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If treatment is necessary in patients with impaired hepatic or renal function, therapy should be initiated at a very low dose and the dosage increased only to the extent that it is compatible with the degree of residual function of these organs.
Alprazolam should not be used in patients suspected of having psychotic tendencies since excitement and other paradoxical reactions can result from the use of anxiolytic-sedatives in these patients. As with other benzodiazepines, alprazolam should not be used in individuals with physiological anxiety or normal stress of daily living but only in the presence of disabling manifestations of an appropriate pathological anxiety disorder.
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Studies in rats have indicated that alprazolam and its metabolites are secreted into the milk. Therefore, nursing should not be undertaken while a patient is receiving the drug.
As with other CNS depressant drugs, patients should be cautioned against activities requiring mental alertness, judgement and physical coordination such as driving or operating machinery, particularly in the early phases of treatment and until proper adjustment to side effects has been established. Alcohol and benzodiazepines should never be mixed when driving because of the unpredictable CNS depressant effects of this combination.
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Clozapine, hydantoins (eg, phenytoin), or valproic acid because the actions and side effects of these medicines may be increased
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<li> Store Xanax at room temperature between 68 and 77 degrees F (20 and 25 degrees C) away from heat, moisture, and light. Do not store in the bathroom. Keep Xanax out of the reach of children and away from pets. </li>
<li> Some MEDICINES MAY INTERACT with Xanax . Tell your health care provider if you are taking any other medicines, especially any of the following: </li>
<li> If you miss a dose of Xanax and you are using it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. </li>
<li> Dr. David Sheehan of the University of South Florida suggested this method to me at a meeting in Tampa years ago. I cannot recall any of my patients experiencing any bothersome withdrawal discomfort in going off Xanax by the above method. Any difficulties I witnessed were relapses of a clinically silent panic disorder that was previously adequately treated by the Xanax at the pre-taper dose. </li>
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<li> Xanax is not recommended for use in CHILDREN; safety and effectiveness have not been confirmed. </li>
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<li> Rifampin or St. John's wort because the effectiveness of Xanax may be decreased </li>
<li> Some medical conditions may interact with Xanax . Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you: </li>
<li> You should never, never, never decide to go off Xanax on your own without your physician's counsel and guidance. Xanax is a remarkably safe medicine except for two things: overdosing on it can be extremely hazardous to driving safety. Sudden or rapid stopping Xanax at daily doses of 4 mg or more can cause moderate to severe withdrawal and, in very rare instances, a convulsion could occur. </li>
<li> You've no doubt heard negative things about Xanax. We have all read stories of some negative aspect of the use of Xanax. These stories are surprising. I, personally, have seldom experienced difficulty in tapering Xanax in patients with panic disorder. This may be a surprise to those who are not experienced in prescribing psychoactive medicants for anxiety disorders. </li>
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<li> There is a neurotransmitter in your brain called GABA. It stands for gamma amino butyric acid. GABA is your natural God-given tranquilizer. It is present at 80% of the nerve connections in your brain. When you are too nervous your brain cells release GABA which causes negatively charged chlorine atoms to stream into your nerve cells. That's good because it makes it harder for other stimulating neurotransmitters to trigger the firing of that nerve. If your brain were a car, anxiety might be like the car speeding down a hill toward a sharp curve. As it comes to a curve it must slow down. The car brakes are applied so that the car can negotiate the curve and not burst through the guard rail. The GABA molecules of your brain are like the brakes in your car. If you don't have enough GABA, your brain is going to be like the car speeding toward a curve with worn out brakes! Xanax acts by making what little GABA you do have work more strongly. This is sort of like applying stronger pressure on worn out brakes so that your car will negotiate a curve safely. </li>
<li> If panic attacks are the cause of your misery, order Xanax and get rid of all your worries and fears. </li>
<li> The fact is that Xanax works very well indeed in treating panic disorder. Tolerance develops to the initial dose. Dose increases are necessary in the first weeks of therapy. Why the tolerance? This is a very good question and should be answered before you start taking Xanax. You can't possibly know how to go off Xanax unless you understand what happens to your body as you are going on it. </li>
<li> Despite popular beleif, it is my opinion that Xanax is under-utilized by clinicians in their patients. Such medicines are remarkably safe. Panic disorder patients seem rarely to abuse such medicine. Compliance problems (patients not following doctors orders) with panic disorder patients on Xanax are rare; and, when seen are most often a matter of the patient not taking as much medicine as is prescribed rather than taking too much. </li>
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<li> Xanax is to be used only by the patient for whom it is prescribed. Do not share it with other people. </li>
<li> If you have any questions about Xanax , please talk with your doctor, pharmacist, or other health care provider. </li>
<li> Avoid eating grapefruit or drinking grapefruit juice while you are being treated with Xanax . </li>
<li> So, tolerance normally develops to Xanax and it may be due to either or both of the above reasons. If you didn't understand those two things, go back and read it again because what follows won't make much sense unless you understand those two ideas. </li>
<li> Use Xanax with caution in the ELDERLY because they may be more sensitive to its effects. </li>
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<li> Each white, triscored tablet (3 scores), with the number "2" on one side and Xanax on the other side contains: Alprazolam 2 mg. The tablets can be broken into 4 equal parts of 0.5 mg. Bottles of 100. </li>
<li> you are allergic to any ingredient in Xanax or other benzodiazepines (eg, diazepam) </li>
<li> Xanax may be habit-forming and lead to DEPENDENCE if used in high doses or for a long period of time. If you are on long-term or high dosage therapy, you may have WITHDRAWAL symptoms (eg, convulsions, tremor, stomach and muscle cramps, vomiting, sweating) if you suddenly stop taking this medicine. Do not stop therapy abruptly or change dosage without asking your pharmacist or doctor. Discuss overuse with your doctor or pharmacist. </li>
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<li> A second reason for tolerance may be down in your liver. Your liver gets rid of Xanax ultimately by making enzymes which destroy Xanax. After you are on Xanax for awhile it is as if your liver says, "Hey we sure are getting a lot of Xanax these days. Let's make more Xanax-destoying enzymes." And so it does. Let's say your dose that you started out on was giving you a blood level of, say, 100 units. But after your liver makes more of this destroying enzyme you have a level of, say, 55 units of Xanax. No wonder you feel like the Xanax isn't working as well. It isn't! Even though you're taking the same dose, your blood level dropped. Remember, it does not really make any difference how many milligrams you swallow. What really matters is how much is running around in your bloodstream. </li>
<li> Now, let's say we have a 26 year old woman, Monica, who has been on 6 mg of Xanax for panic disorder for 3 years. She's doing great. She can drive anywhere she wants and no panic attacks have occurred for 2 years. She even flew from Cincinnati to Cancun Mexico without a problem. She asked her psychiatrist if it would OK if she went off the Xanax now to see if she still needed it. The psychiatrist said yes, 'but you must not do it faster than I order'. The patient was relieved to hear her psychiatrist was urging a gradual decline. You see, the patient's roommate, Suzy, had taken herself off Xanax from 6 mg per day to 3mg a day suddenly. And after only a week she stopped it completely. She thought she would die, she felt so bad; and, she blamed it on 'the addictive nature of Xanax'. Fortunately, Monica was told by her psychiatrist to cut her daily dose from 6.0 mg per day to 5.75 mg per day and to stay on that dose for two weeks. Then she was told to cut to 5.5 mg a day for another 2 weeks, and so on by 0.25 mg off her daily dose every 2 weeks. Monica's psychaitrist explained that there was no way to tell if she still had panic disorder or not and by going down that slowly, if Monica should experience any anxiety symptoms, it would be due to the reappearance of panic disorder symptoms that were inadequately treated by her lower dose of medicine. This would mean that Monica still was afflicted with panic disorder and needed continued treatment, at least for the time being. If, on the other hand, she gradually tapered the Xanax down to zero and had no panic attacks, she would officially be either well or in remission. </li>
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<li> Xanax may be taken with or without food. If stomach upset occurs, take with food to reduce stomach irritation. </li>
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<li> Xanax is a benzodiazepine. It works by slowing down the movement of chemicals in the brain. This results in a reduction in nervous tension (anxiety). </li>
<li> Ask your health care provider any questions you may have about how to use Xanax . </li>

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