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Alprazolam oral

Updated 2 Feb 2023 | Anxiolytics


Tablets containing alprazolam

Drugs List

  • alprazolam 250microgram tablets
  • alprazolam 500microgram tablets
  • XANAX 250microgram tablets
  • XANAX 500microgram tablets
  • Therapeutic Indications


    Anxiety state (severe) - short term relief
    Depressive illness with anxiety

    Short term symptomatic treatment of anxiety

    Anxiety associated with depression

    It is only indicated when the disorder is severe, disabling or subjecting the individual to unacceptable distress


    The overall duration of treatment should not be more than 8 to 12 weeks, including the tapering off process.

    Treatment should be reviewed at least 4 weekly. If extension beyond the maximum treatment period is necessary, it should not take place without re-evaluation of the patient's status with special expertise.

    When higher dosage is required, the evening dose should be increased before the daytime dose.

    Treatment should be taper off gradually by no more than 0.5 mg every three days. Some patients may require an even slower dosage reduction.


    250 to 500 micrograms three times daily, increasing if required to a total daily dose of 3 mg.


    250 micrograms two to three times daily, to be gradually increased if needed and tolerated.


    Children under 18 years
    Myasthenia gravis
    Severe hepatic impairment
    Severe respiratory impairment
    Sleep apnoea

    Precautions and Warnings

    Females of childbearing potential
    Suicidal ideation
    Glucose-galactose malabsorption syndrome
    History of alcohol abuse
    History of drug misuse
    Lactose intolerance
    Mild hepatic impairment
    Muscle weakness
    Personality disorder
    Renal impairment
    Respiratory impairment

    Consider dose modification in patients with respiratory depression
    Reduce dose in patients with hepatic impairment
    Reduce dose in patients with renal impairment
    Advise impaired alertness may affect ability to drive or operate machinery
    Advise patient ability to drive or operate machinery may be impaired
    Advise patient not to drive until they know how the medicine affects them
    Advise patient this medicine may be subject to driving restrictions
    Not suitable as sole treatment of depression or anxiety with depression
    Contains lactose
    Monitor patients with a history of alcoholism and drug abuse
    Neonate exposed in utero: Monitor neonate for adverse effects
    Potential for drug abuse
    Refer women considering pregnancy for specialist advice and monitoring
    Review therapy after 4 weeks
    Tolerance and dependence may occur
    Advise patient to report any new or worsening depression/suicidal ideation
    Advise patients/carers to seek medical advice if suicidal intent develops
    Amnesia may occur
    Discontinue if psychiatric disturbances develop
    Elderly: More susceptible to musculoskeletal weakness & sedation
    Potential for withdrawal symptoms
    Psychological adjustment may be impaired in loss or bereavement
    Avoid abrupt withdrawal
    To discontinue, reduce dose gradually
    Discontinue if paradoxical reactions occur
    Limit prescribing quantity due to suicide risk
    Maintain treatment at the lowest effective dose
    Reduce dose in debilitated patients
    Reduce dose in elderly
    Only recommended for short term use
    Advise patient to avoid alcohol during treatment
    Advise patient of increased risk of falls
    Advise patient on possible rebound phenomena on withdrawal

    It may be useful to specifically discuss the short term nature of the treatment, how it will be tapered off and how rebound phenomenon may occur, in order to minimise the anxiety this may provoke.

    Use with caution in elderly, due to the risk of sedation and/or musculoskeletal weakness that can increase chances of falls, often with serious consequences in this population.

    Pregnancy and Lactation


    Caution is advised in the use of alprazolam during pregnancy. The manufacturer recommends that alprazolam should not be used unless the clinical condition of the mother requires treatment. The patient should be advised of the potential hazard to the foetus if it is used.

    Data on teratogenicity and postnatal development and behaviour following benzodiazepine treatment are inconsistent; some indicate that first trimester exposure is not associated with an increased risk of major malformation but others have found a twofold increased risk of oral clefts. The long-term effects of in utero exposure on neurobehaviour, especially when the exposure occurs in the latter half of pregnancy, have not been studied and are of concern.

    Benzodiazepine treatment at high dose during the second and/or third trimesters has revealed a decrease in foetal active movements and variability of foetal cardiac rhythm. When administered during the last part of pregnancy, even at low doses, floppy infant syndrome has been observed. This is reversible but may last from 1 to 3 weeks, according to the half life of the product. At high doses, it may produce neonatal respiratory depression, apnoea or hypothermia. Neonatal withdrawal symptoms may be observed a few days after birth, even if no floppy infant syndrome is observed, and depend again on the half life of the substance. If alprazolam treatment is necessary, avoid high doses and monitor the neonate for withdrawal symptoms and/or floppy infant syndrome.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Contraindicated in breastfeeding.

    Alprazolam is excreted in breast milk at a low level, probably too low to induce a clinical effect. However, due to the nature of the substance and the potential for neonatal withdrawal symptoms, it should not be used by breastfeeding mothers. A single dose does not require any limitation of breastfeeding however, a shorter-acting benzodiazepine without active metabolites is preferred.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Effects on Ability to Drive and Operate Machinery

    This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act 1988 (England and Wales). When prescribing this medicine: Advise patient the medicine can affect cognitive function and is likely to affect ability to drive. Advise patient not to drive until they know how the medicine affects them.


    Advise the patient or carer regarding the short term nature of the treatment, how it will be tapered off and how rebound phenomenon may occur, in order to minimise the anxiety this may provoke.

    Alcohol should be avoided during treatment.

    Insufficient sleep may also increase the likelihood of impaired alertness.

    Drowsiness, amnesia, impaired concentration and muscle function may adversely affect the ability to drive or use machinery.

    Advise elderly patients of increased risk of falls due to the risk of sedation and/or musculoskeletal weakness.

    Side Effects

    Abdominal cramps
    Abnormal thoughts
    Alteration of autonomic nervous system
    Anterograde amnesia
    Attention disturbances
    Behavioural disturbances
    Blurred vision
    Changes in hepatic function
    Decreased appetite
    Dry mouth
    Gastrointestinal disorder
    Impaired memory
    Increased intra-ocular pressure
    Irregular menstruation
    Loss of balance
    Muscle cramps
    Muscle weakness
    Peripheral oedema
    Pre-existing depression may be unmasked
    Psychomotor hyperactivity
    Reduced libido
    Sexual dysfunction
    Urinary retention
    Weight changes


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: March 2013

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Joint Formulary Committee. British National Formulary(online) London: BMJ Group and Pharmaceutical Press Accessed on 03 June 2016.

    Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.

    Summary of Product Characteristics: Xanax tablets 250 and 500 micrograms. Pharmacia Limited. Revised April 2016.

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Record 335 - Alprazolam
    Last revised: August 31, 2012
    Last accessed: March 7, 2013 Government departments. Department for Transport. Publications. Drug driving and medicine: advice for healthcare professionals. Drug driving: Guidance for healthcare professionals on drug driving. Available at: Last accessed: 6 January 2015 New drug driving offence implications for medicines packaging. Medicines Regulatory News. 10 December 2013. Available at: Last accessed: 6 January 2015

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