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What’s the Difference between Alprazolam (Xanax) and Fluoxetine (Prozac)?

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 and the risks of side effects.

There is a distinct difference between Prozac and Xanax, however, and they are not used interchangeably. It is important for doctors to inform their patients about the nature of these medications and how they impact cognitive functioning and mental health. Physicians should also inform the patients of any potential complications or side effects.

Alprazolam (Xanax)

Brand Names

Alprazolam is sold as:

  • Xanax
  • Xanax XR
  • Niravam
  • Alprazolam Intensol


Because alprazolam is a benzodiazepine, it slows down the action of the central nervous system (CNS), leading to slowed heart rate, breathing rate, and pulse, as well as calming effects. It works by enhancing the action of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain. Its job is to reduce the activity of the neurons that it binds to, thus reducing anxiety and panic in those who take Xanax.

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 they may increase it if necessary.


Alprazolam is a benzodiazepine, a classification of sedative drugs. According to the Drug Enforcement Administration (DEA), it is a Schedule IV drug, which means that it has potential for abuse and addiction, although not as high as other prescription drugs, such as opioid painkillers. However, when benzodiazepine abuse and addiction does occur, it can be fatal.

Prescribed For

Xanax is most often prescribed for the treatment of anxiety disorder and panic disorder. It is also sometimes used to treat insomnia or manage alcohol withdrawal syndrome. It should only be prescribed for short-term relief of these conditions and should not be prescribed for longer than one month, due to the risk of tolerance and dependence.

Side Effects

There are a number of side effects that may be associated with the use of alprazolam. Some are mild, while 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 taking 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.
  • Trouble focusing.
  • Irritability.
  • Nausea.
  • Constipation.
  • Joint pain.

Less common and more serious side effects that may require medical attention include:

  • Serious rash.
  • Yellowing eyes or skin.
  • Shortness of breath.
  • Memory issues.
  • Confusion.
  • Depression.
  • Extreme personality or mood changes.
  • Suicidal thoughts or behaviors.
  • Hallucinations.
  • Seizures.

If you experience any of the above, please call your doctor or 911 immediately.


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, are breastfeeding, or are 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 before undergoing any surgery. Further, 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. Not all medications or supplements will cause drug interactions, but it’s important to tell your doctor about everything that you’re taking so they can ascertain whether Xanax is right for you.

Some examples of medications or supplements that could possibly produce negative effects when taken with Xanax include ketoconazole or itraconazole, certain antidepressants, antifungals, antihistamines, opioid painkillers, oral contraceptives, SSRIS, sedatives or sleeping pills, medications used to manage seizures, and the supplement St. John’s wort.

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


Unlike barbiturates, benzodiazepines, such as Xanax, have a wide therapeutic index, which means that someone would have to take an extremely high dose to experience toxicity or overdose. That said, overdosing on Xanax is possible, particularly when it is abused in high doses or mixed with alcohol, opioids, or other CNS depressants.

Symptoms of overdose on alprazolam may include:

  • Extreme drowsiness.
  • Profound confusion.
  • 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 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 Xanax and snorting or swallowing the powder
  • Dissolving crushed Xanax pills in water and injecting the solution
  • Drinking alcohol or using other substances with Xanax
  • Attempting to get multiple prescriptions for Xanax from several different doctors

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


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. There are many different signs of Xanax addiction, including:

  • Taking more Xanax or for longer than originally intended.
  • Using Xanax in dangerous situations, such as while driving.
  • Sacrificing previously enjoyed activities for Xanax use.
  • Developing physiological dependence, which results in withdrawal symptoms when you stop using.
  • Developing tolerance, which means that you need to take higher doses to achieve the desired effects.
  • Continuing to use Xanax regardless of negative consequences at home, work, or school resulting from use.
  • Continuing to use Xanax regardless of physical or psychological problems resulting from use.

Through medical detox and comprehensive addiction treatment, people can recover from addiction and learn how to manage the symptoms that first caused them to seek treatment through medication.

Fluoxetine (Prozac)

Brand Names

Brand names for fluoxetine include:

  • Sarafem.
  • Prozac.


Although the exact mechanism of action of selective serotonin reuptake inhibitors (SSRIs), such as Prozac, is not fully understood, it is known that the medication increases the amount of serotonin in the brain. Serotonin is an important neurotransmitter involved in mood, sleep, appetite, memory, social behavior, and sexual desire. An SSRI blocks the reuptake or recycling of serotonin, which makes more of it available to interact with receptors. This increase in serotonergic action often helps to reduce a person’s symptoms associated with depression or anxiety, although it takes several weeks of daily use for the medication to take effect.


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

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 the following:

  • Major Depressive Disorder
  • Panic Disorder
  • Bulimia Nervosa
  • Depressive episodes associated with Bipolar Disorder
  • Obsessive Compulsive Disorder

It may also be prescribed to relieve the symptoms associated with premenstrual dysphoric disorder.

Side Effects

There are a number of side effects that can occur when taking Prozac. 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. These may include:

  • Dry mouth and/or sore throat.
  • Loss of appetite and weight loss.
  • Shakiness.
  • Weakness.
  • Nausea.
  • Sweating.
  • Nervousness.
  • Decreased sex drive.

The above symptoms, although uncomfortable, are not typically serious or dangerous. That said, some side effects can be quite dangerous. If patients experience any of the following, they should contact their doctor or call 911 immediately:

  • 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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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.

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, prescription painkillers, tranquilizers, sleeping pills, and the herbal supplements, St. John’s wort or tryptophan.


Prozac is not a drug that one can easily overdose on, except in the event of suicidal attempts. Even in the case of extremely high doses of Prozac, the clinical course is fairly benign. That said, there have been some instances of dangerous consequences associated with Prozac ingestion. Signs of Prozac overdose may include:

  • Seizures.
  • Rapid heart rate.
  • Severe drowsiness.
  • Tremors.
  • Nausea and vomiting.
  • Irregular heartbeat.

If you or someone else is experiencing any of these effects, call 911 immediately.


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.


When taken as prescribed, it is likely that the patient will become physically dependent on fluoxetine, which means that the body has adapted to the presence of the medication and requires it to function optimally. This is a normal adaptation and not worrisome. If and when someone wants to quit taking Prozac, the doctor will create a slow tapering schedule for the patient in which they gradually lower their dose to prevent unwanted withdrawal symptoms.

It’s important to note that physiological dependence does not denote addiction. Since Prozac does not trigger the pleasure pathway in the brain and induce cravings, addiction is unlikely.

Learning about the differences between alprazolam and fluoxetine is important. Discussing the potential side effects and interactions with the prescribing physician can help to ensure optimum safety in use of either or both drugs.

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