Niravam, Xanax, Xanax XR
Classifications: central nervous system agent; anxiolytic; sedative-hypnotic; benzodiazepine
Prototype: Lorazepam
Pregnancy Category: D
Controlled Substance: Schedule IV


0.25 mg, 0.5 mg, 1 mg, 2 mg tablets; 0.5 mg, 1 mg, 2 mg, 3 mg sustained-release tabs; 0.5 mg/5 mL, 1 mg/mL oral solution; 0.25 mg, 0.5 mg, 1 mg, 2 mg orally disintegrating tabs


CNS depressant. Mode of action not known, but appears to act at the limbic, thalamic, and hypothalamic levels of the CNS. It is associated with significantly less drowsiness.

Therapeutic Effects

Drug has antidepressant as well as antianxiety actions.


Management of anxiety disorders or for short-term relief of anxiety symptoms. Also used as adjunct in management of anxiety associated with depression and agitation, and for panic disorders, such as agoraphobia.

Unlabeled Uses

Alcohol withdrawal.


Sensitivity to benzodiazepines; acute narrow angle glaucoma; pulmonary disease; use alone in primary depression or psychotic disorders; during pregnancy (category D), lactation; children <18 y.

Cautious Use

Impaired hepatic function; history of alcoholism; geriatric and debilitated patients. Effectiveness for long-term treatment (>4 mo) not established.

Route & Dosage

Anxiety Disorders
Adult: PO 0.25–0.5 mg t.i.d. (max: 4 mg/d)
Geriatric: PO 0.125–0.25 mg b.i.d.

Panic Attacks
Adult: PO 1–2 mg t.i.d. (max: 8 mg/d); sustained release: initiate with 0.5 mg to 1 mg once/d. Depending on the response, the dose may be increased at intervals of 3 to 4 days in increments of no more than 1 mg/d. Target range 3–6 mg/d (max: 10 mg/d).

Hepatic Impairment
Reduce dose by 50% in hepatic impairment.
Do not discontinue abruptly.



Adverse Effects (1%)

CNS: Drowsiness, sedation, light-headedness, dizziness, syncope, depression, headache, confusion, insomnia, nervousness, fatigue, clumsiness, unsteadiness, rigidity, tremor, restlessness, paradoxical excitement, hallucinations. CV: Tachycardia, hypotension, ECG changes. Special Senses: Blurred vision. Respiratory: Dyspnea.


Drug: Alcohol and other cns depressants, anticonvulsants, antihistamines, barbiturates, narcotic analgesics, benzodiazepines, compound CNS depressant effects; cimetidine, disulfiram, fluoxetine, [tricyclic antidepressants] increase alprazolam levels (decreased metabolism); oral contraceptives may increase or decrease alprazolam effects. Herbal: Kava-kava, valerian may potentiate sedation; St. John's wort decreases serum level of alprazolam. Cigarette smoking may decrease serum level of alprazolam by 50%.


Absorption: Rapidly absorbed. Peak: 1–2 h. Distribution: Crosses placenta. Metabolism: Oxidized in liver to inactive metabolites. Elimination: Renal elimination. Half-Life: 12–15 h.

Nursing Implications

Assessment & Drug Effects

Patient & Family Education

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug