Alprazolam ER (Xanax XR) is a long-acting benzodiazepine. It's taken by mouth once daily to treat panic disorder in adults. Alprazolam ER (Xanax XR) can cause drowsiness, but less so compared to short-acting alprazolam (Xanax). Don't take alprazolam ER (Xanax XR) with alcohol because doing so can lead to serious side effects, such as confusion and agitation.
Panic disorder (with or without agoraphobia)
Alprazolam ER (Xanax XR) is a long-acting benzodiazepine. It relaxes certain chemicals in the brain that are involved in feelings of panic. As it result, it can provide "anti-panic" effects throughout the day.
Alprazolam ER (Xanax XR) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: Taking alprazolam ER (Xanax XR) with opioids or alcohol | History of lung conditions
Some people with long-term pain might already be taking opioid medications. If this applies to you, let your care team know. The combination of alprazolam ER (Xanax XR) with opioid medication should be avoided because this raises the chance of overdose. Ask your care team if safer medication options are available. If you or a loved one notices that you're having trouble breathing or waking up easily, get medical help right away.
Risk factors: History of substance misuse | Alcohol use | Taking more than 4 mg per day | Stopping alprazolam ER (Xanax XR) suddenly
Additionally, taking alprazolam ER (Xanax XR) over longer periods of time can raise the risk for physical dependence. If so, suddenly stopping alprazolam ER (Xanax XR) can lead to withdrawal symptoms, including hallucinations, a change in behavior, and trouble sleeping. Sometimes, withdrawal symptoms can last weeks to years. Don't stop taking alprazolam ER (Xanax XR) without first talking to your HCP. Take alprazolam ER (Xanax XR) only as instructed to lower the risk of dependence and overdose.
Risk factors: Drinking alcohol | Taking other medications that cause drowsiness
Alprazolam ER (Xanax XR) can make you feel sleepy and affect your concentration and focus. Drinking alcohol while taking alprazolam ER (Xanax XR) and taking additional medications that make you feel drowsy can make this effect worse. Avoid activities that require you to be alert, like driving or operating machinery, until you know how the medication affects you.
Risk factors: Taking alprazolam ER (Xanax XR) while pregnant
Alprazolam ER (Xanax XR) can cause harm to your baby if you take the medication while you're pregnant. Newborn babies whose parent took alprazolam ER (Xanax XR) during pregnancy have experienced serious issues like breathing problems, excessive drowsiness, irritability, and feeding difficulties. If you're planning to have a baby or are currently pregnant, speak with your HCP about the best options for your anxiety or panic disorder.
Alprazolam ER (Xanax XR) can interact with other medications. For example, certain medications can cause alprazolam ER (Xanax XR) to reach dangerously high levels in the body, which raises your risk for serious side effects. These include some antifungal medications, cimetidine (Tagamet HB), and some mental health medications like fluvoxamine (Luvox). Talk to your care team about all the medications you're taking or plan to take, including over-the-counter medications and supplements. They might need to make adjustments to the dose of certain medications or recommend safer alternatives.
Risk factors: History of depression
Alprazolam ER (Xanax XR) can make depression worse. Sometimes, manic episodes have occurred when people with depression took alprazolam ER (Xanax XR). Watch for new or worsening signs of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior while taking alprazolam ER (Xanax XR). Get medical help right away if you or a loved one notices any of these changes.
Risk factors: Ages 65 years or older | Liver problems | Medical conditions that affect breathing
Alprazolam ER (Xanax XR) should be taken with caution in people with certain breathing problems, like chronic obstructive pulmonary disease (COPD) or sleep apnea. Alprazolam ER (Xanax XR) can affect your breathing, so it can be dangerous for people with already existing breathing problems. Get medical help right away if you have breathing problems.
Source:Â DailyMed
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Being forgetful
changes in patterns and rhythms of speech
clumsiness or unsteadiness
difficulty with coordination
discouragement
drowsiness
feeling sad or empty
irritability
lack of appetite
lightheadedness
loss of interest or pleasure
relaxed and calm
shakiness and unsteady walk
sleepiness
slurred speech
tiredness
trouble concentrating
trouble performing routine tasks
trouble sleeping
trouble speaking
unsteadiness, trembling, or other problems with muscle control or coordination
unusual tiredness or weakness
Less common
Blurred vision
body aches or pain
burning, crawling, itching, numbness, prickling, "pins and needles, or tingling feelings
changes in behavior
chills
clay-colored stools
confusion about identity, place, and time
dark urine
decrease in frequency of urination
decrease in urine volume
difficult or labored breathing
difficulty in passing urine (dribbling)
difficulty with concentration
difficulty with moving
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
ear congestion
environment seems unreal
fainting
fear or nervousness
feeling of unreality
feeling warm
general feeling of discomfort or illness
headache
hyperventilation
inability to move the eyes
inability to sit still
increased blinking or spasms of the eyelid
irregular heartbeats
itching or rash
joint pain
lack or loss of self-control
loss of bladder control
loss of coordination
loss of memory
loss of voice
mood or mental changes
muscle aches, cramps, pain, stiffness, or weakness
need to keep moving
problems with memory
restlessness
runny or stuffy nose
seeing, hearing, or feeling things that are not there
seizures
sense of detachment from self or body
shaking
shivering
sticking out of the tongue
stomach pain
sweating
swollen joints
talkativeness
tightness in the chest
trouble with balance
twitching, twisting, or uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
uncontrolled twisting movements of the neck, trunk, arms, or legs
unpleasant breath odor
unusual dullness or feeling of sluggishness
unusual facial expressions
unusually deep sleep
unusually long duration of sleep
vomiting of blood
yellow eyes or skin
Rare
Actions that are out of control
attack, assault, or force
continuing ringing or buzzing or other unexplained noise in the ears
decreased awareness or responsiveness
deep or fast breathing with dizziness
ear pain
false or unusual sense of well-being
fast, irregular, pounding, or racing heartbeat or pulse
feeling jittery
feeling unusually cold
generalized slowing of mental and physical activity
hearing loss
hoarseness
lack of feeling or emotion
loss of control of the legs
loss of strength or energy
nightmares
numbness of the feet, hands, and around mouth
severe sleepiness
shakiness in the legs, arms, hands, or feet
sleep talking
swelling
talking, feeling, and acting with excitement
thoughts of killing oneself
uncaring
unusual weak feeling
voice changes
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Confusion
loss of consciousness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Absent, missed, or irregular menstrual periods
decreased appetite
decreased interest in sexual intercourse
decreased sexual performance or desire abnormal ejaculation
difficulty having a bowel movement (stool)
inability to have or keep an erection
increased appetite
increased in sexual ability, desire, drive, or performance
increased interest in sexual intercourse
increased weight
loss in sexual ability, desire, drive, or performance
stopping of menstrual bleeding
watering of the mouth
Less common
Blistering, crusting, irritation, itching, or reddening of the skin
change in taste bad unusual or unpleasant (after) taste
cracked, dry, or scaly skin
double vision
feeling of warmth
menstrual changes
pelvic pain
redness of the face, neck, arms, and occasionally, upper chest
seeing double
stomach bloating and cramping
sudden sweating
unexplained runny nose or sneezing
Rare
Acid or sour stomach
belching
bigger, dilated, or enlarged pupils (black part of the eye)
change in color vision
difficulty seeing at night
feeling of constant movement of self or surroundings
feeling of relaxation
hives or welts
increased sensitivity of the eyes to sunlight
indigestion
redness of the skin
sensation of spinning
stomach discomfort or upset
Incidence not known
Blistering, peeling, or loosening of the skin
red, irritated eyes
red skin lesions, often with a purple center
sores, ulcers, or white spots in the mouth or on the lips
swelling of the breasts or breast soreness in both females and males
unexpected or excess milk flow from the breasts
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Taken once daily
Taken by mouth
If appropriate, can be added on to antidepressant therapy to better manage panic disorders
Can be habit-forming, so it's not typically used for long-term treatment
Stopping suddenly can cause withdrawal symptoms
Not preferred during pregnancy
Make sure to swallow alprazolam ER (Xanax XR) tablets whole. The tablet is made to slowly release the medication in your body throughout the day. Don't crush, chew, or split them because this could make the medication work differently for you.
If you've taken alprazolam ER (Xanax XR) for a while and want to stop the medication, let your care team know. They can help you do so safely by lowering your dose slowly over time to prevent withdrawal symptoms like anxiety, nausea, and seizures.
Avoid taking alprazolam ER (Xanax XR) with opioid pain medications because this combination can cause life-threatening side effects, like trouble breathing and confusion.
Alprazolam ER (Xanax XR) can cause dizziness and drowsiness. Avoid activities that require you to be alert (like driving) until you know how this medication affects you.
Avoid drinking alcohol while you're taking alprazolam ER (Xanax XR). Alcohol can make the side effects of the medication worse.
Limited research shows that alprazolam ER (Xanax XR) can be found in breastmilk. It's best to avoid taking this medication if you're breastfeeding because of the potential harm to babies, such as poor feeding and extreme sleepiness. If you're nursing, speak to your primary care provider about the safest options to treat your condition.
Adults: The typical starting dose of alprazolam ER (Xanax XR) is 0.5 mg to 1 mg by mouth once daily, preferably in the morning.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Taking with medications considered as strong CYP3A inhibitors, except ritonavir (Norvir)
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Actavis Pharma, Inc. (2023). Alprazolam extended release- alprazolam tablet, extended release [package insert]. DailyMed.
Rickels, K. (2004). Alprazolam extended-release in panic disorder. Expert Opinion on Pharmacotherapy.
Stein, M. B., et al. (2009). Practice guideline for the treatment of patients with panic disorder. American Psychiatric Association.
U.S. Food and Drug Administration. (2023). Drug development and drug interactions | Table of substrates, inhibitors, and inducers.
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