolam oral - | 0.5 mg tablet |  | |
| alprazolam oral - | 0.25 mg tablet |  | |
| alprazolam oral - | 2 mg tablet |  | |
| alprazolam oral - | 1 mg tablet |  | |
| alprazolam oral - | 0.5 mg tablet |  | |
| alprazolam oral - | 1 mg tablet |  | |
| alprazolam oral - | 0.25 mg tablet |  | |
| alprazolam oral - | 2 mg tablet |  | |
| alprazolam oral - | 0.5 mg tablet |  | |
| alprazolam oral - | 0.5 mg tablet |  | |
| alprazolam oral - | 3 mg tablet |  | |
| alprazolam oral - | 2 mg tablet |  | |
| alprazolam oral - | 0.5 mg tablet |  | |
| alprazolam oral - | 1 mg tablet |  | |
| alprazolam oral - | 0.25 mg tablet |  | |
| alprazolam oral - | 1 mg tablet |  | |
| alprazolam oral - | 1 mg tablet |  | |
| alprazolam oral - | 2 mg tablet |  | |
| alprazolam oral - | 3 mg tablet |  | |
| alprazolam oral - | 1 mg tablet |  | |
| Xanax oral - | 0.25 mg tablet |  | |
| Xanax oral - | 1 mg tablet |  | |
| Xanax oral - | 0.5 mg tablet |  | |
| Xanax oral - | 2 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
alprazolam oral
ALPRAZOLAM EXTENDED-RELEASE - ORAL
(al-PRA-zoe-lam)
COMMON BRAND NAME(S): Xanax XR
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: This medication is used to treat the panic and anxiety symptoms associated with panic disorder. Alprazolam 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, usually once daily in the morning. Do not take with a high-fat meal because doing so can increase the risk of side effects. Swallow the tablets whole. Do not crush or chew the tablets. Doing so can release all of the drug at once, increasing the risk of side effects. The 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 lasts or gets worse.
SIDE EFFECTS: See also Warning section.Drowsiness, dizziness, increased saliva production, nausea, constipation, or change in sex drive/ability may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.To minimize dizziness and lightheadedness, get up slowly when rising from a seated or lying position.Remember that this medication has been prescribed because your doctor 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 you have any serious side effects, including: mental/mood changes (such as hallucinations, thoughts of suicide), trouble speaking, loss of coordination, trouble walking, memory problems.Get medical help right away if you have any very serious side effects, including: yellowing eyes/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: 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.Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using alprazolam. Alprazolam may harm an unborn baby. Newborn babies of mothers who use this medication late in pregnancy may have symptoms such as slow/shallow breathing, nonstop crying, shaking, or trouble feeding. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.This drug passes into breast milk and may have undesirable effects on a nursing infant. 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 adagrasib, azole antifungals (such as itraconazole, ketoconazole), cimetidine, certain anti-depressants (such as fluoxetine, fluvoxamine, nefazodone), 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.Lab and/or medical tests (such as liver function) should be done while you are taking this medication. Keep all medical and lab appointments. 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 August 2023. Copyright(c) 2023 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.
Formulary
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.
