Here are some of the common tranquilizers and sleeping pills, and their generic names.
- Valium (diazepam)
- Ativan (lorazepam)
- Xanax (alprazolam)
- Klonopin or Rivotril (clonazepam)
- Restoril (temazepam)
- Rohypnol (flunitrazepam)
- Dalmane (flurazepam)
- Imovane (zopiclone)
- Ambien (zoldipem)
- Lunesta (eszopiclone)
Xanax
Generic name: alprazolam (al PRAY zoe lam)
- Tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg
- Orally disintegrating tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg
- Oral solution: 1 mg/mL
- Extended release tablets: 0.5 mg, 1 mg, 2 mg, 3 mg
Brand names:
- Xanax®
- Tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg
- Xanax XR®
- Extended release tablets: 0.5 mg, 1 mg, 2 mg, 3 mg
All FDA black box barnings are at the end of this fact sheet. Please review before taking this medication.
What Is alprazolam And What Does It Treat?
alprazolam is a Benzodiazepine. It is approved for the treatment of generalized anxiety disorder (GAD) and panic disorder with or without agoraphobia. However, benzodiazepines are also commonly used to treat difficulty sleeping and alcohol withdrawal.
Generalized Anxiety Disorder (GAD) occurs when a person experiences excessive anxiety or worry for at least six months. Other symptoms include:
- Restlessness
- Fatigue (low energy, feeling tired all the time)
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance (difficulty falling asleep or waking up in the middle of the night)
Panic Disorder occurs when a person experiences unexpected and repeated episodes of intense fear. These episodes have physical symptoms including chest pain, shortness of breath, heart palpitations, sweating, dizziness, and nausea. Fear of future episodes is also part of panic disorder.
What Is The Most Important Information I Should Know About alprazolam?
Do not drive a car or operate machinery until you know how this medication affects you because you may notice that you feel tired or dizzy.
When starting alprazolam, anxiety or insomnia may improve rapidly or over a period of days.
benzodiazepines, such as alprazolam, are often used for short periods of time only. They may produce emotional and/or physical dependence (addiction) even when used as recommended. With input from you, your health care provider will assess how long you will need to take the medication.
Do not stop taking alprazolam or change your dose without talking to your health care provider first. Stopping alprazolam abruptly may result in one or more of the following withdrawal symptoms: trouble sleeping, anxiety, irritability, nausea, tremor, dizziness, blood pressure changes, rapid heart rate, and seizures. Withdrawal reactions may occur when dosage reduction occurs for any reason.
The use of alprazolam with drugs like Opioid medications has led to serious side effects including slowed and difficulty breathing and death. Opioid drugs are medications used to treat pain and include medications such as: codeine, oxycodone, morphine, and illegal drugs like heroin. Some Opioid medications are also found in cough syrup.
If you are taking alprazolam with an Opioid medication, get medical assistance immediately if you feel dizziness, sleepiness, have slow or troubled breathing, or if you pass out. Caregivers must get medical help right away if a patient does not respond and does not wake up.
Avoid alcohol while taking this medication.
Are There Specific Concerns About alprazolam And Pregnancy?
If you are pregnant or planning to become pregnant, notify your health care provider to best manage your medications. People living with anxiety disorders who wish to become pregnant face important decisions regarding risk versus benefit of Benzodiazepine use in pregnancy. alprazolam can increase the risk of premature birth and low birth weight. Neonatal withdrawal and “floppy baby syndrome” are other potential adverse effects. It is important to discuss this with your doctor and caregivers.
Regarding breastfeeding, caution is advised since alprazolam does pass into breast milk.
What Should I Discuss With My Health Care Provider Before Taking alprazolam?
- Symptoms of your condition that bother you the most
- If you have thoughts of suicide or harming yourself
- Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
- If you experience side effects from your medications, discuss them with your health care provider. Some side effects may pass with time, but others may require changes in the medication.
- Any other psychiatric or medical problems you have including obstructive sleep apnea
- All other medications you are currently taking (including over the counter products and herbal and nutritional supplements) and any medication allergies you have
- Other non-medication treatment you are receiving such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
- If you are elderly or are prone to falls
- If you are pregnant, plan to become pregnant, or are breastfeeding
- If you have liver disease
- If you drink alcohol or use drugs
How Should I Take alprazolam?
alprazolam may be taken with or without food. Take with food if you experience an upset stomach.
alprazolam may be taken every day at regular times or on an as needed (“PRN”) basis. Typically, your health care provider will limit the number of doses you should take in one day.
Your health care provider will determine the dose and method of taking the medication that is right for you based upon your response.
alprazolam orally disintegrating tablets must remain in their original packaging. Open the package with clean dry hands before each dose. Do not try to put tablets in a pillbox if you take the orally disintegrating tablets. Take the tablets right away, do not store for later use.
alprazolam orally disintegrating tablets will dissolve in your mouth within seconds and can be swallowed with or without liquid.
Extended release tablets: Swallow whole. Do not chew, crush or split tablet.
alprazolam liquid: Measure with a dosing spoon or oral syringe, which you can get from your pharmacy.
If you take the medication every day (instead of ‘as needed’), use a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take it. You may also ask a family member or friend to remind you or check in with you to be sure you are taking your medication.
What Happens If I Miss A Dose Of alprazolam?
If you miss a dose of alprazolam, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your health care provider. Do not double your next dose or take more than what is prescribed.
What Should I Avoid While Taking alprazolam?
Avoid drinking alcohol and using illegal drugs while you are taking alprazolam. They may decrease the benefits (e.g., worsen your condition) and increase the adverse effects (e.g., sedation) of the medication. Alcohol increases the risk of accidental overdose with medications like alprazolam.
What Happens If I Overdose With alprazolam?
If an overdose occurs call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.
Symptoms of overdose include confusion, impaired coordination, slow reflexes, coma, and death.
A specific treatment to reverse the effects of alprazolam does exist. This medicine, called flumazenil, can reverse the effects of alprazolam but must be given through an IV at a hospital. Only a doctor can decide if you need this medication.
What Are The Possible Side Effects Of alprazolam?
Common side effects
- Feeling dizzy, drowsy, fatigued, or lightheaded
- Impaired coordination, decreased ability to concentrate
If you experience these side effects after starting alprazolam they will often improve over the first week or two as you continue to take the medication. If side effects do not improve or become problematic, consult your health care provider.
Rare/serious side effects
Shortness of breath, trouble speaking, feeling very tired, dizziness, or passing out.
Increased heart rate, headache, memory impairment, irritability, and restlessness may occur.
Some people taking benzodiazepines develop a severe allergic reaction and swelling of the face. This can occur as early as with the first dose.
Some people taking benzodiazepines for sleep have experienced various behaviors while they were asleep/not fully awake, such as sleep driving, making phone calls, and preparing or eating food. The individuals have no memory of the events when they awaken.
Signs of feeling depressed or low mood, thoughts of harming or killing yourself, or lack of interest in life.
Are There Any Risks For Taking alprazolam For Long Periods Of Time?
alprazolam is a safe and effective medication when used as directed. benzodiazepines may produce emotional and/or physical dependence (addiction) even when used as recommended. Physical dependence may develop after 2 or more weeks of daily use. The risk of withdrawal reactions when stopping therapy with alprazolam is increased with prolonged use of the medication.
What Other Medications May Interact With alprazolam?
The following medications may increase the levels and effects of alprazolam:
- Ketoconazole (Nizoral®), itraconazole (Sporanox®), nefazodone (Serzone®), fluvoxamine (Luvox®), and cimetidine (Tagamet®)
The following medications may decrease the levels and effects of alprazolam:
- Carbamazepine (Tegretol®), phenytoin (Dilantin®), and phenobarbital (Luminal®)
alprazolam should not be taken with other Benzodiazepine medications.
alprazolam may cause drowsiness, so caution should be used when combining it with other medications that cause drowsiness. These could include:
- Antihistamines such as diphenhydramine (Benadryl®)
- Narcotic pain medication such as morphine, oxycodone (OxyContin®), and hydrocodone (Vicodin® and Lortab®)
- Opioid cough medications such as codeine cough syrup
- Sleeping medications such as zolpidem (Ambien®)
- Other anti-anxiety medications, antipsychotic medications, certain anticonvulsant medications, and tricyclic antidepressant medications (such as amitriptyline)
How Long Does It Take For alprazolam To Work?
When starting alprazolam, anxiety or insomnia may improve rapidly or over a period of days or within hours of the first dose of medication.
Summary Of FDA Black Box Warnings
The FDA has found that Benzodiazepine drugs, such as alprazolam, when used in combination with Opioid medications or other sedating medications can result in serious adverse reactions including slowed or difficult breathing and death. Patients taking opioids with benzodiazepines, other sedating medications, or alcohol, and caregivers of these patients, should seek immediate medical attention if that start to experience unusual dizziness or lightheadedness, extreme sleepiness, slow or difficulty breathing, or unresponsiveness.
As a Benzodiazepine, alprazolam comes with the risk of abuse, misuse, and addiction to the medication. Physical dependence to alprazolam can occur with prolonged use of the medication. A withdrawal reaction may occur when stopping alprazolam, but this risk can be reduced by slowly reducing the dose of alprazolam when stopping. Do not stop taking alprazolam abruptly, and do not make any changes to therapy without consulting your health care provider.
A Benzo Story
It’s easy to become dependant on benzodiazapine drugs. People sometimes become dependent on tranquilizers inadvertently. You can become dependent on them if you take tranquilizers for more than a few months. For example, if you followed your doctor’s orders and never abused your prescription, you could still experience significant withdrawal symptoms if you stop them suddenly.
This is a true story about dependence to prescription tranquilizers (sometimes called benzos). Unfortunately it is a story that happens almost every day. Cheryl (not her real name) came to me after ten years of being prescribed Ativan. Although the story is about Ativan, I have heard similar stories about all tranquilizers.
Cheryl was a happy young lady at twenty years old. She rarely took Tylenol for a headache. Life was good, except for her stressful job.
Then one day Cheryl felt a tightness in her chest and had difficulty breathing. Her heart began to race. Her palms were sweaty and her hands were shaking. She was overcome with worry, but didn’t know what she was worried about.
Cheryl went to her doctor who listened to her story and told her that she was experiencing an anxiety attack. The visit lasted less than 15 minutes and at the end of the visit he handed her a prescription for Ativan.
The tranquilizer worked exactly as expected initially. Within a few days Cheryl was more relaxed, and she was sleeping better. Sometimes she slept so soundly that she woke up feeling groggy the next morning. But that passed. Even the stress of work was easier to handle. Both Cheryl and her doctor were relieved.
For the next two years Cheryl continued to use Ativan on and off as needed. She never abused it, and never used more than her prescription. For two years her doctor kept on prescribing Ativan with little reassessment. As time went on Cheryl started using it a little more often. Eventually she was taking a tranquilizer almost every day. Sometimes her family doctor would simply renew the prescription over the phone. Cheryl was just happy that the anxiety attacks had gone.
By the end of the third year Cheryl was concerned, and approached her doctor. Was Ativan addictive she wondered? He assured her it was not. But Cheryl had her doubts and she persuaded her doctor to take her off the drug. One week later, Cheryl was hit with series of anxiety attacks. She felt a little guilty that she questioned her doctor, and he immediately restarted her on Ativan.
What Cheryl didn’t know was that the anxiety attacks may have been avoided if she had been tapered off the drug correctly. In fact, suddenly stopping tranquilizers can be dangerous.
There is a significant risk of seizure, strokes, heart attacks, or hallucinations if you stop tranquilizers suddenly.
Two years later, still not convinced that this was the harmless drug her doctor said it was, Cheryl took herself off the tranquilizers. The withdrawal was rough. Cheryl experienced all kinds of symptoms, including anxiety, mood swings, and poor concentration.
Her husband started to lose patience. But she persisted. Then one day, her boss told her that she had to take on more responsibilities at work. Cheryl tried to explain that she was going through a difficult time and that she wasn’t sure she could take on more stress right now. But her boss said that the company was restructuring and Cheryl’s job might be on the line.
Despite all that stress, Cheryl managed to remain off the pills and get through the withdrawal. But during that time she didn’t dare see her doctor once, because she was afraid that if he made the slightest suggestion she would lose her resolve and go back on Ativan.
Cheryl managed to stay off tranquilizers for a whole year, and was feeling stronger all the time. Given enough time we know she would have done well. It takes about 2 years for patients fully recover from the effects of tranquilizers. But Cheryl’s mother fell ill and Cheryl took on the responsibility of her medical care.
One night, Cheryl suddenly woke up with her heart pounding in her chest. She had difficulty breathing, and she thought she was going to die. She went to the emergency room, and after a full examination was told that there was nothing wrong with her. She had experienced another anxiety attack.
The emergency room sent a follow up letter to her family doctor who booked an appointment to see Cheryl. He said he wanted to refer Cheryl to a psychiatrist.
The psychiatrist explained that Cheryl had a chemical imbalance, and that this was the cause of her anxiety. He said that it was not uncommon, and there was an effective treatment for it. He assured her that it was not addictive, and his very words were, “You can take this medication for the rest of your life.” Then the psychiatrist did something that set Cheryl back another five years. He wrote her a prescription for Ativan.
Now events started to happen a little more quickly. The Ativan wasn’t as effective as it had been in the past, and there were days when Cheryl needed more than her usual dose. The psychiatrist agreed that on bad days Cheryl could take 1 or 2 more pills to deal with her anxiety. By the end, Cheryl was being prescribed 4 times her initial dose. But at each visit her psychiatrist reassured her that she was doing well. Gradually, he spent less and less time with her since the Ativan was working. Some visits consisted of him just writing a prescription.
Cheryl had become dependent on tranquilizers. The more she took them, the more her brain adapted to them, and the more she needed. Whenever she tried to slow down, her withdrawal symptoms forced her to start up again.
The irony of tranquilizers is that they’re prescribed for anxiety and sleep. But the longer you take them the more they increase your anxiety and disturb your sleep.
The doctors had said that Cheryl could take these pills for the rest of her life. And sure enough it was coming true. Tranquilizers are the perfect addictive drug. The longer you take them — the more you need them.
After a while Cheryl began to experience new symptoms. She started feeling depressed. Initially she had a hard time describing it. She was less interested in things. She didn’t have as much energy as she normally did, and she wasn’t as happy. She complained to her psychiatrist who eventually decided to start Cheryl on an antidepressant. But he continued to prescribe the tranquilizer.
Most addictive drugs if taken long enough can cause depression. It is quite common with tranquilizers. Cheryl had been given a tranquilizer that caused depression, and now she was taking an antidepressant to counteract the tranquilizer.
Ten years had passed in one person’s life. What started out as anxiety, probably brought on by work stress, had gradually escalated into dependence and depression.
Finally, it was Cheryl herself who took the initiative and sought help to come off her drugs. She was gradually tapered off her Ativan, and counseled on post-acute withdrawal. Her withdrawal was uncomfortable, but with support she managed to get through it.
Cheryl completed her taper, went through withdrawal, and is now living a better life. Her symptoms disappeared after about two years. She will now happily tell you that she feels better than she’s felt in years, and that it’s good to no longer be dependent on tranquilizers.
Why are benzodiazepines still prescribed? If they’re that awful why do doctors still use them? Because they can be helpful if taken for a short time. Some people need them to deal with unusually stressful situations. But if you take them for longer than a few weeks or months, your body will adapt to them, your anxiety level will rise, and you will need more of them over time. (Reference: www.AddictionsAndRecovery.org)
Potential Symptoms of Long-term Use
The longer you use tranquilizers and sleeping pills the more anxious you become. In the beginning the help you relax and fall asleep. But after a few months they have the opposite effect.(1)
One of the most disturbing symptoms of long-term Benzodiazepine use is Depersonalization. It means not feeling quite real. It’s impossible to describe unless you’ve experienced it, but tranquilizer patients often say things like “I don’t feel quite real,” or “my arms don’t feel connected to my body,” or “when I’m in a group of people I somehow feel outside of myself.” All bizarre descriptions that mean the person is experiencing Depersonalization.
Depersonalization is usually worse during post-acute withdrawal. I have known patients who thought they were going crazy because they had Depersonalization, when in fact they were experiencing typical tranquilizer withdrawal. The Depersonalization will go away eventually, but it can take many months. Of course, you should always see a doctor if you have any unusual symptoms – preferably one who is familiar with addictions.
Benzodiazepine Tapering
There is an excellent website on tranquilizers and tapering off tranquilizers. It is Benzodiazepine Addiction, Withdrawal & Recovery (Benzo.org.uk). This site contains taper schedules from the “Ashton Manual”, written by Professor Heather Ashton, a world authority on Benzodiazepine post-acute withdrawal.
Post-Acute Withdrawal Symptoms
Some of the symptoms of tranquilizer post-acute withdrawal are:
- Anxiety
- Mood swings
- Depersonalization
- Poor concentration
- Social isolation
- Low energy
- Disturbed sleep
Post-acute withdrawal gradually gets better over two years. Your symptoms should show gradual improvement. Measure your progress month to month. If you measure your progress day to day, or week to week, you’ll often have one week that will be worse than the week before. But if you measure your progress month to month you should see steady improvement. If you take care of yourself, and you’re patient, you can get through this.
Look at the post-acute withdrawal page to learn more about those symptoms and how to deal with them.
- Alcohol addiction
- Nicotine/tobacco addiction
- Marijuana addiction
- Cocaine addiction
- Amphetamine Addiction
- Opiate/Opioid addiction (includes heroin and prescription pain medicine)
