Alprazolam

Alprazolam Brand Names

Niravam | Xanax | Xanax XR

What is Alprazolam

Alprazolam is an oral benzodiazepine used for the treatment of anxiety disorders including panic disorder with or without agoraphobia and generalized anxiety disorder.

It is also used for the short term management of nonspecific anxiety.

Benzodiazepines may be used as sedatives, however, treatment options with less addiction potential should be considered prior to initiation of a benzodiazepine for this purpose.

Alprazolam is often preferable to other benzodiazepines, such as chlordiazepoxide, clorazepate, and flurazepam because alprazolam has a shorter half-life and metabolites with minimal activity.

However, alprazolam has a relatively high potential for abuse and if discontinuation becomes necessary, tapering of the drug may take weeks to months. Therefore, other short-acting, high-potency benzodiazepines without active metabolites such as lorazepam and oxazepam are preferred in most instances.

Like other triazolo benzodiazepines such as triazolam, alprazolam may have significant drug interactions involving the hepatic cytochrome P-450 3A4 isoenzyme.

Therefore, it should be used cautiously, if at all, with significant inhibitors of this metabolic pathway.

Alprazolam was approved by the FDA in 1981 and became available as a generic in 1993.

The extended-release formulation of alprazolam (Xanax XR) for treatment of panic disorder was granted approval by the FDA in January 2003.

In general, the precautions, side effects, and drug interactions are similar between the immediate-release and extended-release formulations of alprazolam.

On January 21, 2005, an orally disintegrating formulation of alprazolam (Niravam) was approved by the FDA for use in generalized anxiety disorder and panic disorder.

Indications

• anxiety
• generalized anxiety disorder (GAD)
• panic disorder
• premenstrual dysphoric disorder (PMDD)
• premenstrual syndrome (PMS)

For the treatment of transient symptoms of anxiety, anxiety associated with depression, or generalized anxiety disorder (GAD)

Side Effects

1. abdominal pain
2. abnormal dreams
3. agitation
4. akathisia
5. amnesia
6. angioedema
7. anorexia
8. anxiety
9. appetite stimulation
10. arthralgia
11. asthenia
12. ataxia
13. back pain
14. blurred vision
15. chest pain (unspecified)
16. confusion
17. constipation
18. depression
19. diaphoresis
20. diarrhea
21. diplopia
22. dizziness
23. drowsiness
24. dysarthria
25. dyskinesia
26. dysmenorrhea
27. dyspepsia
28. dysphonia
29. dyspnea
30. dysuria
31. edema
32. elevated hepatic enzymes
33. epistaxis
34. euphoria
35. fatigue
36. fever
37. galactorrhea
38. gynecomastia
39. hallucinations
40. headache
41. hepatic failure
42. hepatitis
43. hostility
44. hot flashes
45. hyperbilirubinemia
46. hyperprolactinemia
47. hypersalivation
48. hyperventilation
49. hypotension
50. hypotonia
51. impaired cognition
52. impulse control symptoms
53. infection
54. influenza
55. insomnia
56. irritability
57. jaundice
58. lethargy
59. libido decrease
60. libido increase
61. malaise
62. mania
63. memory impairment
64. menstrual irregularity
65. muscle cramps
66. myalgia
67. mydriasis
68. nasal congestion
69. nausea
70. nightmares
71. palpitations
72. paresthesias
73. peripheral edema
74. photophobia
75. physiological dependence
76. pruritus
77. psychological dependence
78. psychomotor impairment
79. rash
80. rhinitis
81. rhinorrhea
82. seizures
83. sinus tachycardia
84. Stevens-Johnson syndrome
85. syncope
86. teratogenesis
87. tinnitus
88. tolerance
89. tremor
90. urinary incontinence
91. urticaria
92. vertigo
93. vomiting
94. weakness
95. weight gain
96. weight loss
97. withdrawal
98. xerostomia

Monitoring Parameters

• laboratory monitoring not necessary

Contraindications

• abrupt discontinuation
• anxiety
• benzodiazepine dependence
• benzodiazepine hypersensitivity
• bipolar disorder
• breast-feeding
• children
• chronic obstructive pulmonary disease (COPD)
• closed-angle glaucoma
• CNS depression
• coadministration with other CNS depressants
• coma
• dementia
• depression
• driving or operating machinery
• ethanol ingestion
• ethanol intoxication
• geriatric
• hepatic disease
• infants
• labor
• mania
• myasthenia gravis
• neonates
• obesity
• obstetric delivery
• Parkinson’s disease
• porphyria
• pregnancy
• psychosis
• pulmonary disease
• renal failure
• renal impairment
• respiratory depression
• seizure disorder
• seizures
• shock
• sleep apnea
• status epilepticus
• substance abuse
• suicidal ideation

Interactions

• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Diphenhydramine
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Propoxyphene
• Acetaminophen; Tramadol
• Acetazolamide
• Acrivastine; Pseudoephedrine
• Aldesleukin, IL-2
• Alfentanil
• Amiodarone
• Amitriptyline; Chlordiazepoxide
• Amobarbital
• Amoxapine
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Amprenavir
• Apalutamide
• Apomorphine
• Apraclonidine
• Aprepitant, Fosaprepitant
• Aripiprazole
• Asenapine
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Omeprazole
• Aspirin, ASA; Oxycodone
• Atazanavir
• Atazanavir; Cobicistat
• Atracurium
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Azelastine
• Azelastine; Fluticasone
• Barbiturates
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
• Benzhydrocodone; Acetaminophen
• Benztropine
• Boceprevir
• Bosentan
• Brexpiprazole
• Brimonidine
• Brimonidine; Brinzolamide
• Brimonidine; Timolol
• Brompheniramine
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Guaifenesin
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
• Buprenorphine
• Buprenorphine; Naloxone
• Buspirone
• Butabarbital
• Butorphanol
• Caffeine
• Caffeine; Ergotamine
• Cannabidiol
• Carbamazepine
• Carbetapentane; Chlorpheniramine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pseudoephedrine
• Carbetapentane; Pyrilamine
• Carbinoxamine
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Carbinoxamine; Pseudoephedrine
• Cariprazine
• Cenobamate
• Ceritinib
• Cetirizine
• Cetirizine; Pseudoephedrine
• Chlophedianol; Dexbrompheniramine
• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chlophedianol; Guaifenesin; Phenylephrine
• Chloramphenicol
• Chlorcyclizine
• Chlordiazepoxide
• Chlordiazepoxide; Clidinium
• Chlorpheniramine
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Chlorthalidone; Clonidine
• Cimetidine
• Ciprofloxacin
• Cisapride
• Cisatracurium
• Clarithromycin
• Clemastine
• Clobazam
• Clonazepam
• Clonidine
• Clorazepate
• Clozapine
• Cobicistat
• Codeine
• Codeine; Guaifenesin
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Colchicine; Probenecid
• COMT inhibitors
• Conivaptan
• Crizotinib
• Cyclizine
• Cyclosporine
• Cyproheptadine
• Dalfopristin; Quinupristin
• Danazol
• Darunavir
• Darunavir; Cobicistat
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Delavirdine
• Desflurane
• Deutetrabenazine
• Dexchlorpheniramine
• Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
• Dexmedetomidine
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Guaifenesin; Phenylephrine
• Diazepam
• Dicyclomine
• Digoxin
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Diltiazem
• Dimenhydrinate
• Diphenhydramine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Diphenhydramine; Phenylephrine
• Disulfiram
• Doxacurium
• Doxylamine
• Doxylamine; Pyridoxine
• Dronabinol
• Dronedarone
• Droperidol
• Drospirenone; Ethinyl Estradiol
• Drospirenone; Ethinyl Estradiol; Levomefolate
• Efavirenz
• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Elagolix
• Elbasvir; Grazoprevir
• Elexacaftor; tezacaftor; ivacaftor
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Enflurane
• Enzalutamide
• Ergotamine
• Erythromycin
• Erythromycin; Sulfisoxazole
• Esketamine
• Eslicarbazepine
• Estazolam
• Eszopiclone
• Ethanol
• Ethinyl Estradiol
• Ethinyl Estradiol; Desogestrel
• Ethinyl Estradiol; Ethynodiol Diacetate
• Ethinyl Estradiol; Etonogestrel
• Ethinyl Estradiol; Levonorgestrel
• Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
• Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
• Ethinyl Estradiol; Norelgestromin
• Ethinyl Estradiol; Norethindrone
• Ethinyl Estradiol; Norethindrone Acetate
• Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
• Ethinyl Estradiol; Norethindrone; Ferrous fumarate
• Ethinyl Estradiol; Norgestimate
• Ethinyl Estradiol; Norgestrel
• Ethosuximide
• Etomidate
• Fedratinib
• Felbamate
• Fentanyl
• Fluconazole
• Flumazenil
• Fluoxetine
• Fluoxetine; Olanzapine
• Flurazepam
• Fluvoxamine
• food
• Fosamprenavir
• Fospropofol
• Gabapentin
• General anesthetics
• grapefruit juice
• Green Tea
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guaifenesin; Phenylephrine
• Guanabenz
• Guanfacine
• Haloperidol
• Halothane
• Homatropine; Hydrocodone
• Hydantoins
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydromorphone
• Hydroxyzine
• Ibuprofen; Oxycodone
• Idelalisib
• Iloperidone
• Imatinib
• Indinavir
• Isavuconazonium
• Isoflurane
• Isoniazid, INH
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Itraconazole
• Ivacaftor
• Ketamine
• Ketoconazole
• Lacosamide
• Lamotrigine
• Lasmiditan
• Lefamulin
• Letermovir
• Levetiracetam
• Levocetirizine
• Levomethadyl
• Levomilnacipran
• Levorphanol
• Lithium
• Lofexidine
• Lomitapide
• Lopinavir; Ritonavir
• Lorazepam
• Loxapine
• Lumacaftor; Ivacaftor
• Lumacaftor; Ivacaftor
• Lumateperone
• Lurasidone
• Magnesium Salts
• Maprotiline
• Meclizine
• Meperidine
• Meperidine; Promethazine
• Mephobarbital
• Meprobamate
• Mestranol; Norethindrone
• Methadone
• Methocarbamol
• Methohexital
• Methscopolamine
• Methsuximide
• Methyldopa
• Metoclopramide
• Metyrapone
• Metyrosine
• Midazolam
• Mifepristone
• Milnacipran
• Minocycline
• Mirtazapine
• Mitotane
• Mivacurium
• Molindone
• Monoamine oxidase inhibitors
• Morphine
• Morphine; Naltrexone
• Nabilone
• Nalbuphine
• Nefazodone
• Nelfinavir
• Netupitant, Fosnetupitant; Palonosetron
• Neuromuscular blockers
• Nevirapine
• Nicardipine
• Nifedipine
• Nilotinib
• Nitroglycerin
• Obeticholic Acid
• Olanzapine
• Ombitasvir; Paritaprevir; Ritonavir
• Omeprazole
• Omeprazole; Amoxicillin; Rifabutin
• Omeprazole; Sodium Bicarbonate
• Oritavancin
• Oxazepam
• Oxcarbazepine
• Oxybutynin
• Oxycodone
• Oxymorphone
• Paliperidone
• Pancuronium
• Papaverine
• Paroxetine
• Pazopanib
• Pentazocine
• Pentazocine; Naloxone
• Pentobarbital
• Perampanel
• Phenobarbital
• Phenothiazines
• Phentermine; Topiramate
• Phenylephrine
• Phenylephrine; Promethazine
• Pimozide
• Posaconazole
• Pramipexole
• Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
• Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
• Pregabalin
• Primidone
• Probenecid
• Procarbazine
• Propofol
• Propoxyphene
• Quazepam
• Quetiapine
• Ramelteon
• Ranolazine
• Rapacuronium
• Rasagiline
• Remifentanil
• Ribociclib
• Ribociclib; Letrozole
• Rifabutin
• Rifampin
• Rifapentine
• Risperidone
• Ritonavir
• Rocuronium
• Ropinirole
• Rotigotine
• Rufinamide
• Safinamide
• Saquinavir
• Scopolamine
• Secobarbital
• Sedating H1-blockers
• Segesterone Acetate; Ethinyl Estradiol
• Sertraline
• Sevoflurane
• Simeprevir
• Sincalide
• Skeletal Muscle Relaxants
• Sodium Oxybate
• St. John’s Wort, Hypericum perforatum
• Streptogramins
• Succinimides
• Succinylcholine
• Sufentanil
• Suvorexant
• Tapentadol
• Tasimelteon
• Teduglutide
• Telaprevir
• Telithromycin
• Telotristat Ethyl
• Temazepam
• Tetrabenazine
• Tezacaftor; Ivacaftor
• Thalidomide
• Theophylline, Aminophylline
• Thiopental
• Thiothixene
• Tiagabine
• Tipranavir
• Tizanidine
• tobacco
• Topiramate
• Tramadol
• Trandolapril; Verapamil
• Trazodone
• Triazolam
• Tricyclic antidepressants
• Trihexyphenidyl
• Trimethobenzamide
• Triprolidine
• Tubocurarine
• Valerian, Valeriana officinalis
• Valproic Acid, Divalproex Sodium
• Vecuronium
• Verapamil
• Vigabatrin
• Vilazodone
• Voriconazole
• Zafirlukast
• Zaleplon
• Zileuton
• Ziprasidone
• Zolpidem
• Zonisamide