Alprazolam XR
XANAX XR
Pronunciation: al-PRAY-zoe-lam (ZAN-ax)
“Lil’ Xan, Alp-raised lamb”
No fear → benzos are anxiolytic drugs
Pill bottle → symbol for benzodiazepine class
What it isExtended-release GABA-A positive allosteric modulator (XANAX XR, 2003); panic disorder.
Why this oneSmoother exposure reduces interdose rebound compared with immediate-release alprazolam.
What limits itDependence develops quickly and abrupt withdrawal can cause seizures. Opioids magnify respiratory depression; CYP3A4 interactions matter.
FDA-approved for
- panic disorder (2003)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Panic disorder (with or without agoraphobia) | Adults | 0.5–1 mg QD (AM) | 3–6 mg QD | 10 mg QD |
Titration Adjust at intervals of 3–4 days in increments of ≤1 mg/day
Renal Undefined
Hepatic Start 0.5 mg once daily; increase gradually if tolerated
Geriatric: start 0.5 mg once daily; reduce dose with ritonavir
Instructions
- Swallow whole; do not divide, crush, or chew
- Take once daily, preferably in the morning
- To discontinue, taper by ≤0.5 mg every 3 days
Available strengths
- ER tab 0.5, 1, 2, 3 mg
- tab 0.25, 0.5, 1, 2 mg
- ODT 0.25, 0.5, 1, 2 mg
- sol 1 mg/mL
Contraindications
- Concomitant use with strong cytochrome P450 3A (CYP3A) inhibitors (e.g., ketoconazole, itraconazole), except ritonavir
Cautions
- CNS depression; caution driving/operating machinery
- Worsening depression/suicidality
- Mania/hypomania
- Neonatal sedation and withdrawal syndrome
- Risk in patients with impaired respiratory function
Adverse reactions
- Sedation
- Somnolence
- Memory impairment
- Dysarthria
- Coordination abnormal
- Ataxia
- Decreased libido
- Constipation
- Nausea
- Fatigue
- Depression
Pregnancy Neonatal sedation/withdrawal with late-pregnancy use; no clear major-defect association
Lactation Present in breast milk; breastfeeding not recommended during treatment
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 0.5 mg | ER tab | 30 qd | $4.60 | not offered |
| 1 mg | ER tab | 30 qd | $4.68 | not offered |
| 2 mg | ER tab | 30 qd | $6.18 | not offered |
| 3 mg | ER tab | 30 qd | $7.85 | not offered |
Other forms: Alprazolam (XANAX)
⚠ BOXED WARNINGS
- Risk from concomitant use with opioids
- Abuse, misuse and addiction
- Dependence and withdrawal reactions
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilityRapid dependence and severe withdrawal; overdose becomes dangerous with opioids or other depressants.
Active metabolites
Open Alprazolam XR in the interactive console ↗
Memory aids: interaction avatars
