Both fluoxetine, commonly known as Prozac, and alprazolam, or Xanax, are very commonly prescribed medications in the United States. In some cases, a person may even be prescribed both medications at the same time, depending on the nature of the symptoms experienced.

There is a distinct difference between the two medications, however, and they will not be used interchangeably. It is important for patients to be fully informed about the nature of these medications and how they impact cognitive function and mental health, and to take into consideration potential complications or issues that could arise due to medical disorders or use of other medications.

Alprazolam (Xanax)

Brand Names

Alprazolam is sold as:

  • Xanax
  • Xanax XR
  • Niravam
  • Alprazolam Intensol

Function

Because alprazolam is a benzodiazepine, it works by acting on the central nervous system and slowing down the movement of chemicals in the brain by boosting the effects of gamma-aminobutyric acid (GABA), which inhibits the postsynaptic neurons, thus slowing down the activity of nerve cells in the brain.

Xanax has a rapid onset, meaning that it will work to ease symptoms within 15-20 minutes of taking the drug at a therapeutic dose. Most physicians prescribe a low dose of the medication but may increase it if necessary.

Classification

Alprazolam is a benzodiazepine, a classification of drugs that are sedative in nature. It is a Schedule IV drug, according to the Drug Enforcement Administration (DEA), which is defined as a substance that has a low potential for abuse and addiction. However, when benzodiazepine abuse and addiction does occur, it can be fatal.

Prescribed For

Xanax is most often prescribed for the treatment of anxiety disorders, especially panic disorder, and those who experience physical symptoms associated with anxiety (e.g., hyperventilation, rapid heartbeat, heavy sweating, dizziness, etc.), social anxiety, and certain phobias. It is also sometimes used to treat depression and symptoms associated with premenstrual syndrome.

Missed Dose

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

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Side Effects

There are a number of side effects that may be associated with the use of alprazolam. Some are mild and pass as the individual adjusts to the new medication; others may be more serious and require immediate medical intervention and cessation of use. Patients are advised to seek medical attention immediately and to consult their doctor if they are concerned about any symptoms that develop after using Xanax.

Common side effects may include:

  • Lightheadedness or dizziness
  • Drowsiness and fatigue
  • Dry mouth or excessive salivation
  • Headache
  • Altered sexual interest and ability
  • Altered eating patterns that result in weight change
  • Lack of focus
  • Irritability
  • Nausea
  • Constipation
  • Joint pain

Less common and more serious side effects that require a call to the doctor include:

  • Serious rash
  • Yellowing eyes or skin
  • Shortness of breath
  • Difficulty remembering things
  • Difficulty speaking
  • Confusion
  • Depression
  • Extreme personality or mood changes
  • Suicidal thoughts or behaviors
  • Hallucinations
  • Seizures

Considerations

There are a number of potential issues to take into consideration when taking any medication and especially when taking an addictive substance like Xanax. For example, people who have glaucoma, are pregnant or planning to become pregnant, breastfeeding, or over the age of 65 may experience greater risks with the use of Xanax and will likely be advised to look for other solutions to their medical issue.

Additionally, those who are taking alprazolam should disclose that fact to their doctor or dentist if about to undergo surgery. It is always recommended to avoid driving while under the influence of the medication.

Mixing with Other Substances

There may be negative reactions if taking alprazolam in combination with certain other medications or supplements. For example, patients who are taking ketoconazole or itraconazole, antidepressants, antifungals, antihistamines, painkillers, oral contraceptives, SSRIS, and other medications for the treatment of mental health symptoms (including fluoxetine), sedatives or sleeping pills, medications used to manage seizures, or the supplement St. John’s wort, among others, may experience negative reactions.

Additionally, it is recommended to disclose any allergies to other medications to the prescribing physician and potentially to avoid eating grapefruit or grapefruit products as well.

Overdose

Overdose can occur any time Xanax is taken but is more likely to occur at high doses, when abused or taken outside the bounds of a doctor’s prescription, or when used in combination with other substances, including alcohol.

Symptoms of overdose on alprazolam may include:

  • Extreme drowsiness or appearing “out of it”
  • Confusion
  • Inability to take part in a coherent conversation
  • Lack of coordination
  • Loss of consciousness
  • Bluish tint to skin, lips, or nails
  • Slowed or stopped breathing
  • Slowed or stopped heartbeat

In the event of overdose or if overdose is suspected, call 911 for emergency medical help immediately.

Abuse

Abuse of Xanax can be extremely dangerous, if not fatal. Any of the following behaviors constitute abuse of alprazolam and therefore may mean an increased risk of overdose or accident under the influence:

  • Taking more Xanax than prescribed or taking prescribed doses more frequently than recommended
  • Crushing extended-release versions of Xanax and snorting or swallowing the powder
  • Dissolving crushed Xanax pills in water and injecting the solution
  • Drinking alcohol with Xanax or using other illicit substances with the medication
  • Attempting to get multiple prescriptions for sedatives and/or painkillers from multiple doctors

It is also important to note that driving after use of Xanax, especially after abuse of the drug, can be fatal.

Addiction

When Xanax is abused, especially when it is taken in large amounts frequently or when it is combined with use of alcohol or other drugs, addiction can develop. Though physical dependence is normal with long-term regular use, when it occurs at the same time as psychological dependence, or cravings for Xanax and a feeling that it would be impossible to live without use of the drug, it is time to seek treatment for addiction. Through medical detox and comprehensive therapeutic treatment, people can recover from addiction and learn how to manage the symptoms that first caused them to seek treatment through medication.

Vs.

Fluoxetine (Prozac)

Brand Names

Brand names for fluoxetine include:

  • Rapiflux
  • Selfemra
  • Sarafem
  • Prozac
  • Prozac Weekly
  • Symbyax (contains fluoxetine)

Function

SSRIs function by increasing the amount of serotonin in the brain, a naturally occurring chemical that is related to elevated mood and a sense of emotional balance. An SSRI will block the reuptake of serotonin, making more of it available at one time. While this can help someone to feel better over time, it takes several weeks of regular use for the drug to take effect, and it is not uncommon to increase the dose when tolerance develops or to combine its use with another antidepressant if ineffective.

Classification

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) medication. SSRIs are not controlled substances, according to the DEA’s schedule.

Missed Dose

If a dose of fluoxetine is missed, it is recommended that the patient take the dose as soon as it is remembered – unless it is almost time for the next dose. If it is almost time to take the next dose, do not double up; rather, skip the missed dose and get back on the regular dosing schedule.

Prescribed For

Prozac is prescribed to treat depression; eating disorders such as anorexia and bulimia; anxiety disorders including obsessive-compulsive disorder, panic disorder, some phobias, and post-traumatic stress disorder (PTSD); hot flashes experienced in menopause; and some nervous system and/or sleep disorders, such as narcolepsy or cataplexy. It may also be prescribed to treat attention deficit hyperactivity disorder (ADHD), obesity, borderline personality disorder (BPD), Tourette’s syndrome, and alcoholism.

Side Effects

There are a number of side effects that can occur when taking fluoxetine. Many will subside within a few days, but if any are serious or intrusive, patients are advised to contact their doctors as soon as possible.

  • Dry mouth and/or sore throat
  • Change in eating patterns and weight loss
  • Shakiness
  • Weakness
  • Nausea
  • Sweating
  • Nervousness
  • Decreased sex drive

If serious side effects, such as any of the following occur, patients should contact their doctors right away and get emergency medical care if needed:

  • Rash or hives
  • Joint pain
  • Fever
  • Hard time swallowing or breathing
  • Swelling of the face, throat, or extremities
  • Extreme muscle stiffness
  • Rapid or irregular heartbeat
  • Confusion
  • Hallucinations
  • Seizures

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Considerations

There are a number of situations that may make fluoxetine an unsafe medication for a patient. For example, being pregnant or planning to become pregnant; breastfeeding; undergoing electroshock therapy; having seizures, heart disease, liver disease, or diabetes; and having had a recent heart attack may be problematic. Additionally, adults over the age of 65 may have greater risks with taking the medications, and it is always recommended to avoid driving after taking fluoxetine in order to ensure that driving ability is not impaired by use of the drug.

It is also important to note that the use of fluoxetine can cause glaucoma. It is important that patients discuss all the risks associated with use of the drug with their doctor.

Mixing with Other Substances

It is important to disclose to your doctor all the other medications and supplements you are taking before you begin taking fluoxetine, especially MAOIs, alprazolam (Xanax), antidepressants, anticoagulants, nonsteroidal anti-inflammatory drugs, diuretics, insulin or other diabetes medications, lithium, anti-anxiety medications, medications for Parkinson’s disease or migraines, medications for seizures, painkillers, tranquilizers, sleeping pills, and the herbal supplements St. John’s wort or tryptophan.

Overdose

Accidental overdose will require medical treatment if the person is not breathing or has lost consciousness. Signs of Prozac overdose may include:

  • Confusion or nervousness
  • Lack of coordination or dizziness
  • Non-responsiveness
  • Shakiness
  • Rapid, irregular heartbeat
  • Hallucinations
  • Fever
  • Losing consciousness
  • Coma

Abuse

Because the use of fluoxetine does not cause a high and takes weeks to build up to therapeutic levels in the body, it is not generally abused.

Addiction

It is possible to become physically dependent on fluoxetine, requiring increasing dosages of the drug in order to continue to experience therapeutic effects. However, if and when it is time to stop taking the drug entirely, physical dependence can be managed with a slow tapering of the dose under a doctor’s supervision. Addiction does not occur without psychological dependence, and this does not occur with fluoxetine use because the drug does not trigger the pleasure pathway in the brain and incite cravings.

Learning about the differences between alprazolam and fluoxetine, as well as the potential for negative interaction of the two medications, is important. Discussing these issues with the prescribing physician can help to ensure optimum safety in use of either or both drugs.

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