Do not use this medication if you are allergic to alprazolam or to other benzodiazepines, such as:

• chlordiazepoxide (Librium®)
• clorazepate (Tranxene®)
• diazepam (Valium®)
• lorazepam (Ativan®)
• oxazepam (Serax®)

This medication can cause birth defects in an unborn baby. Do not use alprazolam if you are pregnant.

Before taking alprazolam, tell your doctor if you have:

• breathing problems
• glaucoma
• kidney or liver disease
• a history of depression
• suicidal thoughts
• addiction to drugs or alcohol

Do not drink alcohol while taking alprazolam. This medication can increase the effects of alcohol. Avoid using other medicines that make you sleepy. They can add to sleepiness caused by alprazolam.

Alprazolam may be habit-forming and should be used only by the person it was prescribed for. Alprazolam should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Alprazolam may be habit-forming and should be used only by the person it was prescribed for. Alprazolam should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.

Measure the liquid form of alprazolam with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

How to take alprazolam orally disintegrating tablets (Niravam®):

• Using dry hands, remove a tablet from the bottle and place the tablet on your tongue. It will begin to dissolve right away.
• Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.
• Swallow several times as the tablet dissolves. If desired, you may drink liquid after the tablet has completely dissolved.

Contact your doctor if this medicine seems to stop working as well in treating your panic or anxiety symptoms. Your symptoms may return when you stop using alprazolam after using it over a long period of time.

You may also have seizures or withdrawal symptoms when you stop using alprazolam. Withdrawal symptoms may include:

• blurred vision
• trouble concentrating
• loss of appetite
• diarrhea
• muscle twitching
• numbness or tingling
• increased sensations

Do not stop using alprazolam suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely. To be sure this medication is helping your condition, your doctor will need to check your progress on a regular basis. Do not miss any scheduled visits to your doctor.

Store alprazolam at room temperature away from moisture, heat, and light. Remove any cotton from the bottle of disintegrating tablets, and keep the bottle tightly closed.

Keep track of how many pills have been used from each new bottle of this medicine. Benzodiazepines are drugs of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

Do not use this medication if you have:

• narrow-angle glaucoma
• itraconazole (Sporanox®)
• ketoconazole (Nizoral®)
• chlordiazepoxide (Librium®)
• clorazepate (Tranxene®)
• diazepam (Valium®)
• lorazepam (Ativan®)
• oxazepam (Serax®)

Before taking alprazolam, tell your doctor if you are allergic to any drugs, or if you have:

• asthma
• emphysema
• bronchitis
• chronic obstructive pulmonary disorder (COPD), or other breathing problems
• glaucoma
• kidney or liver disease (especially alcoholic liver disease)
• history of depression or suicidal thoughts or behavior
• history of drug or alcohol addiction

If you have any of these conditions, you may not be able to use alprazolam, or you may need a dosage adjustment or special tests during treatment.

Alprazolam can cause birth defects in an unborn baby. Do not use alprazolam without your doctor's consent if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

Alprazolam can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

The sedative effects of alprazolam may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking alprazolam.

Do not give this medication to anyone under 18 years old.

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

Side Effects

Get emergency medical help if you have any of these signs of an allergic reaction:
• skin rash or hives
• difficulty breathing
• swelling of your face, lips, tongue, or throat

Call your doctor at once if you have any of these serious side effects:

• unusual risk-taking behavior, decreased inhibitions, no fear of danger
• depressed mood, thoughts of suicide or hurting yourself
• hyperactivity, agitation, hostility
• hallucinations
• feeling light-headed, fainting
• seizure (convulsions)
• urinating less than usual or not at all
• muscle twitching, tremor
• jaundice (yellowing of the skin or eyes)

Less serious side effects are more likely to occur, such as:

• drowsiness, dizziness
• amnesia or forgetfulness, trouble concentrating
• feeling irritable
• sleep problems (insomnia)
• muscle weakness
• lack of balance or coordination
• slurred speech
• blurred vision
• appetite or weight changes
• nausea, vomiting
• constipation
• dry or watery mouth
• increased sweating
• loss of interest in sex

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Before taking alprazolam, tell your doctor if you are using any of the following drugs:

• birth control pills
• cimetidine (Tagamet®)
• diltiazem (Tiazac®, Cartia®, Cardizem®)
• isoniazid (Nydrazid®, Rifamate®)
• propoxyphene (Darvon®, Darvocet®)
• seizure medication
• fluconazole (Diflucan®)
• itraconazole (Sporanox®)
• ketoconazole (Nizoral®)
• fluvoxamine (Luvox®)
• desipramine (Norpramin®)
• imipramine (Janimine®, Tofranil®)

If you are using any of these drugs, you may not be able to use alprazolam, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect alprazolam. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.