Alprazolam
XANAX
What it isHigh-potency GABA-A positive allosteric modulator; panic disorder and anxiety.
Why this oneRapid onset and short duration relieve panic quickly but create more interdose rebound than longer-acting benzodiazepines.
What limits itDependence can develop quickly; taper slowly to avoid severe withdrawal. Opioids and other sedatives can cause fatal respiratory depression.
FDA-approved for
- anxiety (1981)
- panic disorder (1990)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Generalized anxiety disorder | Adult | 0.25–0.5 mg TID | — | 4 mg/day divided |
| Panic disorder | Adult | 0.5 mg TID | 5–6 mg/day | 10 mg/day |
| Anxiety / panic | Geriatric | 0.25 mg BID–TID | — | — |
Titration GAD: adjust every 3–4 days. Panic: increase every 3–4 days by ≤1 mg/day.
Renal Undefined
Hepatic Start 0.25 mg 2–3×/day; reduce dose.
Instructions
- Taper to discontinue: decrease by ≤0.5 mg every 3 days (slower if needed).
- Avoid alcohol and other CNS depressants.
- With ritonavir, halve dose initially then increase after 10–14 days; contraindicated with other strong CYP3A inhibitors.
Contraindications
- Concomitant strong CYP3A inhibitors (e.g., ketoconazole, itraconazole), except ritonavir
Cautions
- Concomitant opioid use (respiratory depression)
- Abuse, misuse, addiction
- Dependence and withdrawal (life-threatening; taper)
- Impairs driving/operating machinery
- May worsen depression; suicidality risk
- Hypomania/mania reported
- Neonatal sedation and withdrawal with late-pregnancy use
- Deaths reported in severe pulmonary disease—monitor impaired respiratory function
Adverse reactions
- Drowsiness
- Fatigue
- Impaired coordination
- Memory impairment / cognitive disorder
- Dysarthria
- Light-headedness
- Dry mouth
- Constipation
- Changes in libido
- Appetite/weight changes
Pregnancy Neonatal sedation and/or withdrawal with late-pregnancy use; observational data show no clear association with major birth defects.
Lactation Present in breast milk; breastfeeding not recommended (sedation, poor feeding, poor weight gain reported).
⚠ BOXED WARNINGS
- Risk from concomitant use with opioids
- Abuse, misuse and addiction
- Dependence and withdrawal reactions
Cost, est. cash$4–$80/month
Generic entry1993
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilityRapid dependence and severe withdrawal; overdose becomes dangerous with opioids or other depressants.
Active metabolites
Mechanism of action: Alprazolam ballicule
Open Alprazolam in the interactive console ↗
Memory aids: mascots and interaction avatars
No fear → benzos are anxiolytic drugs
Pill bottle → symbol for benzodiazepine class
