Alprazolam

The recommended dose of alprazolam for adults varies depending on its use. The starting dose for excessive anxiety is 0.25 mg taken 2 or 3 times a day. This is gradually increased until anxiety is controlled and side effects are minimized. Elderly patients may be started at a lower dose of 0.125 mg taken 2 or 3 times a day. The usual maximum dose is 3 mg daily.

The starting dose for panic attacks is 0.5 mg to 1 mg at bedtime or 0.5 mg taken 3 times daily. The dose is then gradually increased until there are no more panic attacks.

The dose is usually started low and increased if necessary, as prescribed by your doctor. It is important that the dose be individualized to your specific needs to avoid excessive sedation or motor impairment.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Alprazolam may be habit-forming when taken for long periods of time. If you have been taking Alprazolam regularly for a long period of time (i.e., more than one month), do not stop taking the medication without speaking with your doctor. A gradual reduction in dose is recommended when stopping Alprazolam to avoid withdrawal symptoms.

It is important to take Alprazolam exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store at room temperature in a dry place and keep it out of reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause memory loss; it may cause headaches; it may cause confusion; it may cause dizziness - use caution when getting up from a lying or sitting position and use caution if driving; it may make your skin more sensitive to UV rays (e.g., sunlight, tanning lamps) - avoid exposure to UV rays as much as possible and protect yourself when out in the sun; it may cause drowsiness that lasts until the next day - use caution until you know how you will react. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

Riva-Alpraz is no longer being manufactured for sale in Canada. For brands that may still be available, search under alprazolam. This article is being kept available for reference purposes only. If you are using Alprazolam, speak with your doctor or pharmacist for information about your treatment options.

Do not take Alprazolam if you:

• are allergic to alprazolam or any ingredients of the medication
• are allergic to any other medications belonging to the benzodiazepine class
• have acute narrow-angle Glaucoma (alprazolam may be used by people with open-angle glaucoma who are receiving appropriate treatment)
• have Myasthenia Gravis
• have severe breathing problems
• have Sleep Apnea
• have severely reduced liver function
• are taking the medications ketoconazole or itraconazole

There may be an interaction between alprazolam and any of the following:

• alcohol
• antihistamines (e.g., cetirizine, doxylamine, Diphenhydramine, Hydroxyzine, Loratadine)
• antipsychotics (e.g., Chlorpromazine, Clozapine, Haloperidol, Olanzapine, Quetiapine, Risperidone)
• antiseizure medications (e.g., Carbamazepine, Clobazam, Gabapentin, Levetiracetam, Phenobarbital, Phenytoin, primidone, Topiramate, Valproic acid, zonisamide)
• Apalutamide
• Aprepitant
• azelastine
• "azole" antifungals (e.g., ketoconazole, itraconazole, fluconazole)
• barbiturates (e.g., butalbital, phenobarbital)
• benzodiazepines (e.g., Diazepam, Lorazepam)
• Bosentan
• Bicalutamide
• birth control pills
• brimonidine
• Buprenorphine
• Buspirone
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• cannabis
• chloral hydrate
• Cobicistat
• conivaptan
• Deferasirox
• Dexamethasone
• dofetilide
• Dronedarone
• Entacapone
• Enzalutamide
• Flibanserin
• general anesthetics (medications used to put people to sleep before surgery)
• grapefruit juice
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• kava kava
• Lomitapide
• lumacaftor
• macrolide antibiotics (e.g., erythromycin, clarithromycin)
• magnesium sulfate
• melatonin
• Methadone
• mifepristone
• Mirtazapine
• Mitotane
• muscle relaxants (e.g., Baclofen, Cyclobenzaprine, methocarbamol, orphenadrine, Tizanidine)
• Modafinil
• Nabilone
• narcotic pain relievers (e.g., Codeine, Fentanyl, Morphine, Oxycodone)
• Olopatadine
• Pramipexole
• rifabutin
• rifampin
• Ropinirole
• Rotigotine
• St. John's wort
• Sarilumab
• scopolamine
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Fluoxetine, Paroxetine, Sertraline)
• siltuximab
• sodium oxybate
• Stiripentol
• Tapentadol
• Tetracycline
• thalidomide
• Theophylline
• Tocilizumab
• Tramadol
• Trazodone
• tricyclic antidepressants (e.g., Amitriptyline, Desipramine, Imipramine)
• tyrosine kinase inhibitors (e.g., Ceritinib, Crizotinib, Dabrafenib, Dasatinib, imatinib)
• valerian
• Yohimbine
• Zolpidem
• Zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Alprazolam. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Alprazolam.

HEALTH CANADA ADVISORY

October 30, 2020

Health Canada has issued new restrictions concerning the use of benzodiazepines and benzodiazepine-like prescription drugs. To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.

Alcohol and other medications that cause drowsiness: People taking Alprazolam should not combine it with alcohol and avoid combining it with other medications, such as narcotic pain relievers, that cause drowsiness. Doing so can cause additive drowsiness and reduced breathing as well as other side effects, which can be dangerous and possibly fatal.

Dependence and withdrawal: Physical dependence (a need to take regular doses to prevent physical symptoms) has been associated with benzodiazepines such as alprazolam. Severe withdrawal symptoms may be experienced if the dose is significantly reduced or suddenly discontinued. These symptoms include seizures, irritability, nervousness, sleep problems, agitation, tremors, diarrhea, abdominal cramps, vomiting, memory impairment, headache, muscle pain, extreme anxiety, tension, restlessness, and confusion. Reducing the dose gradually, under medical supervision, can help prevent or decrease these withdrawal symptoms.

Because the treatment of panic disorder often requires the use of average daily doses of alprazolam above 3 mg, the risk of dependence among people with panic disorder may be higher than that among those treated for less severe anxiety.

Drowsiness/reduced alertness: Alprazolam may affect the mental or physical abilities needed to drive or operate machinery. Do not engage in activities requiring mental alertness, judgment, and physical coordination until you have established how alprazolam affects you. Alcohol can increase the drowsiness effects of alprazolam and should be avoided.

Kidney function: Kidney Disease or reduced kidney function may cause Alprazolam to build up in the body, causing side effects. If you have kidney problems, discuss with your doctor how Alprazolam may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Alprazolam, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause Alprazolam to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how Alprazolam may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Alprazolam, and whether any special monitoring is needed.

Mood changes: Anxiety Disorders are often associated with mood changes, such as depression, mania, or ideas of suicide or self-harm. If you have depression or a history of depression, discuss with your doctor how Alprazolam may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Alprazolam, and whether any special monitoring is needed.

If you experience symptoms of depression such as poor concentration, changes in weight, changes in sleep, decreased interest in activities, or notice them in a family member who is taking Alprazolam contact your doctor as soon as possible.

Pregnancy: Other benzodiazepine medications similar to alprazolam are known to increase the risk of birth defects when taken by a woman who is pregnant. The safety of alprazolam during pregnancy has not been established. It is not recommended for use by pregnant women.

Breast-feeding: Alprazolam may pass into breast milk. If you are a breast-feeding mother and are taking alprazolam, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children and adolescents: The safety and efficacy of alprazolam for children and adolescents under 18 years of age have not been established.

Seniors: Seniors may be at increased risk of experiencing side effects such as sedation, reduced coordination, and dizziness. Use extra caution when rising from a sitting or lying position to reduce the risk of severe dizziness and falls.

The dosage of this medication depends on what it is used for. Depending on the circumstance, it may be used regularly or only as needed. Follow the instructions provided by your health care professional. It is not advisable to stop using this product suddenly, particularly if you have been on it for several weeks. If you are considering stopping the medication, talk to your pharmacist first. This medication may be taken with or without food. Consuming alcohol may intensify the effect of this product. Limit alcohol consumption to occasional small quantities.