Alprazolam

Brand names

• Alprazolam Intensol
• Alti-Alprazolam
• Apo-Alpraz
• Gen-Alprazolam
• Med-Alprazolam
• Novo-Alprazol
• Nu-Alpraz
• Xanax

Usage

To treat anxiety and panic disorder.

How it works

In general, it produces mild sedation by depressing activity in the central nervous system. In particular, it appears to enhance the effect of gamma-aminobutyric acid (GABA), a natural chemical that inhibits the firing of neurons and dampens the transmission of nerve signals, thus decreasing nervous excitation.

Side effects

Serious

Difficulty concentrating, outbursts of anger, other behavior problems, depression, hallucinations, low blood pressure (causing faintness or confusion), memory impairment, muscle weakness, skin rash or itching, sore throat, fever and chills, sores or ulcers in throat or mouth, unusual bruising or bleeding, extreme fatigue, yellowish tinge to eyes or skin.

Common

Drowsiness, loss of coordination, unsteady gait, dizziness, lightheadedness, slurred speech.

Less common

Change in sexual desire or ability, constipation, false sense of well-being, nausea and vomiting, urinary problems, unusual fatigue.

Possible interactions

Other medicaments:

Alprazolam may increase the effects of:

• digoxin (Lanoxin) and cause digoxin toxicity.

Alprazolam may decrease the effects of:



• levodopa (Sinemet, etc.) and reduce its effect in treating Parkinson's disease.

The following medicaments may increase the effects of alprazolam:



• amprenavir (Agenerase).
• itraconazole or ketoconazole (azole antifungals).
• birth control pills (oral contraceptives-various kinds).
• cimetidine (Tagamet).
• delavirdine (Rescriptor).
• disulfiram (Antabuse).
• fluconazole (Diffuse).
• fluoxetine (Prozac).
• fluvoxamine (Luvox).
• isoniazid (INH, Rifamate, etc.).
• macrolide antibiotics (such as erythromycin, clarithromycin or azithromycin).
• medicines that inhibit a liver enzyme (CYP3A4) will increase alprazolam levels (talk to your pharmacist).
• omeprazole (Prilosec).
• paroxetine (Paxil).
• propoxyphene (Darvon, etc.).
• ritonavir (Norvir) and perhaps other protease inhibitors.
• sertraline (Zoloft).
• valproic acid (Depakene).

The following medicaments may decrease the effects of alprazolam:



• carbamazepine (Tegretol).
• rifampin (Rimactane, etc.).
• theophylline (aminophylline, Theo-Dur, etc.).

Alprazolam taken concurrently with:



• alcohol (ethanol) will worsen coordination and mental abilities.
• benzodiazepines can cause increased central nervous system (CNS) depression.
• buspirone (Buspar) can result in additive CNS depression.
• central nervous system active agents can cause increased central nervous system (CNS) depression.
• narcotics (morphine, etc.) cause additive CNS depression.
• nefazidone (Serzone) may double the blood level.
• tricyclic and other kinds of antidepressants results in additional CNS depression.

Herbal medicines or minerals:

Kava and valerian may exacerbate central nervous system depression (avoid this combination). Kola nut, Siberian ginseng, mate, and ephedra may blunt the benefits of this medicine. While St. John's wort is indicated for anxiety, it is also thought to increase (induce) cytochrome P450 enzymes and will tend to blunt alprazolam effectiveness if combined with alprazolam. St. John's wort may also worsen sun sensitivity caused by alprazolam.

Beverages:

Avoid excessive caffeine-containing beverages: coffee, tea, cola (counteracts effects). This medicament may be taken with milk.

Alcohol:

Use with extreme caution. Alcohol may increase the sedative effects of alprazolam. Alprazolam may increase the intoxicating effects of alcohol. Avoid alcohol completely-throughout the day and night-if you find it necessary to drive or engage in any hazardous activity.

Tobacco smoking:

Heavy smoking may reduce calming.

Exposure to sun:

Use caution; rare photosensitivity reports.

Discontinuation:

If this medicament has been taken for an extended period of time, do not stop it abruptly. Slowly reduce dose by 1 mg per week until a total daily dose of 4 mg is reached; by 0.5 mg per week until a total daily dose of 2 mg is reached; and then by 0.25 mg per week thereafter. Ask your doctor for help.