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Call your doctor for medical advice about side effects. XANAX XR Tablets contain alprazolam which is a triazolo analog of the 1,4 benzodiazepine class of central nervous system -active compounds. The molecular formula is C 17 H 3 ClN 4 which corresponds to a molecular weight of Alprazolam is a white crystalline powder, Google groups xanax is soluble in methanol or ethanol but which has no appreciable solubility in water at physiological pH.
The inactive ingredients are lactose, magnesium stearate, colloidal silicon dioxide, and hypromellose. Swallow tablets whole; do not divide, crush, or chew. Depending on the response, the dosage Google groups xanax be adjusted at intervals of every 3 to 4 days in increments of no more than 1 mg daily. The recommended dosage range Google groups xanax 3 mg to 6 mg once daily.
Most patients showed a response in the dosage range of 3 mg to 6 mg per day. Occasional patients required as much as 10 mg per day. If XANAX XR is used for periods longer than 8 weeks, the healthcare provider should periodically reassess the usefulness of the drug for the individual patient. If a patient develops withdrawal reactions, consider pausing the taper or increasing the dosage to the tapered dosage level. Reduce the dosage by no more than 0. Some patients may benefit from an even more gradual discontinuation. Some patients may prove resistant to all discontinuation regimens.
In a controlled postmarketing discontinuation study of panic disorder patients which compared the recommended taper schedule with a slower taper schedule, no difference was observed between the groups in the proportion of patients who tapered to zero dose; however, the slower schedule was associated with a reduction in symptoms associated with a withdrawal syndrome.
This may be gradually increased if needed and tolerated. If the clinical response after switching is inadequate, titrate the dosage as outlined above. Revised: Mar Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
The most common events leading to discontinuation and considered to be drug-related i. Cardiac disorders: Frequent: palpitation; Infrequent: sinus tachycardia. Ear and Labyrinth disorders: Frequent: Vertigo; Infrequent: tinnitus, ear pain. Eye disorders: Frequent: blurred vision; Infrequent: mydriasis, photophobia.
Gastrointestinal disorders: Frequent: diarrhea, vomiting, dyspepsia, abdominal pain; Infrequent: dysphagia, salivary hypersecretion. General Google groups xanax and administration site conditions: Frequent: malaise, weakness, chest pains; Infrequent: fall, pyrexia, thirst, feeling hot and cold, edema, feeling jittery, sluggishness, asthenia, feeling drunk, chest tightness, increased energy, feeling of relaxation, hangover, loss of control of legs, rigors. Musculoskeletal and connective tissue disorders: Frequent: back pain, muscle cramps, muscle twitching. Nervous system disorders: Frequent: headache, dizziness, tremor; Infrequent: amnesia, clumsiness, syncope, hypotonia, seizures, depressed level of consciousness, sleep apnea syndrome, sleep talking, stupor.
Psychiatric system disorders: Frequent: irritability, insomnia, nervousness, derealization, libido increased, restlessness, agitation, depersonalization, nightmare; Infrequent: abnormal dreams, apathy, aggression, anger, bradyphrenia, euphoric mood, logorrhea, mood swings, dysphonia, hallucination, homicidal ideation, mania, hypomania, impulse control, psychomotor retardation, suicidal ideation.
Renal and urinary disorders: Frequent: difficulty in micturition; Infrequent: urinary frequency, urinary incontinence. Respiratory, thoracic, and mediastinal disorders: Frequent: nasal congestion, hyperventilation; Infrequent: choking sensation, Google groups xanax, rhinorrhea. Skin and subcutaneous tissue disorders: Frequent: sweating increased; Infrequent: clamminess, rash, urticaria. Paradoxical reactions such as stimulation, increased muscle spasticitysleep disturbances, hallucinations, and other adverse behavioral effects such as agitation, rage, irritability, and aggressive or hostile behavior have been reported rarely.
Should any of the above events occur, alprazolam should be discontinued.
Isolated published reports involving small s of patients have suggested that patients who have borderline personality disordera prior history of violent or aggressive behavior, or alcohol or substance abuse may be at risk for such events. Instances of irritability, hostility, and intrusive thoughts have been reported during discontinuation of alprazolam in patients with posttraumatic stress disorder. Because these reactions are reported voluntarily from a population of uncertain size, Google groups xanax is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Hepatobiliary disorders: Hepatitishepatic failure, jaundice.
Use of triazolam and alprazolam as premedication for general anesthesia
Reproductive system and breast disorders: Gynecomastiagalactorrheamenstruation irregular. Skin and subcutaneous tissue disorders: Photosensitivity reaction, angioedemaStevens-Johnson syndrome. Although interactions between benzodiazepines and commonly employed clinical laboratory tests have occasionally been reported, there is no consistent pattern for a specific drug or specific test. Abuse is the Google groups xanax, non-therapeutic use of a drug, even once, for its desirable psychological or physiological effects.
Misuse is the intentional use, for therapeutic purposes, of a drug by an individual in a way other than prescribed by a health care provider or for whom it was not prescribed. Drug addiction is a cluster of behavioral, cognitiveand physiological phenomena that may include a strong desire to take the drug, difficulties in controlling drug use e. Even taking benzodiazepines as prescribed may put patients at risk for abuse and misuse of Google groups xanax medication. Abuse and misuse of benzodiazepines may lead to addiction. Death is more often associated with polysubstance use especially benzodiazepines with other CNS depressants such as opioids and alcohol.
Physical dependence is a state that develops as a result of physiological adaptation in response to repeated drug use, manifested by withdrawal s and symptoms after abrupt discontinuation or a ificant dose reduction of a drug. Abrupt discontinuation or rapid dosage reduction of benzodiazepines or administration of flumazenil, a benzodiazepine antagonistmay precipitate acute withdrawal reactions, including seizures, which can be life-threatening. Patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages i.
Acute withdrawal s and symptoms associated with benzodiazepines have included abnormal involuntary movements, anxiety, blurred vision, depersonalization, depression, derealization, dizziness, fatigue, gastrointestinal adverse Google groups xanax e. More severe acute withdrawal s and symptoms, including life-threatening reactions, have included catatonia, convulsions, delirium tremensdepression, hallucinations, mania, psychosisseizures, and suicidality.
Protracted withdrawal syndrome associated with benzodiazepines is characterized by anxiety, cognitive impairment, depression, insomnia, formicationmotor symptoms e. Protracted withdrawal symptoms may last weeks to more than 12 months.
As a result, there may be difficulty in differentiating withdrawal symptoms from potential re-emergence or continuation of symptoms for which the benzodiazepine was being used. Tolerance is a physiological state characterized by a reduced response to a drug after repeated administration i. Tolerance to the therapeutic effect of XANAX XR may develop; however, little tolerance develops to the amnestic reactions and other cognitive Google groups xanax caused by benzodiazepines.
Concomitant use of benzodiazepines, including XANAX XR, and opioids may result in profound sedation, respiratory depression, coma, and death. Because of these risks, reserve concomitant prescribing of these drugs in patients for whom alternative treatment options are inadequate.
Lorazepam vs xanax: what is the difference?
Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioids alone. If a decision is made to prescribe XANAX XR concomitantly with opioids, prescribe the lowest effective dosages and minimum durations of concomitant use, and follow patients closely for s and symptoms of respiratory depression and sedation.
In patients already receiving an opioid analgesicprescribe a lower initial dose of XANAX XR than indicated in the absence of an opioid and titrate based on clinical response. If an opioid is initiated Google groups xanax a patient already taking XANAX XR, prescribe a lower initial dose of Google groups xanax opioid and titrate based upon clinical response. The use of benzodiazepines, including XANAX XR, exposes users to the risks of abuse, misuse, and addiction, which can lead to overdose or death. Prescribe the lowest effective dosage; avoid or minimize concomitant use of CNS depressants and other substances associated with abuse, misuse, and addiction e.
If a substance use disorder is suspected, evaluate the patient and institute or refer them for early treatment, as appropriate. Patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages, and those who have had longer durations of use. Abrupt discontinuation or rapid dosage reduction of XANAX XR after continued use, or administration of flumazenil a benzodiazepine antagonist may precipitate acute withdrawal reactions, which can be life-threatening e.
In some cases, benzodiazepine users have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months Google groups xanax Drug Abuse And Dependence ]. These include a spectrum of withdrawal symptoms; the most important is seizure [see Drug Abuse And Dependence ].
However, in a controlled postmarketing discontinuation study of panic disorder patients who received XANAX, the duration of treatment 3 months compared to 6 months had no effect on the ability of patients to taper to zero dose. In a controlled clinical trial in which 63 patients were randomized to XANAX and where withdrawal symptoms were specifically sought, the following were identified as symptoms of withdrawal: heightened sensory perception, impaired concentration, dysosmia, clouded sensoriumparesthesias, muscle cramps, muscle twitchdiarrhea, blurred vision, appetite decrease, and weight loss.
Other symptoms, such as anxiety and insomnia, were frequently seen during discontinuation, but it could not be determined if they were due to return of illness, rebound, or withdrawal. Early morning anxiety and emergence of anxiety symptoms between doses of XANAX have been reported in patients with panic disorder taking prescribed maintenance doses.
These symptoms may reflect the development of tolerance or a time interval between doses Google groups xanax is longer than the duration of clinical action of the administered dose.
In either case, it is pd that the prescribed dose is not sufficient to maintain plasma levels above those needed to prevent relapse, rebound, or withdrawal symptoms over the entire course of the interdosing interval. Because of its CNS depressant effects, patients receiving XANAX XR should be cautioned against engaging in hazardous occupations or activities requiring complete mental alertness such as operating machinery or driving a motor vehicle.
Use of XANAX XR during the later stages of pregnancy can result in sedation respiratory depression, lethargyhypotonia and withdrawal symptoms hyperreflexia, irritability, restlessness, tremors, inconsolable crying, and feeding difficulties in the neonate. Observe newborns for s of sedation and neonatal withdrawal syndrome and manage accordingly [see Use In Specific Populations ].
Drugs that inhibit this metabolic pathway may have a profound effect on the clearance of alprazolam. Ketoconazole and itraconazole have been shown in vivo to increase plasma alprazolam concentrations 3. Benzodiazepines may worsen depression. Panic disorder has been associated with primary and secondary major depressive disorders and increased reports of suicide among untreated patients. Consequently, appropriate precautions e. There have been reports of death in patients with severe pulmonary disease shortly after the initiation of treatment with alprazolam.
Closely monitor patients with impaired respiratory function. Advise both patients and caregivers about the risks of potentially fatal respiratory depression and sedation when XANAX XR is used with opioids and not to use such drugs concomitantly unless supervised by a healthcare provider. Inform patients that the use Google groups xanax XANAX XR, even at recommended dosages, Google groups xanax users to risks of abuse, misuse, and addiction, which can lead to overdose and death, especially when used in combination with other medications e.
How long does xanax last?
Inform patients that in some cases, patients taking benzodiazepines have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months. Benzodiazepines cross the placenta and may produce respiratory depression and sedation in neonates.
Advise mothers using XANAX XR to monitor neonates for s of sedation, respiratory depression, withdrawal symptoms, and feeding problems. These doses are 29 times and 4. Overall available data from published observational studies of pregnant women exposed to alprazolam Google groups xanax not established a drug-associated risk of major birth defects, miscarriageor adverse maternal or fetal outcomes see Data.
The estimated background risk of major birth defects and Google groups xanax for the indicated population is unknown. All pregnancies have a background risk of birth defectloss, or other adverse outcomes. In the U. Published data from observational studies on the use of benzodiazepines during pregnancy do not report a clear association with benzodiazepines and major birth defects. Although early studies reported an increased risk of congenital malformations with diazepam and chlordiazepoxide, there was no consistent pattern noted. In addition, the majority of recent case-control and cohort studies of benzodiazepine use during pregnancy, which were adjusted for confounding exposures to alcohol, tobaccoand other medications, have not confirmed these findings.