Alprazolam

About Alprazolam

Alprazolam binds the benzodiazepine site of GABA-A receptors in the brain and strengthens GABA’s calming effect. Tablets and the concentrate are labeled for the acute treatment of generalized anxiety disorder and for panic disorder, with or without agoraphobia, in adults, and disintegrating tablets for the same two disorders; extended-release tablets are labeled for panic disorder only. For anxiety, treatment starts at 0.25 to 0.5 mg three times a day, up to 4 mg a day. For panic disorder it starts at 0.5 mg three times a day and rises by no more than 1 mg a day every three to four days; trials used 1 to 10 mg a day. Extended-release tablets start at 0.5 to 1 mg once a day and usually reach 3 to 6 mg. Older adults and people with liver impairment start lower, and safety and effectiveness in children have not been established.

The boxed warning says that taking it with opioids can cause profound sedation, slowed breathing, coma and death; that it exposes users to abuse, misuse and addiction, which can lead to overdose or death; and that continued use causes physical dependence, so stopping suddenly or cutting the dose quickly can bring on withdrawal reactions, which can be life-threatening; the label’s warnings name seizures as an example. The dose is lowered gradually, by no more than 0.5 mg every three days, and some people have withdrawal symptoms for weeks to more than a year. It must not be taken by anyone allergic to benzodiazepines or with strong CYP3A blockers such as ketoconazole (ritonavir excepted). Other warnings cover impaired driving, worsening depression, mania, and risk in people with impaired breathing. The label names poor coordination, low blood pressure, slurred speech and increased sex drive as the most common side effects in trials.

As a Schedule IV drug, a prescription can be refilled up to five times within six months of the date written. Refill information can move between pharmacies only once, unless they share a real-time database, and an unfilled electronic prescription can be transferred once at the patient’s request where state law allows. Extended-release tablets are swallowed whole, never divided, crushed or chewed. Disintegrating tablets contain phenylalanine, which matters in phenylketonuria. The concentrate (Alprazolam Intensol, 1 mg per mL) is measured with its oral syringe and discarded 90 days after opening. Use late in pregnancy can cause sedation and withdrawal in the newborn, and breastfeeding is not recommended.

Taking Alprazolam

How to take it

Tablets, disintegrating tablets and the concentrate usually two to four times a day; extended-release tablets once a day, usually in the morning, swallowed whole. With dry hands, take a disintegrating tablet out of its pack just before the dose and let it dissolve on the tongue, with or without water. Do not stop it on your own.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and continue your regular schedule. Do not take a double dose.

Storage

At room temperature in the original, tightly closed container, away from excess heat and moisture, out of reach of children and others; keep the concentrate away from light. Do not flush it; use a take-back program.

Interactions to know about

Opioids, alcohol, sleep medicines, antihistamines and other sedatives deepen sedation and can slow breathing dangerously. Ketoconazole, itraconazole and clarithromycin must not be combined with it; nefazodone, fluvoxamine, cimetidine and erythromycin raise its levels, ritonavir calls for a lower dose at first, and carbamazepine and phenytoin can lower them. It can raise digoxin levels, and MedlinePlus advises asking about grapefruit.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Alprazolam differs from pharmacy to pharmacy

Each form has its own makers, from several for tablets to one for the concentrate, and no form can be exchanged for another at the counter. A prescription that names Xanax or Xanax XR and blocks substitution is priced as a brand.

Each pharmacy sets its own cash price, including its dispensing fee, so quotes for the same tablet can differ. The concentrate comes in a 30 mL bottle that is thrown away 90 days after opening.

Ways to pay less for Alprazolam without insurance

• Ask for generic alprazolam, and make sure the prescription does not name Xanax or Xanax XR only.
• Ask whether alprazolam is on the pharmacy’s flat-price generic list, and compare quotes before the first fill, since refill information can be transferred only once.
• If disintegrating tablets or the concentrate are prescribed and you can swallow tablets, ask the prescriber whether regular tablets would suit you.
• Choose the pharmacy before the prescription is sent electronically: an unfilled electronic prescription can be transferred between pharmacies only once, at your request.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Alprazolam

1. 1.Is it safe with my pain, sleep or allergy medicines, or with an antifungal or HIV medicine?
2. 2.Can I drive, and should I avoid alcohol and grapefruit while I take it?
3. 3.How will my dose be lowered when it is time to stop?
4. 4.How many refills does my prescription carry, and when does it expire?

Related medications