💊 Alprazolam (Alprazolam Extended Release)
Alprazolam extended-release tablets are a benzodiazepine indicated for the treatment of panic disorder with or without agoraphobia in adults. They are taken once daily and carry a boxed warning about concomitant opioid use, abuse, misuse and addiction, and dependence and withdrawal reactions. They should only be used as prescribed and supervised by a doctor.
In Arabic: ألبرازولام (أقراص ممتدة المفعول)
🏷️ Brand names & manufacturers
Packages shown are US-market (DailyMed). Brands available in Palestine are in the price section below.
Xanax🏭 PHARMACIA & UPJOHN COMPANY LLC
Xanax Xr🏭 Viatris Specialty LLC
Alprazolam Xr🏭 Mylan Pharmaceuticals Inc.
Alprazolam🏭 Mylan Pharmaceuticals Inc.
Alprazolam🏭 Aurobindo Pharma Limited✅ What it is used for
- Treatment of panic disorder with or without agoraphobia in adults
🧪 Active ingredient
Alprazolam: a benzodiazepine that binds to the benzodiazepine site of GABA-A receptors in the brain and enhances GABA-mediated synaptic inhibition, which underlies its effect in panic disorder.
🌿 Benefits
- Relief of panic attacks in adults with panic disorder
- Convenient once-daily extended-release formulation
📝 How to use
- Taken by mouth once daily, preferably in the morning.
- Swallow tablets whole; do not divide, crush, or chew.
- The dose is set by your doctor or pharmacist based on your condition and response; do not change it on your own.
- Do not stop suddenly; the dose must be tapered gradually under medical supervision to reduce the risk of withdrawal reactions.
- If used for longer than 8 weeks, the healthcare provider should periodically reassess whether the drug is still useful for you.
💊 Dosage forms
- Extended-release tablets: 0.5 mg (white to off-white)
- 1 mg (yellow)
- 2 mg (peach)
- 3 mg (light green)
⚠️ Common side effects
- Somnolence (drowsiness)
- Memory impairment
- Dysarthria (slurred speech)
- Abnormal coordination
- Ataxia (unsteady walking)
- Decreased libido
- Constipation
- Nausea
- Sedation and fatigue (reasons for discontinuation in trials)
🚨 Serious — seek medical help
- Profound sedation, respiratory depression, coma, and death, especially with opioids or alcohol
- Withdrawal reactions, which can be life-threatening, after abrupt discontinuation or rapid dose reduction
- Abuse, misuse, addiction, and physical dependence, which can lead to overdose or death
- Angioedema (allergic swelling)
- Depression or worsening depression
⛔ Do not use if
- Known hypersensitivity to alprazolam or other benzodiazepines
- Concomitant use with strong CYP3A inhibitors such as ketoconazole or itraconazole (except ritonavir)
❗ Warnings & precautions
- Boxed warning: concomitant use with opioids may cause profound sedation, respiratory depression, coma, and death.
- Risk of abuse, misuse, and addiction, which is increased with other medications, alcohol, or illicit substances.
- Physical dependence and withdrawal risk increase with longer treatment duration and higher daily dose.
- Avoid driving or operating machinery, and avoid alcohol and other CNS depressants.
- Use caution in patients with signs or symptoms of depression; prescribe the fewest tablets feasible to avoid intentional overdose.
- Use during pregnancy can result in neonatal sedation and/or withdrawal.
- Risk in patients with impaired respiratory function.
🔄 Drug interactions
- Opioids (e.g., morphine, oxycodone, fentanyl, tramadol): increased risk of respiratory depression.
- Other CNS depressants (psychotropic medications, anticonvulsants, antihistamines, ethanol): additive CNS depressant effects.
- Digoxin: increased risk of digoxin toxicity.
- CYP3A inhibitors (except ritonavir): increased risk of alprazolam adverse reactions.
- CYP3A inducers: risk of reduced alprazolam efficacy.
🤰 Pregnancy
Neonates born to mothers using benzodiazepines late in pregnancy have been reported to experience sedation and/or withdrawal; benzodiazepines cross the placenta and may cause respiratory depression, hypotonia, and sedation in neonates. Observational data do not show a clear association with major birth defects. Consult your doctor before use during pregnancy.
🍼 Breastfeeding
Breastfeeding is not recommended during treatment.
🧒 Children
Safety and effectiveness have not been established in pediatric patients.
👴 Older adults
Geriatric patients have higher alprazolam plasma concentrations (reduced clearance) and may be more sensitive to benzodiazepines; dose reduction is recommended and the doctor will determine the appropriate dose.
🌡️ Storage
The provided label text does not include storage conditions; follow your pharmacist's advice and the package labeling.
⏰ Missed dose
The provided label text does not include instructions for a missed dose; ask your doctor or pharmacist and do not double the dose on your own.
🆘 Overdose
Overdose may cause drowsiness, confusion, slurred speech, lethargy, diminished reflexes, ataxia, and hypotonia, and in severe cases respiratory depression and coma; it may be fatal in combination with alcohol or opioids. Seek emergency medical help immediately or contact a poison control center.
💰 Price & brands in your area
🏛️ Official price in Palestine — Ministry of Health price list:
| Product | Company | Pack | Price |
|---|---|---|---|
| XANAX XR 0.50MG-30TAB Alprazolam | Alram Drug Store | 30 TAB | 20 ₪ |
| XANAX XR 1 MG-30 TAB Alprazolam | Alram Drug Store | 30 TAB | 31 ₪ |
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Mechanism of action
A 1,4 benzodiazepine that binds the benzodiazepine site of GABA-A receptors and enhances GABA-mediated synaptic inhibition. Absolute bioavailability is about 90%; peak plasma concentration (Cmax) occurs about 10 hours after a morning dose; mean elimination half-life is 10.7–15.8 hours in healthy adults; about 80% is bound to serum protein.
Labeled dosing
Label adult dosing: starting dose 0.5 mg to 1 mg once daily (preferably in the morning), adjusted at 3–4 day intervals by no more than 1 mg daily. Recommended range 3 mg to 6 mg once daily; occasional patients required up to 10 mg. Geriatric patients start at 0.5 mg once daily. When discontinuing, reduce by no more than 0.5 mg every 3 days; some patients need slower tapering. Tablets are swallowed whole. The final dose is determined by the prescriber.
- Reassess the usefulness of therapy periodically if used beyond 8 weeks; long-term efficacy has not been systematically evaluated.
- If withdrawal reactions occur, consider pausing the taper or returning to the previous dose, then taper more slowly.
- In placebo-controlled trials, about 17% of treated patients discontinued due to adverse events vs 8% on placebo; sedation, somnolence, and dysarthria were most common.
- Overdose: general supportive measures (IV fluids, airway management); flumazenil can precipitate withdrawal and seizures and is contraindicated in patients given a benzodiazepine for a life-threatening condition.
- Monitor neonates exposed during pregnancy or labor for sedation, respiratory depression, hypotonia, feeding problems, and withdrawal.
🎓 Key points for students
- Class: benzodiazepine; indication: panic disorder with/without agoraphobia in adults.
- Mechanism: enhances GABA-A–mediated inhibition.
- Triple boxed warning: opioid co-use, abuse/misuse/addiction, dependence/withdrawal.
- Contraindications: hypersensitivity to benzodiazepines; strong CYP3A inhibitors (except ritonavir).
- Taper: no more than 0.5 mg every 3 days.
- Common adverse effects: somnolence, memory impairment, dysarthria, ataxia, constipation, nausea, decreased libido.
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What is alprazolam extended-release used for?
It is used to treat panic disorder with or without agoraphobia in adults.
Can I stop it suddenly?
No. Abrupt discontinuation or rapid dose reduction can cause serious withdrawal reactions. The dose must be tapered gradually under medical supervision.
Can I take it with alcohol or opioids?
This is not advised; the combination can cause profound sedation, respiratory depression, coma, and death.
Can I drive while taking it?
You should avoid driving and operating machinery because it can cause drowsiness and impaired coordination.
Can I crush or chew the tablet?
No. Swallow the tablet whole without dividing, crushing, or chewing.
Is it safe in pregnancy and breastfeeding?
It can cause sedation or withdrawal in newborns, and breastfeeding is not recommended. Talk to your doctor.
⚕️ For education only — not a substitute for advice from your doctor or pharmacist. Do not start or stop any medicine without advice. Source: official FDA drug label via openFDA (2024-05), simplified. Updated: 2026-11-11.