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Indications and usage:
Xanax (Alprazolam) is a benzodiazepine indicated for the:
- Acute treatment of generalized anxiety disorder in adults.
- Treatment of panic disorder with or without agoraphobia in adults.
Dosage and administration:
- Generalized anxiety disorder:
– Recommended starting oral dosage of alprazolam (xanax) tablets is 0.25 mg to 0.5 mg three times daily.
– Dosage may be increased, at intervals of every 3 to 4 days, to a maximum recommended daily dose of 4 mg, given in divided doses.
– Use the lowest possible effective dose and frequently assess the need for continued treatment.
- Panic disorder: recommended starting oral dosage is 0.5 mg three times daily. The dosage may be increased at intervals of every 3 to 4 days in increments of no more than 1 mg per day.
- When tapering, decrease dosage by no more than 0.5 mg every 3 days. Some patients may require an even slower dosage reduction.
- See the full prescribing information for the recommended dosage in geriatric patients, patients with hepatic impairment, and with use with ritonavir.
Dosage forms and strengths:
Xanax (Alprazolam) tablets 0.25 mg, 0.5 mg, 1 mg, 2 mg.
Manifestations of alprazolam overdosage include somnolence, confusion, impaired coordination, diminished reflexes, and coma. Death has been reported in association with overdoses of alprazolam by itself, as it has with other benzodiazepines. In addition, fatalities have been reported in patients who have overdosed with a combination of a single benzodiazepine, including alprazolam, and alcohol; alcohol levels seen in some of these patients have been lower than those usually associated with alcohol-induced fatality.
Management of overdose:
In case of an overdosage by Xanax (Alprazolam) pills, consult a certified poison control center at 1-800-222-1222 (in the USA) for latest recommendations.
As in all cases of drug overdosage, respiration, pulse rate, and blood pressure should be monitored. General supportive measures should be employed, along with immediate gastric lavage. Intravenous fluids should be administered and an adequate airway maintained. As with the management of intentional overdosing with any drug, it should be borne in mind that multiple agents may have been ingested.
Flumazenil may be useful in situations when an overdose with a benzodiazepine is known or suspected. Prior to the administration of flumazenil, necessary measures should be instituted to secure airway, ventilation, and intravenous access. Flumazenil is intended as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. Patients treated with flumazenil should be monitored for re-sedation, respiratory depression, and other residual benzodiazepine effects for an appropriate period after treatment. The prescriber should be aware of a risk of seizure in association with flumazenil treatment, particularly in long-term benzodiazepine users and in cyclic antidepressant overdose. The complete flumazenil package insert should be consulted prior to use.
- Known hypersensitivity to alprazolam or other benzodiazepines.
- Concomitant use with strong cytochrome P450 3A (CYP3A) inhibitors, except ritonavir.
Warnings and precautions:
- Effects on driving and operating machinery: patients receiving Xanax should be cautioned against operating machinery or driving a motor vehicle, as well as avoiding concomitant use of alcohol and another central nervous system (CNS) depressant drugs.
- Neonatal sedation and withdrawal syndrome (NOWS): use of alprazolam during pregnancy can result in neonatal sedation and neonatal withdrawal syndrome.
- Patients with depression: exercise caution in patients with signs or symptoms of depression. Prescribe the least number of tablets feasible to avoid intentional overdosage.
Adverse reactions, side effects:
The most common adverse reactions of alprazolam reported in clinical trials for generalized anxiety disorder and panic disorder (incidence >= 5% and at least twice that of placebo) include: impaired coordination, hypotension, dysarthria, and increased libido.
To report suspected adverse reactions of Xanax (Alprazolam) tablets, contact Pfizer, Inc. pharmaceutical company or your local FDA.
- Use with opioids: increase the risk of respiratory depression.
- Use with other CNS depressants: produces additive CNS depressant effects.
- Use with digoxin: increase the risk of digoxin toxicity.
- Use with CYP3A inhibitors (except ritonavir): increase the risk of adverse reactions of alprazolam.
- Use with CYP3A inducers: increase the risk of reduced efficacy of Xanax.
Use in specific populations:
Lactation: breastfeeding not recommended.
Drug abuse and dependence:
Xanax contains alprazolam, which is a controlled substance in some countries (for example, Schedule IV in the United States and Canada).
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