Niravam, Xanax, Xanax XR
Classifications: anxiolytic; sedative-hypnotic; benzodiazepine; Therapeutic: antianxiety; sedative-hypnotic
Pregnancy Category: D
Controlled Substance: Schedule IV
0.25 mg, 0.5 mg, 1 mg, 2 mg tablets; 0.5 mg, 1 mg, 2 mg, 3 mg sustained-release tabs; 1 mg/mL oral solution; 0.25 mg, 0.5 mg, 1 mg, 2 mg orally disintegrating tabs
A CNS depressant that appears to act at the limbic, thalamic, and hypothalamic levels of the CNS.
Has antianxiety and sedative effects with addictive potential.
Management of anxiety disorders or for short-term relief of anxiety symptoms. Also used as adjunct in management of anxiety
associated with depression and agitation, and for panic disorders, such as agoraphobia.
Sensitivity to benzodiazepines; acute narrow angle glaucoma; pulmonary disease; use alone in primary depression or psychotic
disorders, bipolar disorders, organic brain disorders; myasthenia gravis; pregnancy (category D), lactation; children <18
Impaired hepatic function; history of alcoholism; renal impairment, hepatic disease; geriatric and debilitated patients.
Effectiveness for long-term treatment (>4 mo) not established.
Route & Dosage
Adult: PO 0.250.5 mg t.i.d. (max: 4 mg/d)
Geriatric: PO 0.1250.25 mg b.i.d.
Adult: PO 12 mg t.i.d. (max: 8 mg/d); sustained release: initiate with 0.5 mg to 1 mg once/d. Depending on the response, the dose may be increased at intervals of 3 to 4 days in increments of no more than 1 mg/d. Target
range 36 mg/d (max: 10 mg/d).
Reduce dose by 50% in hepatic impairment.
Do not discontinue abruptly.
- Reduce drug gradually when discontinuing drug.
- Store in light-resistant containers at 15°30° C (59°86° F), unless otherwise directed.
Adverse Effects (≥1%)CNS: Drowsiness, sedation,
light-headedness, dizziness, syncope, depression
, headache, confusion, insomnia
, nervousness, fatigue
, clumsiness, unsteadiness,
rigidity, tremor, restlessness, paradoxical excitement, hallucinations. CV:
Tachycardia, hypotension, ECG changes. Special Senses:
Blurred vision. Respiratory: Dyspnea
Interactions Drug: Alcohol
and other cns depressants
, narcotic analgesics
depressant effects; cimetidine, disulfiram, fluoxetine, tricyclic antidepressants
increase alprazolam levels (decreased metabolism
); oral contraceptives
may increase or decrease alprazolam effects. Herbal: Kava, valerian
may potentiate sedation; St. John's wort
level of alprazolam. Cigarette smoking may decrease serum
level of alprazolam by 50%.
Rapidly absorbed. Peak:
12 h. Distribution:
Crosses placenta. Metabolism:
Oxidized in liver to inactive metabolites by CYP3A4. Elimination: Renal
Assessment & Drug Effects
- Monitor for S&S of drowsiness and sedation, especially in older adults or the debilitated; they may require supervised ambulation
and/or side rails.
- Lab tests: Monitor periodic blood counts, urinalyses, and blood chemistry studies, particularly during continuing therapy.
Patient & Family Education
- Note: Adverse reactions that may occur during early high-dose therapy. These usually disappear with continuing therapy, but dosage
adjustments may be indicated.
- Make position changes slowly and in stages to prevent dizziness.
- Do not use alcohol, other CNS depressants, or OTC medications containing antihistamines (e.g., sleep aids, cold, hay fever,
or allergy remedies) without consulting physician.
- Do not drive or engage in potentially hazardous activities until response to drug is known.
- Taper dosage following continuous use; abrupt discontinuation of drug may cause withdrawal symptoms: nausea, vomiting, abdominal
and muscle cramps, sweating, confusion, tremors, convulsions.