Buy Xanax

Generic Name: alprazolam (al PRAH zoe lam) Brand Names: Niravam, Xanax, Xanax XR What is the most important information I should know about alprazolam? • Use caution when driving, operating machinery, or performing other hazardous activities. Alprazolam will cause drowsiness and may cause dizziness. If you experience drowsiness or dizziness, avoid these activities. • Avoid alcohol while taking alprazolam. Alcohol may increase drowsiness and dizziness caused by alprazolam. • Do not crush, chew, or break the extended-release form alprazolam (Xanax XR). Swallow them whole. These tablets are specially formulated to release the medication slowly in the body. • Alprazolam is habit forming. You can become physically and psychologically dependent on the medication. Do not take more than the prescribed amount of medication or take it for longer than is directed by your doctor. Withdrawal effects may occur if alprazolam is stopped suddenly after several weeks of continuous use. Seizures may be a side effect of sudden discontinuation of the medication. Your doctor may recommend a gradual reduction in dose. What is alprazolam? • Alprazolam is in a class of drugs called benzodiazepines. Alprazolam affects chemicals in the brain that may become unbalanced and cause anxiety. • Alprazolam is used to relieve anxiety, nervousness, and tension associated with anxiety disorders. Alprazolam is also used to treat panic disorders. • Alprazolam may also be used for purposes other than those listed in this medication guide. What should I discuss with my healthcare provider before taking alprazolam? • Do not take alprazolam if you have narrow-angle glaucoma. Alprazolam may worsen this condition. • Before taking this medication, tell your doctor if you · have kidney disease; · have liver disease; · have a history of alcohol or drug abuse; · have asthma, bronchitis, emphysema, or another respiratory disease; · are depressed or have suicidal thoughts; or · have mania, bipolar disorder, or another psychiatric condition (other than anxiety or panic disorder). • You may not be able to take alprazolam, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above. • Alprazolam is in the FDA pregnancy category D. This means that alprazolam is known to be harmful to an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant or could become pregnant during treatment. • It is not known whether alprazolam passes into breast milk. Do not take alprazolam without first talking to your doctor if you are breast-feeding a baby. • If you are over 65 years of age, you may be more likely to experience side effects from alprazolam. Your doctor may prescribe a lower dose of the medication. How should I take alprazolam? • Take alprazolam exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you. • Take each dose with a full glass of water. • Do not crush, chew, or break the extended-release form alprazolam (Xanax XR). Swallow them whole. These tablets are specially formulated to release the medication slowly in the body. • Do not take more of the medication than is prescribed for you. • Alprazolam is habit forming. You can become physically and psychologically dependent on the medication. Do not take more than the prescribed amount of medication or take it for longer than is directed by your doctor. Withdrawal effects may occur if alprazolam is stopped suddenly after several weeks of continuous use. Seizures may be a side effect of sudden discontinuation of the medication. Your doctor may recommend a gradual reduction in dose. • Store alprazolam at room temperature away from moisture and heat. What happens if I miss a dose? • Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the dose you missed and take only the next regularly scheduled dose. Do not take a double dose of this medication. A double dose could be dangerous. Some doctors prescribe Xanax to treat alcohol withdrawal, fear of open spaces and strangers, depression, irritable bowel syndrome, and premenstrual syndrome. -------------------------------------------------------------------------------- Most important fact about this drug Return to top Tolerance and dependence can occur with the use of Xanax. You may experience withdrawal symptoms if you stop using the drug abruptly. The drug dosage should be gradually reduced and only your doctor should advise you on how to discontinue or change your dose. -------------------------------------------------------------------------------- How should you take this medication? Return to top Xanax may be taken with or without food. Take it exactly as prescribed. Do not chew, crush, or break the Xanax XR tablets. --If you miss a dose... If you are less than 1 hour late, take it as soon as you remember. Otherwise skip the dose and go back to your regular schedule. Never take 2 doses at the same time. --Storage instructions... Store Xanax at room temperature. -------------------------------------------------------------------------------- What side effects may occur? Return to top Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Xanax. Your doctor should periodically reassess the need for this drug. Side effects of Xanax are usually seen at the beginning of treatment and disappear with continued medication. However, if dosage is increased, side effects will be more likely. More common side effects may include: Abdominal discomfort, abnormal involuntary movement, agitation, allergies, anxiety, blurred vision, chest pain, confusion, constipation, decreased or increased sex drive, depression, diarrhea, difficult urination, dream abnormalities, drowsiness, dry mouth, fainting, fatigue, fluid retention, headache, hyperventilation (too frequent or too deep breathing), inability to fall asleep, increase or decrease in appetite, increased or decreased salivation, impaired memory, irritability, lack of or decreased coordination, light-headedness, low blood pressure, menstrual problems, muscular twitching, nausea and vomiting, nervousness, painful menstruation, palpitations, rapid heartbeat, rash, restlessness, ringing in the ears, sedation, sexual dysfunction, skin inflammation, speech difficulties, stiffness, stuffy nose, sweating, tiredness/sleepiness, tremors, upper respiratory infections, weakness, weight gain or loss Less common or rare side effects may include: Abnormal muscle tone, arm or leg pain, concentration difficulties, dizziness, double vision, fear, hallucinations, hot flushes, inability to control urination or bowel movements, infection, itching, joint pain, loss of appetite, muscle cramps, muscle spasticity, rage, seizures, shortness of breath, sleep disturbances, slurred speech, stimulation, talkativeness, taste alterations, temporary memory loss, tingling or pins and needles, uninhibited behavior, urine retention, weakness in muscle and bone, yellow eyes and skin Side effects due to decrease or withdrawal from Xanax or Xanax XR: Anxiety, blurred vision, decreased concentration, decreased mental clarity, depression, diarrhea, headache, heightened awareness of noise or bright lights, hot flushes, impaired sense of smell, insomnia, loss of appetite, loss of reality, muscle cramps, nervousness, rapid breathing, seizures, tingling sensation, tremor, twitching, weight loss -------------------------------------------------------------------------------- Why should this drug not be prescribed? Return to top If you are sensitive to or have ever had an allergic reaction to Xanax or other tranquilizers, you should not take this medication. Also avoid Xanax while taking the antifungal drugs Sporanox or Nizoral. Make sure that your doctor is aware of any drug reactions that you have experienced. Do not take this medication if you have been diagnosed with the eye condition called narrow-angle glaucoma. Anxiety or tension related to everyday stress usually does not require treatment with Xanax. Discuss your symptoms thoroughly with your doctor. -------------------------------------------------------------------------------- Special warnings about this medication Return to top Xanax may cause you to become drowsy or less alert; therefore, driving or operating dangerous machinery or participating in any hazardous activity that requires full mental alertness is not recommended. If you are being treated for panic disorder, you may need to take a higher dose of Xanax than for anxiety alone. High doses--more than 4 milligrams a day--of this medication taken for long intervals may cause emotional and physical dependence. It is important that your doctor supervise you carefully when you are using this medication. Remember that withdrawal symptoms can occur when Xanax is stopped suddenly or the doctor lowers your dosage. These include abnormal skin sensations, blurred vision, decreased appetite, diarrhea, distorted sense of smell, heightened senses, muscle cramps or twitching, problems concentrating, weight loss, and rarely, seizures. Withdrawal symptoms can be minimized or even avoided altogether by decreasing the Xanax dose gradually. As with all antianxiety medication, there is a small chance that Xanax could encourage suicidal thoughts or episodes of euphoria known as mania. If you notice any new or unusual symptoms after starting Xanax, call your doctor immediately. Xanax should be used with caution in elderly or weak patients, and in those with lung disease, alcoholic liver disease, or any disorder that could hinder the elimination of the drug. -------------------------------------------------------------------------------- Possible food and drug interactions when taking this medication Return to top Xanax may intensify the effect of alcohol. Do not drink alcohol while taking this medication. Never combine Xanax with Sporanox or Nizoral. These drugs cause a buildup of Xanax in the body. If Xanax is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is important to check with your doctor before combining Xanax with the following: Amiodarone (Cordarone) Antihistamines such as Benadryl and Tavist Carbamazepine (Tegretol) Certain antibiotics such as Biaxin and erythromycin Certain antidepressant drugs, including Elavil, Norpramin, and Tofranil Cimetidine (Tagamet) Cyclosporine (Neoral, Sandimmune) Digoxin (Lanoxin) Diltiazem (Cardizem) Disulfiram (Antabuse) Ergotamine Fluoxetine (Prozac) Fluvoxamine (Luvox) Grapefruit juice Isoniazid (Rifamate) Major tranquilizers such as Mellaril and Thorazine Nefazodone (Serzone) Nicardipine (Cardene) Nifedipine (Adalat, Procardia) Oral contraceptives Other central nervous system depressants such as Valium and Demerol Paroxetine (Paxil) Propoxyphene (Darvon) Sertraline (Zoloft) -------------------------------------------------------------------------------- Special information if you are pregnant or breastfeeding Return to top Do not take this medication if you are pregnant or planning to become pregnant. There is an increased risk of respiratory problems and muscular weakness in your baby. Infants may also experience withdrawal symptoms. Xanax may appear in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to stop breastfeeding until your treatment with this medication is finished. -------------------------------------------------------------------------------- Recommended dosage Return to top ADULTS -------------------------------------------------------------------------------- Anxiety disorder The usual starting dose of Xanax is 0.25 to 0.5 milligram taken 3 times a day. The dose may be increased every 3 to 4 days to a maximum daily dose of 4 milligrams, divided into smaller doses. Panic disorder The usual starting dose of regular Xanax is 0.5 milligram 3 times a day. This dose can be increased by 1 milligram a day every 3 or 4 days. You may be given a dose from 1 up to a total of 10 milligrams, according to your needs. The typical dose is 5 to 6 milligrams a day. If you're taking Xanax XR, the usual starting dose is 0.5 to 1 milligram once a day taken in the morning. Depending on your response, the dose may be gradually increased by no more than 1 milligram every 3 or 4 days. The usual effective dose is 3 to 6 milligrams a day. Some people may need a larger dose to relieve their symptoms. Others, including older adults and those with liver disease or other serious illnesses, may need to use lower doses. Your doctor will reassess your treatment periodically to be sure you're getting the right amount of medication. CHILDREN -------------------------------------------------------------------------------- Safety and effectiveness have not been established in children under 18 years of age. OLDER ADULTS -------------------------------------------------------------------------------- The usual starting dose for an anxiety disorder is 0.25 milligram, 2 or 3 times daily. The starting dose of Xanax XR is 0.5 milligrams once a day. This dose may be gradually increased if needed and tolerated. PATIENTS SWITCHING FROM XANAX TO XANAX XR -------------------------------------------------------------------------------- If you're taking divided doses of Xanax, the doctor will switch you to a once-daily dose of Xanax XR that equals the current amount you're taking. If your symptoms return after switching, the dose can be increased as needed. -------------------------------------------------------------------------------- Overdosage Return to top Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately. Symptoms of Xanax overdose may include: Confusion, coma, impaired coordination, sleepiness, slowed reaction time An overdose of Xanax, alone or after combining it with alcohol, can be fatal. In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For benzodiazepines, the following should be considered: Allergies-Tell your doctor if you have ever had any unusual or allergic reaction to benzodiazepines. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes. Certain benzodiazepine products may contain lactose, parabens, or soybean oil. Pregnancy-Chlordiazepoxide and diazepam have been reported to increase the chance of birth defects when used during the first 3 months of pregnancy. Although similar problems have not been reported with the other benzodiazepines, the chance always exists since all of the benzodiazepines are related. Studies in animals have shown that clonazepam, lorazepam, and temazepam cause birth defects or other problems, including death of the animal fetus. Too much use of a benzodiazepine during pregnancy may cause the baby to become dependent on the medicine. This may lead to withdrawal side effects after birth. Also, use of benzodiazepines during pregnancy, especially during the last weeks, may cause body temperature problems, breathing problems, difficulty in feeding, drowsiness, or muscle weakness in the newborn infant. Benzodiazepines given just before or during labor may cause weakness in the newborn infant. When diazepam is given in high doses (especially by injection) within 15 hours before delivery, it may cause breathing problems, muscle weakness, difficulty in feeding, and body temperature problems in the newborn infant. Breast-feeding-Benzodiazepines may pass into the breast milk and cause drowsiness, difficulty in feeding, and weight loss in nursing babies of mothers taking these medicines. Children-Most of the side effects of these medicines are more likely to occur in children, especially the very young. These patients are usually more sensitive than adults to the effects of benzodiazepines. It is possible that using clonazepam for long periods of time may cause unwanted effects on physical and mental growth in children. If such effects do occur, they may not be noticed until many years later. Before this medicine is given to children for long periods of time, you should discuss its use with your child's doctor. Older adults-Most of the side effects of these medicines are more likely to occur in the elderly, who are usually more sensitive to the effects of benzodiazepines. Taking benzodiazepines for trouble in sleeping may cause more daytime drowsiness in elderly patients than in younger adults. In addition, falls and related injuries are more likely to occur in elderly patients taking benzodiazepines. Other medicines-Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking or receiving benzodiazepines it is especially important that your health care professional know if you are taking any of the following: Central nervous system (CNS) depressants (medicines that cause drowsiness)-The CNS depressant effects of either these medicines or benzodiazepines may be increased; your doctor may want to change the dose of either or both medicines Fluvoxamine (e.g., Luvox) or Nefazodone (e.g., Serzone)-Higher blood levels of benzodiazepines may occur, increasing the chance that side effects will occur; your doctor may want to change the dose of either or both medicines, or give you a different medicine Itraconazole (e.g., Sporanox) or Ketoconazole (e.g., Nizoral)-These medicines should NOT be used if you are taking a benzodiazepine. Other medical problems-The presence of other medical problems may affect the use of benzodiazepines. Make sure you tell your doctor if you have any other medical problems, especially: Alcohol abuse (or history of) or Drug abuse or dependence (or history of)-Dependence on benzodiazepines may be more likely to develop Brain disease-CNS depression and other side effects of benzodiazepines may be more likely to occur Difficulty in swallowing (in children) or Emphysema, asthma, bronchitis, or other chronic lung disease or Hyperactivity or Mental depression or Mental illness (severe) or Myasthenia gravis or Porphyria or Sleep apnea (temporary stopping of breathing during sleep)-Benzodiazepines may make these conditions worse Epilepsy or history of seizures-Although some benzodiazepines are used in treating epilepsy, starting or suddenly stopping treatment with these medicines may increase seizures Glaucoma, acute narrow angle-Benzodiazepines should NOT be used if you have this condition. Glaucoma, open angle-Benzodiazepines can be used but your doctor should be monitoring your condition carefully. Kidney or liver disease-Higher blood levels of benzodiazepines may result, increasing the chance that side effects will occur -------------------------------------------------------------------------------- Proper Use of This Medicine For caregivers administering diazepam rectal gel : Discuss with the patient's medical doctor exactly when and how to use diazepam rectal gel. Discuss with the patient's medical doctor when you should call for emergency help. Read the instructions that you received with the medicine before you need to use it. Stay with the patient after administering diazepam rectal gel to check his or her condition as instructed by the doctor. For patients taking clorazepate extended-release tablets : Swallow tablets whole. Do not crush, break, or chew before swallowing. For patients taking alprazolam, diazepam, or lorazepam concentrated oral solution : Measure each dose carefully using the dropper provided with the medicine. It is recommended that each dose be mixed with water, soda or soda-like beverages, or semisolid food such as applesauce or pudding, just before it is taken. Take the entire mixture right away. It should not be saved to be used later. For patients taking lorazepam sublingual tablets : Do not chew or swallow the tablet. This medicine is meant to be absorbed through the lining of the mouth. Place the tablet under your tongue (sublingual) and let it slowly dissolve there. Do not swallow for at least 2 minutes. For patients taking alprazolam oral disintegrating tablets : Make sure your hands are dry. Just prior to taking the tablet, remove the tablet from the bottle. Immediately place the tablet on top of the tongue. The tablet will dissolve in seconds, and you may swallow it with your saliva. You do not need to drink water or other liquid to swallow the tablet. If you have split apart a tablet and only taken one half of the tablet, you should throw away the unused part of the tablet right away because it may not remain stable. Take this medicine only as directed by your doctor . Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. If too much is taken, it may become habit-forming (causing mental or physical dependence). If you think this medicine is not working properly after you have taken it for a few weeks, do not increase the dose . Instead, check with your doctor. For patients taking this medicine on a regular schedule for epilepsy or other seizure disorder : In order for this medicine to control your seizures, it must be taken every day in regularly spaced doses as ordered by your doctor . This is necessary to keep a constant amount of the medicine in the blood. To help keep the amount constant, do not miss any doses. For patients taking this medicine for insomnia : Do not take this medicine when your schedule does not permit you to get a full night's sleep (7 to 8 hours) . If you must wake up before this, you may continue to feel drowsy and may experience memory problems, because the effects of the medicine have not had time to wear off. For patients taking flurazepam : When you begin to take this medicine, your sleeping problem will improve somewhat the first night. However, 2 or 3 nights may pass before you receive the full effects of this medicine . Dosing-The dose of benzodiazepines will be different for different patients. Follow your doctor's orders or the directions on the label . The following information includes only the average doses of benzodiazepines. If your dose is different, do not change it unless your doctor tells you to do so. The number of capsules or tablets, or the amount of solution that you take, or the number of injections you receive, depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking benzodiazepines . For alprazolam For oral dosage form (solution or tablets): For anxiety: Adults-At first, 0.25 to 0.5 milligram (mg) three times a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 4 mg a day. Children younger than 18 years of age-Use and dose must be determined by your doctor. Older adults-At first, 0.25 mg two or three times a day. Your doctor may increase your dose if needed. For panic disorder: Adults-At first, 0.5 mg three times a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 10 mg a day. Children younger than 18 years of age-Use and dose must be determined by your doctor. For bromazepam For oral dosage form (tablets): For anxiety: Adults-6 to 30 milligrams (mg) a day, taken in smaller doses during the day. Children younger than 18 years of age-Use and dose must be determined by your doctor. Older adults-At first, up to 3 mg a day. Your doctor may change your dose if needed. For chlordiazepoxide For oral dosage form (capsules): For anxiety: Adults-5 to 25 milligrams (mg) three or four times a day. Children 6 years of age and older-5 mg two to four times a day. Your doctor may increase your dose if needed. Children younger than 6 years of age-Use and dose must be determined by your doctor. Older adults-At first, 5 mg two to four times a day. Your doctor may increase your dose if needed. For sedation during withdrawal from alcohol: Adults-At first, 50 to 100 mg, repeated if needed. However, the dose usually is not more than 400 mg a day. Children-Use and dose must be determined by your doctor. For injection dosage form: For anxiety: Adults-At first, 50 to 100 mg, injected into a muscle or vein. Then, if needed, 25 to 50 mg three or four times a day. Teenagers-25 to 50 mg, injected into a muscle or vein. Children younger than 12 years of age-Use and dose must be determined by your doctor. Older adults-25 to 50 mg, injected into a muscle or vein. For sedation during withdrawal from alcohol: Adults-At first, 50 to 100 mg, injected into a muscle or vein. If needed, the dose may be repeated in two to four hours. Children-Use and dose must be determined by your doctor. For clobazam For oral dosage form (tablets): For control of seizures: Adults-At first, 5 to 15 milligrams (mg) a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 80 mg a day. Children 2 to 16 years of age-At first, 5 mg a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 40 mg a day. Children younger than 2 years of age-Dose is based on body weight and must be determined by your doctor. For clonazepam For oral dosage form (tablets): For control of seizures: Adults-At first, 0.5 milligram (mg) three times a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 20 mg a day. Infants and children younger than 10 years of age-Dose is based on body weight and must be determined by your doctor. For panic disorder: Adults-At first, 0.25 mg two times a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 4 mg a day. Children-Use and dose must be determined by your doctor. For clorazepate For oral dosage form (capsules or tablets): For anxiety: Adults and teenagers-7.5 to 15 mg two to four times a day. Or your doctor may want you to start by taking 15 mg at bedtime. Children younger than 12 years of age-Use and dose must be determined by your doctor. Older adults-At first, 3.75 to 15 mg a day. Your doctor may increase your dose if needed. For sedation during withdrawal from alcohol: Adults and teenagers-At first, 30 mg. Your doctor will set up a schedule that will gradually reduce your dose. Children younger than 12 years of age-Use and dose must be determined by your doctor. For control of seizures: Adults and teenagers-At first, up to 7.5 mg taken three times a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 90 mg a day. Children 9 to 12 years of age-At first, up to 7.5 mg two times a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 60 mg a day. Children younger than 9 years of age-Use and dose must be determined by your doctor. For oral dosage form (extended-release tablets): For anxiety: Adults and teenagers-Your doctor may change your dosage form to the extended-release tablet if you are already taking 3.75 or 7.5 milligrams (mg) of clorazepate three times a day. The extended-release tablet is taken one time each day. Children younger than 12 years of age-Use and dose must be determined by your doctor. For control of seizures: Adults, teenagers, and children 9 to 12 years of age-Your doctor may change your dosage form to the extended-release tablet if you are already taking 3.75 or 7.5 milligrams (mg) of clorazepate three times a day. The extended-release tablet is taken one time each day. Children younger than 9 years of age-Use and dose must be determined by your doctor. For diazepam For oral dosage form (solution or tablets): For anxiety: Adults-2 to 10 mg two to four times a day. Children 6 months of age and older-Dose is based on body weight or size and must be determined by your doctor. Children younger than 6 months of age-Use is not recommended. Older adults-2 to 2.5 mg one or two times a day. Your doctor may increase your dose if needed. For sedation during withdrawal from alcohol: Adults-At first, 10 mg three or four times a day. Your doctor will set up a schedule that will gradually decrease your dose. Children-Use and dose must be determined by your doctor. For control of seizures: Adults-2 to 10 mg two to four times a day. Children 6 months of age and older-Dose is based on body weight or size and must be determined by your doctor. Children younger than 6 months of age-Use is not recommended. Older adults-2 to 2.5 mg one or two times a day. Your doctor may increase your dose if needed. For relaxing muscles: Adults-2 to 10 mg three or four times a day. Children 6 months of age and older-Dose is based on body weight or size and must be determined by your doctor. Children younger than 6 months of age-Use is not recommended. Older adults-2 to 2.5 mg one or two times a day. Your doctor may increase your dose if needed. For injection dosage form: For anxiety: Adults-2 to 10 mg, injected into a muscle or vein. Children-Use and dose must be determined by your doctor. For older adults-2 to 5 mg, injected into a muscle or vein. For sedation during withdrawal from alcohol: Adults-At first, 10 mg injected into a muscle or vein. If needed, 5 to 10 mg may be given three or four hours later. Children-Use and dose must be determined by your doctor. For sedation before surgery or other procedures: Adults-5 to 20 mg, injected into a muscle or vein. Children-Use and dose must be determined by your doctor. Older adults-2 to 5 mg, injected into a muscle or vein. For control of seizures: Adults-At first, 5 to 10 mg, usually injected into a vein every ten to fifteen minutes, stopping if the total dose reaches 30 mg. If needed, this treatment may be repeated in two to four hours. Children 5 years of age and older-At first, 1 mg, usually injected into a vein every two to five minutes, stopping if the total dose reaches 10 mg. This treatment may be repeated in two to four hours. Infants older than 30 days of age and children younger than 5 years of age-At first, 0.2 to 0.5 mg, usually injected into a vein every two to five minutes, stopping if the total dose reaches 5 mg. This treatment may be repeated in two to four hours. Newborns and infants 30 days of age and younger-Use and dose must be determined by your doctor. Older adults-2 to 5 mg, injected into a muscle or vein. For relaxing muscle spasms: Adults-At first, 5 to 10 mg injected into a muscle or vein. The dose may be repeated in three or four hours. Children-Use and dose must be determined by your doctor. Older adults-2 to 5 mg, injected into a muscle or vein. For relaxing muscles in tetanus: Adults-At first, 5 to 10 mg injected into a muscle or vein. Your doctor may increase your dose if needed. Children 5 years of age and older-5 to 10 mg, injected into a muscle or vein. The dose may be repeated every three to four hours if needed. Infants older than 30 days of age and children younger than 5 years of age-1 to 2 mg, injected into a muscle or vein. The dose may be repeated every three to four hours if needed. Newborns and infants 30 days of age and younger-Use and dose must be determined by your doctor. For rectal dosage form (gel or solution): For control of seizures: Adults and teenagers-Dose is based on body weight and must be determined by your doctor. Children-Dose is based on body weight and must be determined by your doctor. For estazolam For oral dosage form (tablets): For trouble in sleeping: Adults-1 milligram (mg) at bedtime. Your doctor may increase your dose if needed. However, the dose usually is not more than 2 mg. Children younger than 18 years of age-Use and dose must be determined by your doctor. For flurazepam For oral dosage form (capsules or tablets): For trouble in sleeping: Adults-15 or 30 milligrams (mg) at bedtime. Children younger than 15 years of age-Use and dose must be determined by your doctor. Older adults-At first, 15 mg at bedtime. Your doctor may increase your dose if needed. For halazepam For oral dosage form (tablets): For anxiety: Adults-20 to 40 milligrams (mg) three or four times a day. Children younger than 18 years of age-Use and dose must be determined by your doctor. Older adults-20 mg one or two times a day. For lorazepam For oral dosage form (concentrate or tablets): For anxiety: Adults and teenagers-1 to 3 milligrams (mg) two or three times a day. Children younger than 12 years of age-Use and dose must be determined by your doctor. Older adults-0.5 to 2 mg a day, taken in smaller doses during the day. For trouble in sleeping: Adults and teenagers-2 to 4 mg taken at bedtime. Children younger than 12 years of age-Use and dose must be determined by your doctor. For sublingual tablet dosage form: For anxiety: Adults-2 to 3 mg a day, in smaller doses placed under the tongue during the day. Your doctor may increase your dose if needed. However, the dose usually is not more than 6 mg a day. Children younger than 18 years of age-Use and dose must be determined by your doctor. Older adults-At first, 0.5 mg a day. Your doctor may increase your dose if needed. For sedation before surgery: Adults-Dose is based on body weight and will be determined by your doctor. However, the dose usually is not more than 4 mg, placed under the tongue, one to two hours before surgery. Children-Use and dose must be determined by your doctor. For injection dosage form: For sedation before surgery or other procedures: Adults-Dose is based on body weight and will be determined by your doctor. However, the dose usually is not more than 4 mg, injected into a muscle or vein. Children younger than 18 years of age-Use and dose must be determined by your doctor. For control of seizures: Adults-At first, 4 mg slowly injected into a vein. The dose may be repeated after ten to fifteen minutes if needed. Children younger than 18 years of age-Use and dose must be determined by your doctor. For nitrazepam For oral dosage form (tablets): For trouble in sleeping: Adults-5 to 10 milligrams (mg) at bedtime. Children-Use and dose must be determined by your doctor. Older adults-At first, 2.5 mg taken at bedtime. Your doctor may increase your dose if needed. For control of seizures: Children less than 30 kilograms (66 pounds) of body weight-Dose is based on body weight and will be determined by your doctor. For oxazepam For oral dosage form (capsules or tablets): For anxiety: Adults-10 to 30 milligrams (mg) three or four times a day. Children younger than 12 years of age-Use and dose must be determined by your doctor. Older adults-At first, 5 mg one or two times a day or 10 mg three times a day. Your doctor may increase your dose if needed. However, the dose usually is not more than 15 mg four times a day. For sedation during withdrawal from alcohol: Adults-15 to 30 mg three or four times a day. Children younger than 12 years of age-Use and dose must be determined by your doctor. For quazepam For oral dosage form (tablets): For trouble in sleeping: Adults-7.5 to 15 milligrams (mg) at bedtime. Children younger than 18 years of age-Use and dose must be determined by your doctor. For temazepam For oral dosage form (capsules): For trouble in sleeping: Adults-15 milligrams (mg) at bedtime. Your doctor may change your dose if needed. Children younger than 18 years of age-Use and dose must be determined by your doctor. Older adults-At first, 7.5 mg at bedtime. Your doctor may increase your dose if needed. For triazolam For oral dosage form (tablets): For trouble in sleeping: Adults-0.125 to 0.25 milligram (mg) at bedtime. Children younger than 18 years of age-Use and dose must be determined by your doctor. Older adults-At first, 0.125 mg at bedtime. Your doctor may increase your dose if needed. Missed dose-If you are taking this medicine regularly (for example, every day as for epilepsy) and you miss a dose, take it right away if you remember within an hour or so of the missed dose. However, if you do not remember until later, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Storage-To store this medicine: Keep out of the reach of children. Overdose of benzodiazepines may be especially dangerous in children. Store away from heat and direct light. Do not store the capsule or tablet form of this medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down. Keep the liquid form of this medicine from freezing. Keep the oral disintegrating tablet form of this medicine in a tightly sealed bottle and discard any cotton that was included in the bottle Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children. -------------------------------------------------------------------------------- Precautions While Using This Medicine If you will be taking a benzodiazepine regularly for a long time : Your doctor should check your progress at regular visits to make sure that this medicine does not cause unwanted effects. If you are taking a benzodiazepine for convulsions (seizures), this is also important during the first few months of treatment. Check with your doctor at regular visits to see if you need to continue taking this medicine. If you are taking a benzodiazepine for epilepsy or another seizure disorder : Your doctor may want you to carry a medical identification card or bracelet stating that you are taking this medicine. If you are taking a benzodiazepine for insomnia (trouble in sleeping): If you think you need this medicine for more than 7 to 10 days, be sure to discuss it with your doctor. Insomnia that lasts longer than this may be a sign of another medical problem. You may have difficulty sleeping (rebound insomnia) for the first few nights after you stop taking this medicine. Benzodiazepines may be habit-forming (causing mental or physical dependence) , especially when taken for a long time or in high doses. Some signs of dependence on benzodiazepines are: A strong desire or need to continue taking the medicine. A need to increase the dose to receive the effects of the medicine. Withdrawal effects (for example, irritability, nervousness, trouble in sleeping, abdominal or stomach cramps, trembling or shaking) occurring after the medicine is stopped. If you think you may have become mentally or physically dependent on this medicine, check with your doctor . Do not stop taking it suddenly. If you have been taking this medicine in large doses or for a long time, do not stop taking it without first checking with your doctor . Your doctor may want you to reduce gradually the amount you are taking before stopping completely. Stopping this medicine suddenly may cause withdrawal side effects, including seizures. Stopping this medicine suddenly is most likely to cause seizures if you have been taking it for epilepsy or another seizure disorder. This medicine will add to the effects of alcohol and other central nervous system (CNS) depressants (medicines that slow down the nervous system, possibly causing drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. This effect may last for a few days after you stop taking this medicine. Check with your doctor before taking any of the above while you are taking this medicine . If you think you or someone else may have taken an overdose of this medicine, get emergency help at once . Taking an overdose of a benzodiazepine or taking alcohol or other CNS depressants with the benzodiazepine may lead to unconsciousness and possibly death. Some signs of an overdose are continuing slurred speech or confusion, severe drowsiness, severe weakness, and staggering. Before you have any medical tests, tell the medical doctor in charge that you are taking this medicine. The results of the metyrapone test may be affected by chlordiazepoxide. If you develop any unusual and strange thoughts or behavior while you are taking this medicine, be sure to discuss it with your doctor. Some changes that have occurred in people taking this medicine are like those seen in people who drink alcohol and then act in a manner that is not normal. Other changes may be more unusual and extreme, such as confusion, agitation, and hallucinations (seeing, hearing, or feeling things that are not there). This medicine may cause some people, especially older persons, to become drowsy, dizzy, lightheaded, clumsy or unsteady, or less alert than they are normally. Even if taken at bedtime, it may cause some people to feel drowsy or less alert on arising. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert . -------------------------------------------------------------------------------- Side Effects of This Medicine Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Check with your doctor as soon as possible if any of the following side effects occur: Less common Anxiety; confusion (may be more common in the elderly); fast, pounding, or irregular heartbeat; lack of memory of events taking place after benzodiazepine is taken (may be more common with triazolam); mental depression Rare Abnormal thinking, including disorientation, delusions (holding false beliefs that cannot be changed by facts), or loss of sense of reality; agitation; behavior changes, including aggressive behavior, bizarre behavior, decreased inhibition, or outbursts of anger; convulsions (seizures); hallucinations (seeing, hearing, or feeling things that are not there); hypotension (low blood pressure); muscle weakness; skin rash or itching; sore throat, fever, and chills; trouble in sleeping; ulcers or sores in mouth or throat (continuing); uncontrolled movements of body, including the eyes; unusual bleeding or bruising; unusual excitement, nervousness, or irritability; unusual tiredness or weakness (severe); yellow eyes or skin Symptoms of overdose Confusion (continuing); convulsions (seizures); drowsiness (severe) or coma; shakiness; slow heartbeat; slow reflexes; slurred speech (continuing); staggering; troubled breathing; weakness (severe) For patients having chlordiazepoxide, diazepam, or lorazepam injected : Check with your doctor if there is redness, swelling, or pain at the place of injection. Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome: More common Clumsiness or unsteadiness; dizziness or lightheadedness; drowsiness; slurred speech Less common or rare Abdominal or stomach cramps or pain; blurred vision or other changes in vision; changes in sexual desire or ability; constipation; diarrhea; dryness of mouth or increased thirst; false sense of well-being; headache; increased bronchial secretions or watering of mouth; muscle spasm; nausea or vomiting; problems with urination; trembling or shaking; unusual tiredness or weakness Not all of the side effects listed above have been reported for each of these medicines, but they have been reported for at least one of them. All of the benzodiazepines are similar, so any of the above side effects may occur with any of these medicines. After you stop using this medicine, your body may need time to adjust. During this time, check with your doctor if you notice any of the following side effects: More common Irritability; nervousness; trouble in sleeping Less common Abdominal or stomach cramps; confusion; fast or pounding heartbeat; increased sense of hearing; increased sensitivity to touch and pain; increased sweating; loss of sense of reality; mental depression; muscle cramps; nausea or vomiting; sensitivity of eyes to light; tingling, burning, or prickly sensations; trembling or shaking Rare Confusion as to time, place, or person; convulsions (seizures); feelings of suspicion or distrust; hallucinations (seeing, hearing, or feeling things that are not there) Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor. -------------------------------------------------------------------------------- Additional Information Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, some of the benzodiazepines are used in certain patients with the following medical conditions: Nausea and vomiting caused by cancer chemotherapy Tension headache Tremors Other than the above information, there is no additional information relating to proper use, precautions, or side effects for these uses. -------------------------------------------------------------------------------- Revised: 02/24/2005 The information contained in the Thomson Healthcare (Micromedex) products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you. The use of the Thomson Healthcare products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Thomson Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Healthcare does not assume any responsibility or risk for your use of the Thomson Healthcare products.

Important Safety Information: XANAX XR should not be used if you are allergic to benzodiazepines, have a condition called acute narrow angle glaucoma, or are taking the anti-fungal medications ketoconazole or itraconazole. XANAX XR is not recommended for use in pregnancy. Therefore, let your doctor know if you are pregnant, if you are planning to become pregnant, or if you become pregnant while you are taking this medication. Let your doctor know if you are nursing. The most common side effect is sedation, but this often decreases or goes away in most people after their bodies get used to the drug. Until you experience how XANAX XR affects you, do not drive a car or operate potentially dangerous machinery, etc. Other common side effects, which occur in fewer patients, include sleepiness, memory impairment, impaired speech, abnormal coordination and/or muscle action, and reduced sexual drive. Some patients may experience side effects associated with psychological and/or physical dependence on XANAX XR. Medications like XANAX XR, even when used as recommended, may produce psychological and/or physical dependence. This may make it very difficult to discontinue treatment with XANAX XR. Discontinuation symptoms, including the possibility of seizures, may occur following abrupt discontinuation from any dose, but the risk may be increased with extended use at doses greater than 4 mg/day. It is important that you get your doctor's advice on how to discontinue treatment safely and carefully. Gradually tapering your XANAX XR dose will help to decrease the possibility of discontinuation symptoms. Xanax is a tranquilizer used in the short-term relief of symptoms of anxiety or the treatment of anxiety disorders. Anxiety disorder is marked by unrealistic worry or excessive fears and concerns. Anxiety associated with depression is also responsive to Xanax. Xanax and the extended-release formulation, Xanax XR, are also used in the treatment of panic disorder, which appears as unexpected panic attacks and may be accompanied by a fear of open or public places called agoraphobia. Only your doctor can diagnose panic disorder and best advise you about treatment. Some doctors prescribe Xanax to treat alcohol withdrawal, fear of open spaces and strangers, depression, irritable bowel syndrome, and premenstrual syndrome. -------------------------------------------------------------------------------- Most important fact about this drug Return to top Tolerance and dependence can occur with the use of Xanax. You may experience withdrawal symptoms if you stop using the drug abruptly. The drug dosage should be gradually reduced and only your doctor should advise you on how to discontinue or change your dose. -------------------------------------------------------------------------------- How should you take this medication? Return to top Xanax may be taken with or without food. Take it exactly as prescribed. Do not chew, crush, or break the Xanax XR tablets. --If you miss a dose... If you are less than 1 hour late, take it as soon as you remember. Otherwise skip the dose and go back to your regular schedule. Never take 2 doses at the same time. --Storage instructions... Store Xanax at room temperature. -------------------------------------------------------------------------------- What side effects may occur? Return to top Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Xanax. Your doctor should periodically reassess the need for this drug. Side effects of Xanax are usually seen at the beginning of treatment and disappear with continued medication. However, if dosage is increased, side effects will be more likely. More common side effects may include: Abdominal discomfort, abnormal involuntary movement, agitation, allergies, anxiety, blurred vision, chest pain, confusion, constipation, decreased or increased sex drive, depression, diarrhea, difficult urination, dream abnormalities, drowsiness, dry mouth, fainting, fatigue, fluid retention, headache, hyperventilation (too frequent or too deep breathing), inability to fall asleep, increase or decrease in appetite, increased or decreased salivation, impaired memory, irritability, lack of or decreased coordination, light-headedness, low blood pressure, menstrual problems, muscular twitching, nausea and vomiting, nervousness, painful menstruation, palpitations, rapid heartbeat, rash, restlessness, ringing in the ears, sedation, sexual dysfunction, skin inflammation, speech difficulties, stiffness, stuffy nose, sweating, tiredness/sleepiness, tremors, upper respiratory infections, weakness, weight gain or loss Less common or rare side effects may include: Abnormal muscle tone, arm or leg pain, concentration difficulties, dizziness, double vision, fear, hallucinations, hot flushes, inability to control urination or bowel movements, infection, itching, joint pain, loss of appetite, muscle cramps, muscle spasticity, rage, seizures, shortness of breath, sleep disturbances, slurred speech, stimulation, talkativeness, taste alterations, temporary memory loss, tingling or pins and needles, uninhibited behavior, urine retention, weakness in muscle and bone, yellow eyes and skin Side effects due to decrease or withdrawal from Xanax or Xanax XR: Anxiety, blurred vision, decreased concentration, decreased mental clarity, depression, diarrhea, headache, heightened awareness of noise or bright lights, hot flushes, impaired sense of smell, insomnia, loss of appetite, loss of reality, muscle cramps, nervousness, rapid breathing, seizures, tingling sensation, tremor, twitching, weight loss -------------------------------------------------------------------------------- Why should this drug not be prescribed? Return to top If you are sensitive to or have ever had an allergic reaction to Xanax or other tranquilizers, you should not take this medication. Also avoid Xanax while taking the antifungal drugs Sporanox or Nizoral. Make sure that your doctor is aware of any drug reactions that you have experienced. Do not take this medication if you have been diagnosed with the eye condition called narrow-angle glaucoma. Anxiety or tension related to everyday stress usually does not require treatment with Xanax. Discuss your symptoms thoroughly with your doctor. -------------------------------------------------------------------------------- Special warnings about this medication Return to top Xanax may cause you to become drowsy or less alert; therefore, driving or operating dangerous machinery or participating in any hazardous activity that requires full mental alertness is not recommended. If you are being treated for panic disorder, you may need to take a higher dose of Xanax than for anxiety alone. High doses--more than 4 milligrams a day--of this medication taken for long intervals may cause emotional and physical dependence. It is important that your doctor supervise you carefully when you are using this medication. Remember that withdrawal symptoms can occur when Xanax is stopped suddenly or the doctor lowers your dosage. These include abnormal skin sensations, blurred vision, decreased appetite, diarrhea, distorted sense of smell, heightened senses, muscle cramps or twitching, problems concentrating, weight loss, and rarely, seizures. Withdrawal symptoms can be minimized or even avoided altogether by decreasing the Xanax dose gradually. As with all antianxiety medication, there is a small chance that Xanax could encourage suicidal thoughts or episodes of euphoria known as mania. If you notice any new or unusual symptoms after starting Xanax, call your doctor immediately. Xanax should be used with caution in elderly or weak patients, and in those with lung disease, alcoholic liver disease, or any disorder that could hinder the elimination of the drug. -------------------------------------------------------------------------------- Possible food and drug interactions when taking this medication Return to top Xanax may intensify the effect of alcohol. Do not drink alcohol while taking this medication. Never combine Xanax with Sporanox or Nizoral. These drugs cause a buildup of Xanax in the body. If Xanax is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is important to check with your doctor before combining Xanax with the following: Amiodarone (Cordarone) Antihistamines such as Benadryl and Tavist Carbamazepine (Tegretol) Certain antibiotics such as Biaxin and erythromycin Certain antidepressant drugs, including Elavil, Norpramin, and Tofranil Cimetidine (Tagamet) Cyclosporine (Neoral, Sandimmune) Digoxin (Lanoxin) Diltiazem (Cardizem) Disulfiram (Antabuse) Ergotamine Fluoxetine (Prozac) Fluvoxamine (Luvox) Grapefruit juice Isoniazid (Rifamate) Major tranquilizers such as Mellaril and Thorazine Nefazodone (Serzone) Nicardipine (Cardene) Nifedipine (Adalat, Procardia) Oral contraceptives Other central nervous system depressants such as Valium and Demerol Paroxetine (Paxil) Propoxyphene (Darvon) Sertraline (Zoloft) -------------------------------------------------------------------------------- Special information if you are pregnant or breastfeeding Return to top Do not take this medication if you are pregnant or planning to become pregnant. There is an increased risk of respiratory problems and muscular weakness in your baby. Infants may also experience withdrawal symptoms. Xanax may appear in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to stop breastfeeding until your treatment with this medication is finished. -------------------------------------------------------------------------------- Recommended dosage Return to top ADULTS -------------------------------------------------------------------------------- Anxiety disorder The usual starting dose of Xanax is 0.25 to 0.5 milligram taken 3 times a day. The dose may be increased every 3 to 4 days to a maximum daily dose of 4 milligrams, divided into smaller doses. Panic disorder The usual starting dose of regular Xanax is 0.5 milligram 3 times a day. This dose can be increased by 1 milligram a day every 3 or 4 days. You may be given a dose from 1 up to a total of 10 milligrams, according to your needs. The typical dose is 5 to 6 milligrams a day. If you're taking Xanax XR, the usual starting dose is 0.5 to 1 milligram once a day taken in the morning. Depending on your response, the dose may be gradually increased by no more than 1 milligram every 3 or 4 days. The usual effective dose is 3 to 6 milligrams a day. Some people may need a larger dose to relieve their symptoms. Others, including older adults and those with liver disease or other serious illnesses, may need to use lower doses. Your doctor will reassess your treatment periodically to be sure you're getting the right amount of medication. CHILDREN -------------------------------------------------------------------------------- Safety and effectiveness have not been established in children under 18 years of age. OLDER ADULTS -------------------------------------------------------------------------------- The usual starting dose for an anxiety disorder is 0.25 milligram, 2 or 3 times daily. The starting dose of Xanax XR is 0.5 milligrams once a day. This dose may be gradually increased if needed and tolerated. PATIENTS SWITCHING FROM XANAX TO XANAX XR -------------------------------------------------------------------------------- If you're taking divided doses of Xanax, the doctor will switch you to a once-daily dose of Xanax XR that equals the current amount you're taking. If your symptoms return after switching, the dose can be increased as needed. -------------------------------------------------------------------------------- Symptom Relief. XANAX XR is a prescription medicine proven effective in the treatment of patients with panic disorder with or without agoraphobia. It boosts the effects of GABA, a natural chemical in your body that sends messages to your brain that tell it to "calm down." Do you have panic symptoms? Once-a-Day Convenience. XANAX XR gives you the benefits of a benzodiazepine to treat panic disorder, in a once-daily formula. You won't have to "watch the clock" or worry about where you'll be when you have to take your next dose. And that can help you relax. Learn how XANAX XR can help you. All Day Relief. Most benzodiazepines have to be taken 2 to 4 times within 24 hours for all day relief. With other medicines, you may feel calm after you take the medicine but then lose that feeling before it's time to take the next dose. Learn how once-daily treatment can work for you. Advanced Formula. XANAX XR is a long-acting formulation of XANAX® (alprazolam), the most prescribed medication of its kind in the United States.1 Learn more about what makes it different. Could XANAX XR help you? XANAX XR is a prescription medication for the treatment of patients with panic disorder, with or without agoraphobia. XANAX XR is an advanced form of XANAX® (alprazolam). It is the first and only medicine of its kind made to be taken just once a day for panic disorder. It works quickly and keeps working all day long. Explore this section to learn more about the benefits of XANAX XR and how it may help you focus on everyday living, instead of when to take your next Nine-wk, open label, switch study of 30 patients with panic disorder, with or without agoraphobia (DSM-IV™). Dosage— patients were stabilized for 3 wk on XANAX (0.75-10 mg/d), then switched to equivalent dose of XANAX XR. Results depicted are from Wk 3 and 4 for XANAX and XANAX XR, respectively, and based on patient diary data, in which patients kept an hourly record of degree (on a 0- to 10-point scale) of anxiolytic benefit they received from each dose of medication. Diaries were compiled and analyzed to determine the time it took, in hours, to reach a maximum score after the first morning dose. While all patients are different, some patients may begin to see improvement in their symptoms as early as the first week. However, the full effect may take several weeks. To get the full benefit of your medicine, be sure to take it as prescribed by your doctor. When you start taking XANAX XR, you may not feel its effects right away. This is because it is released slowly into your system so that it will last throughout the day. As shown in the chart below, XANAX XR took 1.6 hours to reach maximum benefit, compared to 1.5 hours with XANAX® (alprazolam), suggesting that it essentially works just as quickly. If you're wondering if XANAX XR may help you, talk to your doctor. He or she may suggest that XANAX XR will allow you to take your medicine just once a day. Here are some tips to help you prepare for your doctor's visit. Write down your questions in advance. Bring the list with you and take notes during your visit to help yourself remember the answers later. Write down the names of any medicines you are currently taking. If you're taking medicine for panic symptoms, what is the dose and how often do you take your medicine each day? (Consider asking about a convenient once-daily dose.) You may want to consider bringing a family member or friend along to help you remember everything that is discussed and also for support. Learn all you can about panic disorder before you visit the doctor so you can discuss it while you're there. Keep a list of your symptoms, including where and when they occur. You may be able to spot trends or more easily see patterns when you write them down and look at your notes all at once. Xanax This page contains drug information on Xanax. The information provided includes the following: what is Xanax the possible side effects of Xanax what happens if you miss a dose of Xanax what happens if you overdose with Xanax the most important information about Xanax how to use Xanax other drugs that may affect Xanax what to avoid while using Xanax Generic Name: alprazolam (al PRAH zoe lam) Brand Names: Niravam, Xanax, Xanax XR What is the most important information I should know about alprazolam? • Use caution when driving, operating machinery, or performing other hazardous activities. Alprazolam will cause drowsiness and may cause dizziness. If you experience drowsiness or dizziness, avoid these activities. • Avoid alcohol while taking alprazolam. Alcohol may increase drowsiness and dizziness caused by alprazolam. • Do not crush, chew, or break the extended-release form alprazolam (Xanax XR). Swallow them whole. These tablets are specially formulated to release the medication slowly in the body. • Alprazolam is habit forming. You can become physically and psychologically dependent on the medication. Do not take more than the prescribed amount of medication or take it for longer than is directed by your doctor. Withdrawal effects may occur if alprazolam is stopped suddenly after several weeks of continuous use. Seizures may be a side effect of sudden discontinuation of the medication. Your doctor may recommend a gradual reduction in dose. What is alprazolam? • Alprazolam is in a class of drugs called benzodiazepines. Alprazolam affects chemicals in the brain that may become unbalanced and cause anxiety. • Alprazolam is used to relieve anxiety, nervousness, and tension associated with anxiety disorders. Alprazolam is also used to treat panic disorders. • Alprazolam may also be used for purposes other than those listed in this medication guide. What should I discuss with my healthcare provider before taking alprazolam? • Do not take alprazolam if you have narrow-angle glaucoma. Alprazolam may worsen this condition. • Before taking this medication, tell your doctor if you · have kidney disease; · have liver disease; · have a history of alcohol or drug abuse; · have asthma, bronchitis, emphysema, or another respiratory disease; · are depressed or have suicidal thoughts; or · have mania, bipolar disorder, or another psychiatric condition (other than anxiety or panic disorder). • You may not be able to take alprazolam, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above. • Alprazolam is in the FDA pregnancy category D. This means that alprazolam is known to be harmful to an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant or could become pregnant during treatment. • It is not known whether alprazolam passes into breast milk. Do not take alprazolam without first talking to your doctor if you are breast-feeding a baby. • If you are over 65 years of age, you may be more likely to experience side effects from alprazolam. Your doctor may prescribe a lower dose of the medication. How should I take alprazolam? • Take alprazolam exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you. • Take each dose with a full glass of water. • Do not crush, chew, or break the extended-release form alprazolam (Xanax XR). Swallow them whole. These tablets are specially formulated to release the medication slowly in the body. • Do not take more of the medication than is prescribed for you. • Alprazolam is habit forming. You can become physically and psychologically dependent on the medication. Do not take more than the prescribed amount of medication or take it for longer than is directed by your doctor. Withdrawal effects may occur if alprazolam is stopped suddenly after several weeks of continuous use. Seizures may be a side effect of sudden discontinuation of the medication. Your doctor may recommend a gradual reduction in dose. • Store alprazolam at room temperature away from moisture and heat. What happens if I miss a dose? • Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the dose you missed and take only the next regularly scheduled dose. Do not take a double dose of this medication. A double dose could be dangerous. What happens if I overdose? • Seek emergency medical attention if an overdose is suspected. • Symptoms of an alprazolam overdose include sleepiness, dizziness, confusion, a slow heart beat, difficulty breathing, difficulty walking and talking, an appearance of being drunk, and unconsciousness. What should I avoid while taking alprazolam? • Use caution when driving, operating machinery, or performing other hazardous activities. Alprazolam will cause drowsiness and may cause dizziness. If you experience drowsiness or dizziness, avoid these activities. • Avoid alcohol while taking alprazolam. Alcohol may increase drowsiness and dizziness caused by alprazolam. • Alprazolam may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, seizure medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any other medicine without first talking to your doctor. What are the possible side effects of alprazolam? • If you experience any of the following serious side effects, stop taking alprazolam and seek emergency medical attention or contact your doctor immediately: · an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, face, or tongue; or hives); · sores in the mouth or throat; · yellowing of the skin or eyes; · a rash; · hallucinations or severe confusion; or · changes in vision. • Other, less serious side effects may be more likely to occur. Continue to take alprazolam and talk to your doctor if you experience · drowsiness, dizziness, or clumsiness; · depression; · nausea, vomiting, diarrhea, or constipation; · difficulty urinating; · vivid dreams; · headache; · dry mouth; · decreased sex drive; or · changes in behavior. • Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. What other drugs will affect alprazolam? • Do not take ketoconazole (Nizoral) or itraconazole (Sporanox) during treatment with alprazolam without first talking to your doctor. • Alprazolam may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, seizure medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any medicine without first talking to your doctor. • Antacids may decrease the effects of alprazolam. Separate doses of an antacid and alprazolam by several hours whenever possible. • Drugs other than those listed here may also interact with alprazolam. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products. Where can I get more information? • Your pharmacist has additional information about alprazolam written for health professionals that you may read. -------------------------------------------------------------------------------- • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. • Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/ or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Xanax ( Alprazolam ) is an anti-anxiety agent benzodiazepine used primarily for short-term relief of mild to moderate anxiety and nervous tension. Alprazolam is also effective in the treatment of activity depression or panic attacks. It can also be useful in treating irritable bowel syndrome and anxiety due to a neurosis. Xanax ( Alprazolam ) may help the symptoms of PMS if extreme, and, if given with various narcotics, the pain from some cancers. Xanax ( Alprazolam ) is used to relieve anxiety, nervousness, and tension associated with anxiety disorders, agoraphobia, essential tremor, fibromyalgia ( low dosage ), and ringing ears. Xanax ( Alprazolam ) is in a class of drugs called benzodiazepines. Xanax ( Alprazolam ) affects chemicals in the brain that may become unbalanced and cause anxiety. Xanax ( Alprazolam ) may also be used for purposes other than those listed here. Use caution when driving, operating machinery, or performing other hazardous activities as Xanax ( Alprazolam ) may cause drowsiness or dizziness. If you experience drowsiness or dizziness, avoid these activities. (If it is definite that Xanax ( Alprazolam ) causes drowsiness you cannot then is “If you experience”) Avoid alcohol while taking Xanax ( Alprazolam ) . Alcohol may increase drowsiness and dizziness caused by Xanax ( Alprazolam ) . Do not crush, chew, or break the extended-release form Alprazolam ( Xanax XR ). Swallow whole. These tablets are specially formulated to slowly release the medication in the body. Xanax ( Alprazolam ) is habit forming. You can become physically and psychologically dependent on the medication. Do not take more than the prescribed amount of medication or take it for longer than directed by your doctor. Withdrawal effects may occur if alprazolam is stopped suddenly after several weeks of continuous use. Seizures may be a side effect of sudden discontinuation of the medication. Xanax ( Alprazolam ) may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives ( used to treat insomnia ), pain relievers, anxiety medicines, seizure medicines and muscle relaxants. Do not use if: you had negative reactions to other benzodiazepines you have a history of drug dependence. you have had a stroke. you have multiple sclerosis. you have Alzheimer's disease. you are seriously depressed or if you have other brain disorders. you have myasthenia gravis or acute narrow-angle glaucoma. you are pregnant or planning to become pregnant. you are breast-feeding. you are under eighteen, and only in small doses with very close monitoring if over sixty. Inform Physician if: you have a seizure disorder, impaired liver / kidney function, history of alcoholism / drug abuse, psychosis, palpitations or tachycardia. Xanax ( Alprazolam ) Symptoms or Effects Common: Clumsiness, Sleepiness, Drowsiness, Dizziness, Depression, Nausea, Vomiting, Diarrhea / Constipation, Difficulty urinating, Vivid dreams, Headache, Dry mouth, Decreased sex drive, and/or changes in behavior. Rare: Abdominal cramps, blurred vision, dry mouth, racing heartbeat / palpitations, shaking / slurred speech, urination problems, convulsions,hallucinations, memory loss, trouble breathing, staggering / trembling, headache, confusion, sore breast / milk secretion, or irregular menstruation. ( Be consistent in what you capitalize in both “common” and “rare” . Either is fine, it just needs to be consistent. ) Always see physician for these side effects and for severe clumsiness and sleepiness. See physician NOW: Convulsions, hallucinations, memory loss, trouble breathing or staggering / trembling. An allergic reaction (difficulty breathing, closing of the throat, swelling of the lips, face, or tongue or hives.) Sores in the mouth or throat. Yellowing of the skin or eyes. A rash. Hallucinations or severe confusion. Changes in vision. If you experience any of the above serious side effects, stop taking Alprazolam and seek emergency medical attention or contact your doctor immediately. Other names by country: Xanax® - United States, Australia, United Kingdom Xanax XR® - (an extended release formulation) United States Apo-Alpraz® - Canada (also made by other companies under different names) Xanor® - Finland, Philippines, South Africa, Sweden Kalma® - Australia, New Zealand Ralozam® - Australia, New Zealand Zamhexal® - Australia Alplax® - Argentina Alviz® - Indonesia Alzolam® - India, Malaysia Alprax® - India Tranax® - India Restyl® - Bahrain, Cyprus, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Oman, Qatar, Republic of Yemen, Saudi Arabia, Syria, United Arab Emirates Tranquinal® - Ecuador, Peru Trankimazin® - Spain Tafil® - Costa Rica, Denmark, El Salvador, Germany, Guatemala, Honduras, Mexico, Nicaragua, Panama, Venezuela Tafil AP® - (an extended release formulation) Mexico Constan® - Japan Solanax® - Japan Zolarem® - Bahrain, Benin, Burkina-Faso, Cyprus, Egypt, Ethiopia, Gambia, Ghana, Guinea, Iran, Iraq, Israel, Ivory Coast, Jordan, Kenya, Kuwait, Lebanon, Liberia, Libya, Malawi, Mali, Mauritania, Mauritius, Morocco, Niger, Nigeria, Oman, Qatar, Republic of Yemen, Saudi Arabia, Senegal, Seychelles, Sierra-Leone, South Africa, Sudan, Syria, Tanzania, Tunia, Uganda, United Arab Emirates, Zambia, Zimbabwe Zoldac® - Benin, Burkina-Faso, Ethiopia, Gambia, Ghana, Guinea, India, Ivory Coast, Kenya, Liberia, Malawi, Mali, Mauritania, Mauritius, Morocco, Niger, Nigeria, Senegal, Seychelles, Sierra-Leone, South Africa, Sudan, Tanzania, Tunia, Uganda, Zambia, Zimbabwe Calmax® - Ireland XANAX (alprazolam tablets) is in a class of drugs called benzodiazepines. Controlled clinical trials have demonstrated that XANAX is effective in the treatment of Generalized Anxiety Disorder, anxiety associated with depression, and Panic Disorder with or without agoraphobia. XANAX XR is a prescription medicine for the treatment of panic disorder. XANAX XR is a once daily formulation of XANAX® (alprazolam tablets). XANAX XR allows patients to take a single daily dose rather than 3 to 4 times per day with XANAX. About Xanax | Alprazolam Intensol Xanax (alprazolam) is an anti-panic and anti-anxiety medication. Xanax is in the group of drugs known as benzodiazepines, a class of antidepressants, anti-panic agents, and muscle relaxants. Xanax is only available by prescription. Xanax is usually used as a short term treatment for major anxiety and certain phobias. Xanax is not usually necessary to relieve everyday stress or anxiety. Store Xanax away from light and heat. Xanax Side Effects Xanax side effects are usually temporary, and fade with continued treatment. Higher dosage also increases the risk of side effects. Operating automobiles or heavy machinery is not recommended while taking Xanax. Be aware of how this medication affects you before attempting any potentially dangerous activities. Common Xanax side effects: drowsiness, fatigue, light-headedness, or speech problems. Less common Xanax side effects: abdominal cramps, constipation, dry mouth, hyperventilation, blurred vision, nausea, chest pain, change in sex drive, confusion, headache, change in appetite, insomnia, unusual dreams, change in salivation, low blood pressure, racing heartbeat, fainting, nasal congestion, difficulty urinating, sweating, weight change, skin irritation, twitching or tremors, nervous or anxious state, sun sensitivity, respiratory infection, memory impairment, menstrual difficulties, and loss of coordination. Speak to your doctor about any of these effects; your dosage may need to be adjusted or treatment discontinued. Rare Xanax side effects: difficulty concentrating, slurred or unusual speech, double vision, fear, altered sense of taste, lack of inhibition, muscle cramps or spasms, urination problems, tingling, incontinence, warmth, weakness, change in muscle tone, or yellow eyes and skin. Speak to your doctor if you experience any of these effects; your treatment may need to be discontinued. Xanax treatment should be discontinued if any of the following occur: hyperexcitement, muscle spasm, anxiety, hallucinations, rage or other hostile behavior, tremors, insomnia, sleeping difficulties or overstimulation. Cautions: Xanax has been known to interact undesirably with certain medical conditions. Tell your doctor if you have, or have a history of, any of the following conditions: Alcohol or drug abuse - may increase likelihood of Xanax dependence Allergic reaction to Xanax, or other benzodiazepine. Always tell your doctor about any allergies before starting a medication. Borderline personality disorder or a history of violent behavior. Brain disease - may increase likelihood of side effects from Xanax Breathing difficulties such as asthma, bronchitis, emphysema, or any other chronic lung disease - Xanax may worsen this condition. Difficulty swallowing - This condition may become more pronounced in children. Epilepsy or seizures - Abruptly starting or stopping treatment with Xanax may increase seizures. Although Xanax can be used as an aid to anti-tremor therapy, it should be used cautiously and strictly according to a doctor's instructions in these cases. Glaucoma - Xanax should not be prescribed to patients with acute narrow-angle glaucoma. Patients receiving treatment for open angle glaucoma should consult their doctor, as Xanax may be an acceptable treatment for them. Hyperactivity Kidney or liver problems - In isolated cases, Xanax has been reported to cause jaundice. If you experience yellowing of the skin or eyes, seek medical treatment immediately. More Xanax may end up in your bloodstream if you have a pre-existing kidney or liver condition, increasing the likelihood of side effects. Major Depression Myasthenia gravis - This autoimmune disorder characterized by muscle weakness may be aggravated by Xanax treatment. Porphyria - Xanax (alprazolam) is listed as an unsafe drug for porphyria, an enzyme deficiency that can cause fragile skin that is sensitive to sunlight, digestive difficulties, anxiety, and reddish-brown urine. Psychosis or other serious mental illness - Xanax has not proved to be an effective treatment for these conditions, and is not recommended. Sleep apnea (temporary suspension of breathing during sleep) - Xanax may worsen this condition. Individuals with sleep apnea should not generally use sedatives as sleep aids. (See Sleep Disorders) Dependence: Xanax has been known to be habit-forming. Withdrawal symptoms may occur if treatment is discontinued abruptly. Follow your doctor's advice about how much, and how often, you should take Xanax. If you are considering stopping Xanax treatment, ask your doctor how to safely decrease and then stop Xanax. Xanax Interactions Xanax slows the central nervous system, and should be taken with care with medications that do the same thing. When Xanax is taken with certain other medications, the rate of side effects may increase, and the action of either medication may be increased or altered. Certain medications can cause an undesirable build-up of Xanax in the body. Ask your doctor's advice about combining Xanax with any of the following: Alcohol - Xanax should not be mixed with alcohol, it increases the risk of overdose and fatal toxicity. Agenerase (amprenavir) Any medication which may cause drowsiness Antibiotics (esp. macrolide antibiotics) like azithromycin, biaxin, clarythromycin, or erythromycin Antihistamines like Tavist or Benadryl Adalat, Procardia (nifedipine) Antabuse (disulfiram) Antiseizure medication like Cerebyx (fosphenytoin), Dilantin (phenytoin), or Tegretol (carbamazepine). Benzodiazepines of any other type, such as Valium (diazepam), Halcion (triazolam), Restoril (temazepam), Librium (chlordiazepoxide), Tranxene-SD (clorazepate), Paxipam (halazepam), ProSom (estazolam), Klonopin (clonazepam) BuSpar (buspirone) - Can result in oversedation. Cardene (nicardipine) Cordarone (amiodarone) Desyrel (trazodone) - Risk of additive CNS depression. Diflucan (fluconazole) Ergotamine derivatives Grapefruit juice Kava kava - Do not take this herb while taking Xanax. Lanoxin (digoxin) MAO inhibitors such as the antidepressants Nardil or Parnate. Narcotic analgesics of any kind, like Darvon (propoxyphene), Darvocet (propoxyphene, acetaminophen), Demerol (meperidine), Codeine, Percocet (oxycodone, acetaminophen), Vicodin (hydrocodone, acetaminophen), Vicoprofen (hydrocodone and ibuprofen) or OxyContin (oxycodone) may accelerate central nervous system or respiratory depression when taken with Xanax. Also, Xanax may decrease the effectiveness of these medications as pain relievers. Norflex (orphenadrine) - Risk of oversedation. Neoral, Sandimmune (cyclosporine) Nicotine - Heavy smoking may reduce the effectiveness of your treatment. Nizoral (ketoconazole) - Xanax should not be mixed with this antifungal medication. Oral contraceptives - May increase the effects of Xanax. Prilosec (omeprazole) - May increase the effects of Xanax. Rescriptor (delavirdine) Rifamate (isoniazid), Rifater (rifampin), or Mycobutin (rifabutin) Sedatives like Fioricet (butalbital, acetaminophen, and caffeine), Fiorinal (butalbital, aspirin, and caffeine), Phenobarbitol, Seconal, or other barbiturates Selective serotonin reuptake inhibitors (SSRIs) like Celexa (citalopram), Paxil (paroxetine), Prozac (fluoxetine), Luvox (fluvoxamine), or Zoloft (sertraline). Serzone (nefazodone) Skeletal muscle relaxants such as Flexeril (cyclobenzaprine), Skelaxin (metaxalone), Soma (carisoprodol), or Robaxin (methocarbamol) may cause oversedation in combination with this medication. Sleep medication like Ambien (zolpidem), Sonata (zaleplon), or over the counter sleeping pills should be used with Xanax only as, and if, advised by your doctor. Sporanox (itraconazole) - Xanax should not be mixed with this antifungal medication. Street drugs - Marijuana may increase sedative effects from Xanax. St. John's Wort - Do not take this herb while taking Xanax. Tagamet (cimetidine) Tranquilizers such as Haldol (haloperidol), Mellaril (thioridazine), or Thorazine (chlorpromazine) may cause oversedation. Tricyclic antidepressants such as Elavil (amitriptyline), Asendin (amoxapine), Anafranil (clomipramine), Pertofrane or Norpramin (desipramine), Sinequan (doxepin), Tofranil (imipramine), Aventyl or Pamelor (nortriptyline), Vivactil (protriptyline), and Surmontil (trimipramine), may increase the risk of side effects from Xanax. Valerian - Do not take this herb while taking Xanax. Talk with your doctor if you are considering mixing an antidepressant and anxiety medication like Xanax with any other antidepressant, or any medication that may cause drowsiness. Anxiety medication can have increased, unexpected, or severe side effects when mixed with other medications that affect the central nervous system. Stimulants of any type may blunt the effectiveness of Xanax. Xanax Dosages Xanax comes in doses of .25 mg (white oval tablet), .5 mg (pink oval tablet), 1 mg (blue oval tablet), and 2mg (white oblong tablet, scored). The usual starting dose is .25-.5 mg, 3-4 times per day, up to a maximum of 4-6 mg per day, divided among several doses. Xanax should be taken exactly as your doctor recommends. Don't take more or less than prescribed, and don't double your doses if you should miss one. Take your doctor's advice about how quickly or slowly to ease off Xanax treatment if you plan to stop taking it. Xanax should not be started or stopped abruptly, as it strongly increases the likelihood of side effects. If you have a convulsive disorder, or experience severe muscle spasming, abruptly stopping or starting Xanax could increase these effects. Xanax overdose symptoms can include confusion, poor coordination, sleepiness, or coma. Seek medical treatment immediately if you suspect an overdose. Xanax and Pregnancy Xanax is not recommended for women who are breastfeeding, pregnant, or planning to become pregnant. Xanax could cause breathing problems or muscle weakness in an infant. Also, a newborn whose mother had been taking Xanax might experience withdrawal symptoms. Other benzodiazepines, similar to Xanax, have been seen to cause an increase in birth defects. While Xanax has not been demonstrated to be a high risk factor for birth defects, the possibility exists that it could increase their likelihood. Xanax and Children Xanax has not been studied for use in children. Xanax and Seniors Older adults taking Xanax are usually encouraged to start with smaller doses (.25 mg 3-4 times per day) and limit intake to the smallest effective dose. Seniors are more likely to become too heavily sedated, or experience decreased muscle coordination. What Xanax Treats Xanax has been prescribed as a treatment for: Anxiety disorder characterized by unrealistic fears and excessive worries. Panic Disorder, sometimes accompanied by fear of open spaces (agoraphobia). Also for the temporary symptoms of alcohol withdrawal, depression, fear of strangers, irritable bowel, and premenstrual syndrome. Dosage varies. Xanax may be prescribed in low doses to treat fibromyalgia. Xanax is a trademark of Pharmacia & Upjohn Do not take ketoconazole (Nizoral) or itraconazole (Sporanox) during treatment with alprazolam without first talking to your doctor. • Alprazolam may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, seizure medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any medicine without first talking to your doctor. • Antacids may decrease the effects of alprazolam. Separate doses of an antacid and alprazolam by several hours whenever possible. • Drugs other than those listed here may also interact with alprazolam. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products. According to the National Institute of Mental Health, 19.1 million Americans, age 18-54, suffer from anxiety disorders. We know that everyday life has become an extremely hectic and stressful endeavor. Unfortunately, human nature pushes us to continually strive for more and achieve bigger and better things. Many times people are able to deal with the pressure of everyday life. However, there are certain individuals that cannot. Those people can suffer from debilitating effects of stress, anxiety, and even depression. Symptoms of generalized anxiety disorder include, inability to relax, sleeplessness, and extreme nervousness. So many people just cannot gain control over their anxiety., and turn toward prescription medication as an answer. Hectic lifestyles, combined with added pressure to succeed, unfortunately for us, is a formula for disaster. Anxiety, stress, and depression have reached epidemic proportions in the U.S. and continues to grow. And we know that anxiety, stress, and depression can be considered one of the leading causes of disability today. In light of these dramatic statistics, a number of products have appeared on the market aimed at reducing symptoms of anxiety, stress, and depression. These products include vitamins, minerals, and herbal supplements, as well as prescription pharmaceutical medications which can only be obtained under a doctor’s recommendation. Is Xanax® (alprazolam) the solution for you? By using an anxiety relief agent, and finding ways to restore a normal, less stressful and hectic lifestyle, it may be possible to decrease symptoms of anxiety without negative side effects associated with prescription medications. Prescription Drug Xanax® (alprazolam) Alprazolam hydrochloride, generic name for the popular anti-anxiety medication Xanax®. Xanax® is indicated for generalized anxiety disorder (GAD), panic disorder, and anxiety associated with depression. Xanax® (alprazolam) is sometimes used as a sleeping agent. Caution should be used, as Xanax® has been shown to cause physical dependence. Xanax® (alprazolam) has also been shown to cause seizures. Xanax® (alprazolam) can cause decreased appetite (weight loss) in some people and increased appetite (weight gain) in others. Xanax® (alprazolam) is classified pharmacologically as a benzodiazepine. The use of benzodiazepines and related drugs may be associated with side effects such as, drowsiness that can occur in up to 75% of the people taking benzodiazepines. Discontinued use, especially when abrupt, may result in spontaneous side effects including tremor, abdominal cramping, sweating, insomnia, and convulsions. Side effects may also include fatigue, memory impairment, nausea, vomiting, constipation, blurred vision, sexual dysfunction, and decreased sexual drive. Are there alternatives? Non-Prescription All Natural Anxiety Relief Products What makes a non-prescription anxiety relief product so appealing? Is it the all natural and diminished side effect properties? Prescription products have many potential side effects and drug interactions. The elite non-prescription products contain ingredients which addresses anxiety relief through different mechanisms: 1: restores and balances healthy neurologic function 2: provides the nutritional support your body needs for overall well-being You might not need to resort to prescription strength drugs to achieve your anxiety relief goals. All natural supplements can support a new less hectic and stressful lifestyle. Natural supplements give you an excellent alternative to prescription strength anti-anxiety drugs. These products have limited side effects, less drug interactions, and are less expensive than a lot of the prescription strength anti-anxiety medications available on the market today. Unlike prescription anti-anxiety medications, alternative therapies can be used with a greater amount of safety and ease. What is the best all natural anxiety relief product on the market today? We reviewed a wide array of all natural anti-depressant and anti-anxiety alternatives on the market today. At the conclusion of our review, we found Anxietol 7™, manufactured by MedaBiotics, demonstrates overall safety and effective anxiety and depression relief at a reasonable cost. That is why we have rated it Consumer Health Digest's Best Buy. Alprazolam is an FDA-approved medication that is used to treat panic disorder, Generalized Anxiety Disorder (GAD), and anxiety associated with depression. Information: Most Common Medical Uses Alprazolam affects chemicals in the brain that may become unbalanced and cause anxiety. Alprazolam is most commonly used to relieve anxiety, nervousness, and tension associated with anxiety disorders. Alprazolam is also used to treat panic disorders. Alprazolam may also be used for purposes other than those listed here. How to Take This Medication Take alprazolam exactly as directed by your doctor. Take each dose with a full glass of water. Do not take more than is prescribed for you. Alprazolam is habit forming. You can become physically and psychologically dependent on the medication. Do not take more than the prescribed amount of medication or take it for longer than is directed by your doctor. Withdrawal effects may occur if alprazolam is stopped suddenly after several weeks of continuous use. Your doctor may recommend a gradual reduction in dose. Possible Side Effects Stop taking alprazolam and seek emergency medical attention or contact your doctor immediately: an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, face, or tongue; or hives); sores in the mouth or throat; yellowing of the skin or eyes; a rash; hallucinations or severe confusion; or changes in your vision. Other, less serious side effects may be more likely to occur. Continue to take alprazolam and talk to your doctor if you experience drowsiness, dizziness, or clumsiness; depression; nausea, vomiting, diarrhea, or constipation; difficulty urinating; vivid dreams; headache; dry mouth; decreased sex drive; or changes in behavior. Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. Precautions Do not take alprazolam if you have narrow-angle glaucoma. Alprazolam may worsen this condition. Before taking this medication, tell your doctor if you have kidney disease; have liver disease; have asthma, bronchitis, emphysema, or another respiratory disease; or if you are depressed or have suicidal thoughts. Do not take this medication without first talking to your doctor if you are pregnant or breast-feeding a baby.If you are over 65 years of age, you may be more likely to experience side effects from alprazolam. You may require a lower dose of this medication. Alprazolam is not approved for use by children younger than 18 years of age. Drug Interactions Do not take ketoconazole (Nizoral) or itraconazole (Sporanox) during treatment with alprazolam without first talking to your doctor. Alprazolam may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, seizure medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any medicine without first talking to your doctor. Antacids may decrease the effects of alprazolam. Separate doses of an antacid and alprazolam by several hours whenever possible. Drugs other than those listed here may also interact with alprazolam. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products. Missed Dose Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the dose you missed and take only the next regularly scheduled dose. Do not take a double dose of this medication. A double dose could be dangerous. Storage Store at room temperature away from moisture and heat. Keep this and all medications out of the reach of children. Notes Use caution when driving, operating machinery, or performing other hazardous activities. Alprazolam will cause drowsiness and may cause dizziness. If you experience drowsiness or dizziness, avoid these activities. Avoid alcohol while taking alprazolam. Alcohol may increase drowsiness and dizziness caused by alprazolam. Alprazolam is habit forming. You can become physically and psychologically dependent on the medication. Do not take more than the prescribed amount of medication or take it for longer than is directed by your doctor. Withdrawal effects may occur if alprazolam is stopped suddenly after several weeks of continuous use. Your doctor may recommend a gradual reduction in dose.

XANAX® is in a class of drugs called benzodiazepines. Approved by the FDA in 1981, controlled clinical trials have demonstrated that XANAX is effective in the treatment of Generalized Anxiety Disorder, anxiety associated with depression*, and Panic Disorder with or without agoraphobia. (Safety and effectiveness of XANAX in individuals below 18 years of age have not been established. For more Important Safety Information about XANAX, click here.) How XANAX works is not known, but it is believed to affect some of the chemicals in the brain. Recently, a new, once daily formulation of XANAX® was approved by the FDA and is now available to patients. XANAX XR® (alprazolam extended-release tablets) is indicated for the treatment of Panic Disorder. To learn more about XANAX XR, click here for safety and product information. Click the speaker to hear how XANAX®(ZAN-aks) is pronounced! *XANAX is not indicated for the treatment of depression. Important Safety Information XANAX should not be used if you have a condition called acute narrow angle glaucoma. It can be used if you have open angle glaucoma. Ask your doctor if you have questions. Side effects, if they occur, are generally observed at the beginning of therapy and usually disappear upon continued use. The most commonly reported side effects in clinical trials were drowsiness, fatigue, impaired coordination, irritability, light-headedness, memory impairment, insomnia, and headache. To assure safe and effective use of benzodiazepines make sure that you: Inform your physician about any alcohol consumption and medicine you are currently taking, including medication you may buy without a prescription. XANAX is not recommended for use in pregnancy. Inform your physician if you are pregnant, if you are planning to become pregnant, or if you become pregnant while taking this medication. Inform your physician if you are nursing. Until you experience how the medication affects you, do not drive a car or operate hazardous machinery. Do not increase the dose even if you think the medication isn't working, without consulting your physician. Benzodiazepines, even when used as recommended, may produce emotional and/physical dependence. Do not stop taking this medication abruptly or decrease the dose without consulting your physician, since discontinuation symptoms may occur. Important Considerations for Patients Diagnosed with Panic Disorder At doses greater than 4 mg per day, XANAX has the potential to cause severe emotional and physical dependence in some patients and these individuals may find it exceedingly difficult to terminate treatment. It is important that your physician help you discontinue this medication in a careful and safe manner to avoid overly extended use of XANAX. In addition, the extended use of XANAX at doses greater than 4 mg per day appears to increase the incidence and severity of withdrawal reactions when the drug is discontinued. These are generally minor but seizure can occur, especially if you reduce the dose too rapidly or discontinue the medication abruptly. Seizure can be life-threatening. PDR Drug information for Xanax Tablets Manufacturer: Pharmacia & Upjohn DESCRIPTION XANAX Tablets contain alprazolam which is a triazolo analog of the 1,4 benzodiazepine class of central nervous system-active compounds. The chemical name of alprazolam is 8-Chloro-1-methyl-6-phenyl-4H-s-triazolo [4,3-(alpha)] [1,4] benzodiazepine. The structural formula is represented below: Inactive ingredients: Cellulose, corn starch, docusate sodium, lactose, magnesium stearate, silicon dioxide and sodium benzoate. In addition, the 0.5 mg tablet contains FD&C Yellow No. 6 and the 1 mg tablet contains FD&C Blue No. 2. CLINICAL PHARMACOLOGY CNS agents of the 1,4 benzodiazepine class presumably exert their effects by binding at stereo specific receptors at several sites within the central nervous system. Their exact mechanism of action is unknown. Clinically, all benzodiazepines cause a dose-related central nervous system depressant activity varying from mild impairment of task performance to hypnosis. Following oral administration, alprazolam is readily absorbed. Peak concentrations in the plasma occur in one to two hours following administration. Plasma levels are proportionate to the dose given; over the dose range of 0.5 to 3.0 mg, peak levels of 8.0 to 37 ng/mL were observed. Using a specific assay methodology, the mean plasma elimination half-life of alprazolam has been found to be about 11.2 hours (range: 6.3-26.9 hours) in healthy adults. The predominant metabolites are (alpha)-hydroxy-alprazolam and a benzophenone derived from alprazolam. The biological activity of (alpha)-hydroxy-alprazolam is approximately one-half that of alprazolam. The benzophenone metabolite is essentially inactive. Plasma levels of these metabolites are extremely low, thus precluding precise pharmacokinetic description. However, their half-lives appear to be of the same order of magnitude as that of alprazolam. Alprazolam and its metabolites are excreted primarily in the urine. The ability of alprazolam to induce human hepatic enzyme systems has not yet been determined. However, this is not a property of benzodiazepines in general. Further, alprazolam did not affect the prothrombin or plasma warfarin levels in male volunteers administered sodium warfarin orally. In vitro, alprazolam is bound (80 percent) to human serum protein. Changes in the absorption, distribution, metabolism and excretion of benzodiazepines have been reported in a variety of disease states including alcoholism, impaired hepatic function and impaired renal function. Changes have also been demonstrated in geriatric patients. A mean half-life of alprazolam of 16.3 hours has been observed in healthy elderly subjects (range: 9.0-26.9 hours, n=16) compared to 11.0 hours (range: 6.3-15.8 hours, n=16) in healthy adult subjects. In patients with alcoholic liver disease the half-life of alprazolam ranged between 5.8 and 65.3 hours (mean: 19.7 hours, n=17) as compared to between 6.3 and 26.9 hours (mean=11.4 hours, n=17) in healthy subjects. In an obese group of subjects the half-life of alprazolam ranged between 9.9 and 40.4 hours (mean=21.8 hours, n=12) as compared to between 6.3 and 15.8 hours (mean=10.6 hours, n=12) in healthy subjects. Because of its similarity to other benzodiazepines, it is assumed that alprazolam undergoes transplacental passage and that it is excreted in human milk. INDICATIONS AND USAGE XANAX Tablets (alprazolam) are indicated for the management of anxiety disorder (a condition corresponding most closely to the APA Diagnostic and Statistical Manual [DSM-III-R] diagnosis of generalized anxiety disorder) or the short-term relief of symptoms of anxiety. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic. Generalized anxiety disorder is characterized by unrealistic or excessive anxiety and worry (apprehensive expectation) about two or more life circumstances, for a period of six months or longer, during which the person has been bothered more days than not by these concerns. At least 6 of the following 18 symptoms are often present in these patients: Motor Tension (trembling, twitching, or feeling shaky; muscle tension, aches, or soreness; restlessness; easy fatigability); Autonomic Hyperactivity (shortness of breath or smothering sensations; palpitations or accelerated heart rate; sweating, or cold clammy hands; dry mouth; dizziness or light-headedness; nausea, diarrhea, or other abdominal distress; flushes or chills; frequent urination; trouble swallowing or 'lump in throat'); Vigilance and Scanning (feeling keyed up or on edge; exaggerated startle response; difficulty concentrating or `mind going blank' because of anxiety; trouble falling or staying asleep; irritability). These symptoms must not be secondary to another psychiatric disorder or caused by some organic factor. Anxiety associated with depression is responsive to XANAX. XANAX is also indicated for the treatment of panic disorder, with or without agoraphobia. Studies supporting this claim were conducted in patients whose diagnoses corresponded closely to the DSM-III-R criteria for panic disorder (see CLINICAL STUDIES ). Panic disorder is an illness characterized by recurrent panic attacks. The panic attacks, at least initially, are unexpected. Later in the course of this disturbance certain situations, eg, driving a car or being in a crowded place, may become associated with having a panic attack. These panic attacks are not triggered by situations in which the person is the focus of others' attention (as in social phobia). The diagnosis requires four such attacks within a four week period, or one or more attacks followed by at least a month of persistent fear of having another attack. The panic attacks must be characterized by at least four of the following symptoms: dyspnea or smothering sensations; dizziness, unsteady feelings, or faintness; palpitations or tachycardia; trembling or shaking; sweating; choking; nausea or abdominal distress; depersonalization or derealization; paresthesias; hot flashes or chills; chest pain or discomfort; fear of dying; fear of going crazy or of doing something uncontrolled. At least some of the panic attack symptoms must develop suddenly, and the panic attack symptoms must not be attributable to some known organic factors. Panic disorder is frequently associated with some symptoms of agoraphobia. Demonstrations of the effectiveness of XANAX by systematic clinical study are limited to four months duration for anxiety disorder and four to ten weeks duration for panic disorder; however, patients with panic disorder have been treated on an open basis for up to eight months without apparent loss of benefit. The physician should periodically reassess the usefulness of the drug for the individual patient. CONTRAINDICATIONS XANAX Tablets are contraindicated in patients with known sensitivity to this drug or other benzodiazepines. XANAX may be used in patients with open angle glaucoma who are receiving appropriate therapy, but is contraindicated in patients with acute narrow angle glaucoma. XANAX is contraindicated with ketoconazole and itraconazole, since these medications significantly impair the oxidative metabolism mediated by cytochrome P450 3A (CYP 3A) (see WARNINGS and PRECAUTIONS - Drug Interactions ). WARNINGS Dependence and withdrawal reactions, including seizures: Certain adverse clinical events, some life-threatening, are a direct consequence of physical dependence to XANAX. These include a spectrum of withdrawal symptoms; the most important is seizure (see DRUG ABUSE AND DEPENDENCE ). Even after relatively short-term use at the doses recommended for the treatment of transient anxiety and anxiety disorder (ie, 0.75 to 4.0 mg per day), there is some risk of dependence. Spontaneous reporting system data suggest that the risk of dependence and its severity appear to be greater in patients treated with doses greater than 4 mg/day and for long periods (more than 12 weeks). However, in a controlled postmarketing discontinuation study of panic disorder patients, the duration of treatment (three months compared to six months) had no effect on the ability of patients to taper to zero dose. In contrast, patients treated with doses of XANAX greater than 4 mg/day had more difficulty tapering to zero dose than those treated with less than 4 mg/day. The importance of dose and the risks of XANAX as a treatment for panic disorder: Because the management of panic disorder often requires the use of average daily doses of XANAX above 4 mg, the risk of dependence among panic disorder patients may be higher than that among those treated for less severe anxiety. Experience in randomized placebo-controlled discontinuation studies of patients with panic disorder showed a high rate of rebound and withdrawal symptoms in patients treated with XANAX compared to placebo treated patients. Relapse or return of illness was defined as a return of symptoms characteristic of panic disorder (primarily panic attacks) to levels approximately equal to those seen at baseline before active treatment was initiated. Rebound refers to a return of symptoms of panic disorder to a level substantially greater in frequency, or more severe in intensity than seen at baseline. Withdrawal symptoms were identified as those which were generally not characteristic of panic disorder and which occurred for the first time more frequently during discontinuation than at baseline. In a controlled clinical trial in which 63 patients were randomized to XANAX and where withdrawal symptoms were specifically sought, the following were identified as symptoms of withdrawal: heightened sensory perception, impaired concentration, dysosmia, clouded sensorium, paresthesias, muscle cramps, muscle twitch, diarrhea, blurred vision, appetite decrease and weight loss. Other symptoms, such as anxiety and insomnia, were frequently seen during discontinuation, but it could not be determined if they were due to return of illness, rebound or withdrawal. In a larger database comprised of both controlled and uncontrolled studies in which 641 patients received XANAX, discontinuation-emergent symptoms which occurred at a rate of over 5% in patients treated with XANAX and at a greater rate than the placebo treated group were as follows: DISCONTINUATION-EMERGENT SYMPTOM INCIDENCE Percentage of 641 XANAX-Treated Panic Disorder Patients Reporting Events Body System/Event Neurologic Gastrointestinal Insomnia 29.5 Nausea/Vomiting 16.5 Light-headedness 19.3 Diarrhea 13.6 Abnormal involuntary movement 17.3 Decreased salivation 10.6 Headache 17.0 Metabolic-Nutritional Muscular twitching 6.9 Weight loss 13.3 Impaired coordination 6.6 Decreased appetite 12.8 Muscle tone disorders 5.9 Weakness 5.8 Dermatological Psychiatric Sweating 14.4 Anxiety 19.2 Fatigue and Tiredness 18.4 Cardiovascular Irritability 10.5 Tachycardia 12.2 Cognitive disorder 10.3 Memory impairment 5.5 Special Senses Depression 5.1 Blurred vision 10.0 Confusional state 5.0 From the studies cited, it has not been determined whether these symptoms are clearly related to the dose and duration of therapy with XANAX in patients with panic disorder. In two controlled trials of six to eight weeks duration where the ability of patients to discontinue medication was measured, 71%-93% of XANAX treated patients tapered completely off therapy compared to 89%-96% of placebo treated patients. In a controlled postmarketing discontinuation study of panic disorder patients, the duration of treatment (three months compared to six months) had no effect on the ability of patients to taper to zero dose. Seizures attributable to XANAX were seen after drug discontinuance or dose reduction in 8 of 1980 patients with panic disorder or in patients participating in clinical trials where doses of XANAX greater than 4 mg/day for over 3 months were permitted. Five of these cases clearly occurred during abrupt dose reduction, or discontinuation from daily doses of 2 to 10 mg. Three cases occurred in situations where there was not a clear relationship to abrupt dose reduction or discontinuation. In one instance, seizure occurred after discontinuation from a single dose of 1 mg after tapering at a rate of 1 mg every three days from 6 mg daily. In two other instances, the relationship to taper is indeterminate; in both of these cases the patients had been receiving doses of 3 mg daily prior to seizure. The duration of use in the above 8 cases ranged from 4 to 22 weeks. There have been occasional voluntary reports of patients developing seizures while apparently tapering gradually from XANAX. The risk of seizure seems to be greatest 24-72 hours after discontinuation (see DOSAGE AND ADMINISTRATION for recommended tapering and discontinuation schedule). Status epilepticus and its treatment: The medical event voluntary reporting system shows that withdrawal seizures have been reported in association with the discontinuation of XANAX. In most cases, only a single seizure was reported; however, multiple seizures and status epilepticus were reported as well. Ordinarily, the treatment of status epilepticus of any etiology involves use of intravenous benzodiazepines plus phenytoin or barbiturates, maintenance of a patent airway and adequate hydration. For additional details regarding therapy, consultation with an appropriate specialist may be considered. Interdose Symptoms: Early morning anxiety and emergence of anxiety symptoms between doses of XANAX have been reported in patients with panic disorder taking prescribed maintenance doses of XANAX. These symptoms may reflect the development of tolerance or a time interval between doses which is longer than the duration of clinical action of the administered dose. In either case, it is presumed that the prescribed dose is not sufficient to maintain plasma levels above those needed to prevent relapse, rebound or withdrawal symptoms over the entire course of the interdosing interval. In these situations, it is recommended that the same total daily dose be given divided as more frequent administrations (see DOSAGE AND ADMINISTRATION ). Risk of dose reduction: Withdrawal reactions may occur when dosage reduction occurs for any reason. This includes purposeful tapering, but also inadvertent reduction of dose (eg, the patient forgets, the patient is admitted to a hospital, etc.). Therefore, the dosage of XANAX should be reduced or discontinued gradually (see DOSAGE AND ADMINISTRATION ). XANAX Tablets are not of value in the treatment of psychotic patients and should not be employed in lieu of appropriate treatment for psychosis. Because of its CNS depressant effects, patients receiving XANAX should be cautioned against engaging in hazardous occupations or activities requiring complete mental alertness such as operating machinery or driving a motor vehicle. For the same reason, patients should be cautioned about the simultaneous ingestion of alcohol and other CNS depressant drugs during treatment with XANAX. Benzodiazepines can potentially cause fetal harm when administered to pregnant women. If XANAX is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. Because of experience with other members of the benzodiazepine class, XANAX is assumed to be capable of causing an increased risk of congenital abnormalities when administered to a pregnant woman during the first trimester. Because use of these drugs is rarely a matter of urgency, their use during the first trimester should almost always be avoided. The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered. Patients should be advised that if they become pregnant during therapy or intend to become pregnant they should communicate with their physicians about the desirability of discontinuing the drug. Alprazolam interaction with drugs that inhibit metabolism via cytochrome P450 3A: The initial step in alprazolam metabolism is hydroxylation catalyzed by cytochrome P450 3A (CYP 3A). Drugs that inhibit this metabolic pathway may have a profound effect on the clearance of alprazolam. Consequently, alprazolam should be avoided in patients receiving very potent inhibitors of CYP 3A. With drugs inhibiting CYP 3A to a lesser but still significant degree, alprazolam should be used only with caution and consideration of appropriate dosage reduction. For some drugs, an interaction with alprazolam has been quantified with clinical data; for other drugs, interactions are predicted from in vitro data and/or experience with similar drugs in the same pharmacologic class. The following are examples of drugs known to inhibit the metabolism of alprazolam and/or related benzodiazepines, presumably through inhibition of CYP 3A. Potent CYP 3A inhibitors: Azole antifungal agents --Although in vivo interaction data with alprazolam are not available, ketoconazole and itraconazole are potent CYP 3A inhibitors and the coadministration of alprazolam with them is not recommended. Other azole-type antifungal agents should also be considered potent CYP 3A inhibitors and the coadministration of alprazolam with them is not recommended (see CONTRAINDICATIONS ). Drugs demonstrated to be CYP 3A inhibitors on the basis of clinical studies involving alprazolam (caution and consideration of appropriate alprazolam dose reduction are recommended during coadministration with the following drugs): Nefazodone --Coadministration of nefazodone increased alprazolam concentration two-fold. Fluvoxamine --Coadministration of fluvoxamine approximately doubled the maximum plasma concentration of alprazolam, decreased clearance by 49%, increased half-life by 71%, and decreased measured psychomotor performance. Cimetidine --Coadministration of cimetidine increased the maximum plasma concentration of alprazolam by 86%, decreased clearance by 42%, and increased half-life by 16%. Other drugs possibly affecting alprazolam metabolism: Other drugs possibly affecting alprazolam metabolism by inhibition of CYP 3A are discussed in the PRECAUTIONS section (see PRECAUTIONS -- Drug Interactions ). PRECAUTIONS General: If XANAX Tablets are to be combined with other psychotropic agents or anticonvulsant drugs, careful consideration should be given to the pharmacology of the agents to be employed, particularly with compounds which might potentiate the action of benzodiazepines (see DRUG INTERACTIONS ). As with other psychotropic medications, the usual precautions with respect to administration of the drug and size of the prescription are indicated for severely depressed patients or those in whom there is reason to expect concealed suicidal ideation or plans. It is recommended that the dosage be limited to the smallest effective dose to preclude the development of ataxia or oversedation which may be a particular problem in elderly or debilitated patients. (See DOSAGE AND ADMINISTRATION .) The usual precautions in treating patients with impaired renal, hepatic or pulmonary function should be observed. There have been rare reports of death in patients with severe pulmonary disease shortly after the initiation of treatment with XANAX. A decreased systemic alprazolam elimination rate (eg, increased plasma half-life) has been observed in both alcoholic liver disease patients and obese patients receiving XANAX (see CLINICAL PHARMACOLOGY ). Episodes of hypomania and mania have been reported in association with the use of XANAX in patients with depression. Alprazolam has a weak uricosuric effect. Although other medications with weak uricosuric effect have been reported to cause acute renal failure, there have been no reported instances of acute renal failure attributable to therapy with XANAX. Information for Patients: For all users of XANAX: To assure safe and effective use of benzodiazepines, all patients prescribed XANAX should be provided with the following guidance. In addition, panic disorder patients, for whom doses greater than 4 mg/day are typically prescribed, should be advised about the risks associated with the use of higher doses. Inform your physician about any alcohol consumption and medicine you are taking now, including medication you may buy without a prescription. Alcohol should generally not be used during treatment with benzodiazepines. Not recommended for use in pregnancy. Th