Niravam

This medication is used to treat certain anxiety and panic disorders. Alprazolam belongs to a class of medications called benzodiazepines. It acts on the brain and nerves to produce a calming effect and helps relieve panic and anxiety symptoms.

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

Take this medication by mouth usually two to three times daily, or as directed by your doctor. Dosage and length of treatment is based on your medical condition, age, and response to therapy. Take the exact dose as prescribed by your doctor. Your dose may be gradually increased until the drug starts working well. The manufacturer does not recommend taking more than 4 milligrams a day unless you are being treated for panic disorder. Follow your doctor's instructions closely to reduce the risk of side effects. Do not increase or decrease your dose, or suddenly stop taking your medication, without consulting your doctor first. It is best not to take this medication with a high-fat meal because absorption may be slowed. Make sure your hands are dry before you are ready to take this medication. Place the tablet on top of your tongue immediately after removing it from the bottle. The tablet will dissolve in your mouth. Although it is not necessary to take this medication with any liquid, you may take it with water. If your dose is only half a tablet, be sure to throw away the unused portion of the tablet. Do not save it for future use because it may become inactive. This medication may cause withdrawal reactions, especially if it has been used regularly for a long time or in high doses. In such cases, withdrawal symptoms (such as abdominal or muscle cramps, diarrhea, vomiting, sweating, tremors, insomnia, and seizures) may occur if you suddenly stop using this medication. To prevent withdrawal reactions, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details, and report any withdrawal reactions immediately. Though it is very unlikely to occur, this medication can also result in abnormal drug-seeking behavior (addiction/habit forming). Do not increase your dose, take it more frequently, or use it for a longer period of time than prescribed. Properly stop the medication when so directed. This will lessen the chances of becoming addicted. When used for an extended period, this medication may not work as well and may require different dosing. Talk with your doctor if this medication stops working well. Inform your doctor if your condition persists or worsens.

See also the How to Use section. Your healthcare professionals (e.g., doctor or pharmacist) may already be aware of any possible drug interactions and may be monitoring you for it. Do not start, stop or change the dosage of any medicine before checking with them first. This drug should not be used with the following medications because very serious interactions may occur: certain antifungals (e.g., itraconazole, ketoconazole), delavirdine, indinavir, sodium oxybate. If you are currently using any of these medications, tell your doctor or pharmacist before starting alprazolam. Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: other azole antifungals (e.g., fluconazole and voriconazole), cimetidine, clozapine, digoxin, disulfiram, certain tricyclic antidepressants (e.g., imipramine, desipramine), drugs that affect stomach acid (e.g., antacids, omeprazole), kava, certain antidepressants (e.g., fluoxetine, fluvoxamine, nefazodone), other drugs affecting enzymes that remove alprazolam from your body (e.g., amiodarone, macrolide antibiotics such as clarithromycin, rifamycins such as rifampin, certain HIV medications such as ritonavir, oral contraceptives, cyclosporine, ergotamine, isoniazid, certain calcium channel blockers such as diltiazem and nifedipine, St. John's wort). Tell your doctor or pharmacist if you take drugs that cause drowsiness such as: certain antihistamines (e.g., diphenhydramine), certain anti-seizure medications (e.g., carbamazepine, phenobarbital), medicine for sleep (e.g., zolpidem), muscle relaxants (e.g., methocarbamol), narcotic pain relievers (e.g., codeine, propoxyphene), psychiatric medicines (e.g., phenothiazines such as chlorpromazine), tranquilizers. Check the labels on all your medicines (e.g., cough-and-cold products) because they may contain ingredients which cause drowsiness. Ask your pharmacist about the safe use of those products. Cigarette smoking decreases blood levels of this medication. Tell your doctor if you smoke or if you have recently stopped smoking because your dose may need to be adjusted. This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

Do not share this medication with others. It is against the law. This medication has been prescribed for your current condition only. Do not use it later for another condition unless told to do so by your doctor. A different medication may be necessary in those cases. If this drug is used for an extended period of time, laboratory and/or medical tests (e.g., liver function tests, complete blood counts) may be performed periodically to check for side effects. Consult your doctor for more details.

If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include: slowed breathing, confusion, excessive drowsiness, slowed/reduced reflexes, loss of consciousness.

Before taking alprazolam, tell your doctor or pharmacist if you are allergic to it; or to other benzodiazepines (e.g., diazepam, lorazepam, temazepam); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have the following conditions: a certain eye problem (narrow-angle glaucoma), intoxication with medications that depress the nervous system or your breathing (CNS/respiratory depressants such as alcohol or tranquilizers/sedatives). Before using this medication, tell your doctor or pharmacist your medical history, especially of: seizures, open-angle glaucoma, mental/mood disorders (e.g., mania, depression, thoughts of suicide), kidney or liver disease, severe lung/breathing problems (e.g., chronic obstructive pulmonary disease, sleep apnea), personal or family history of regular use/abuse of drugs/alcohol/other substances. To minimize dizziness and lightheadedness, get up slowly when rising from a seated or lying position. This drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Avoid alcoholic beverages. Before having surgery, tell your doctor or dentist that you are using this medication. Caution is advised when using this drug in the elderly because they may be more sensitive to its side effects, especially loss of coordination and drowsiness. This medication is not recommended for use during pregnancy due to the potential for harm to an unborn baby. Consult your doctor for more details. This drug passes into breast milk and may have undesirable effects on a nursing infant. Therefore, breast-feeding while using this medication is not recommended. Consult your doctor before breast-feeding.

Store at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Brief storage between 59-86 degrees F (15-30 degrees C) is permitted. Do not store in the bathroom. Keep all medicines away from children and pets. Store in a tightly sealed container provided by your pharmacist. After opening the bottle, throw away any cotton that you find inside. Reseal the bottle tightly to prevent moisture from getting into the bottle. If the tablets are exposed to moisture, they may not work properly. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

Drowsiness, dizziness, tiredness, clumsiness, changes in appetite, constipation, or changes in sexual ability/interest may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. Inform your doctor if you notice early-morning anxiety or anxiety symptoms between doses. Your doctor can adjust your dosing schedule. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor immediately if any of these unlikely but serious side effects occur: mental/mood changes, slurred speech or difficulty speaking, difficulty remembering things, unusual behavior, uncontrolled muscle movements, slowed breathing, fainting, trouble urinating, vision changes. Tell your doctor immediately if any of these rare but very serious side effects occur: yellowing of eyes or skin, dark urine, persistent nausea/vomiting, seizures. A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.