Patient Information Overview

Pronounced: ZAN-ax
Generic name: Alprazolam
Other brand name: Xanax XR
Category: Anti-Anxiety Medication

Why is Xanax prescribed?

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 Xanax

Tolerance and dependence can occur with the use of Xanax. You may experience withdrawal symptoms if you stop using Xanax 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 Xanax?

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 when using Xanax?

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?

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 Xanax

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 Xanax

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

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 for Xanax

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

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.

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Reviewed: 01/2006