Difference between Alprazolam (Xanax) & Fluoxetine (Prozac)?
Both fluoxetine (Prozac), and alprazolam (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 mental health symptoms that require treatment and the risks of side effects.1
Hailing from two different pharmaceutical classes, there are several pharmacologic distinctions between Prozac and Xanax; though both have approved indications for managing panic disorder, they are not intended to be used interchangeably. It is important for those taking these medications to be informed about the nature of these medications, their side effects, and their potential interactions.
Alprazolam may be prescribed under the following brand names:2
- Xanax XR
Because alprazolam is a benzodiazepine, it increases inhibitory neural signaling throughout the central nervous system (CNS), leading to a reduction in anxiety and panic. It works by enhancing the action of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain. Because Xanax depresses the CNS, it can also cause drowsiness, impaired coordination, and slowed breathing.3
After taking a therapeutic dose of Xanax, you will likely feel peak effects within 0.7 to 1.6 hours.4
Xanax is indicated for short-term use and should not be prescribed for longer than one month, due to risks such as dependence and addiction.6 Its efficacy as an anxiolytic has also not been sufficiently evaluated in the longer-term.
Alprazolam is in the benzodiazepine class of sedative drugs. It is a DEA Schedule IV drug, which means that it has some potential for abuse and dependence and may only be used with a valid prescription.7
There are a number of potential side effects associated with alprazolam. Some are mild, while others may be more serious and require immediate medical intervention and cessation of use.
Common side effects may include:8
- Lightheadedness or dizziness.
- Trouble focusing.
- Memory issues.
- Dry mouth or excessive salivation.
- Altered sexual interest and ability.
- Altered eating patterns that result in weight change.
- Problems urinating.
- Joint pain.
Less common and more serious side effects that may require medical attention include: 8 Yellowing eyes or skin.
- Shortness of breath.
- Problems speaking.
- Extreme personality or mood changes.
- Suicidal thoughts or behaviors.
There are a number of potential issues to take into consideration when taking any medication and especially when taking an addictive substance like Xanax. Your doctor will need to know if you have a history of alcoholism or misuse/abuse of prescription medications before prescribing Xanax.8 Misusing this medication, especially in combination with alcohol or other depressant drugs, can be extremely dangerous.
People who have glaucoma, are pregnant or planning to become pregnant, are breastfeeding, or are over the age of 65 may have additional risks associated with the use of Xanax.8
Mixing with Other Substances:
There may be contraindications to taking alprazolam in combination with certain other medications, such as the antifungal medications ketoconazole and itraconazole.9
It is especially dangerous to mix Xanax with alcohol, opioids, or other sedating drugs. These substances can compound the CNS depressing effects, such as drowsiness and problems breathing. Combining these substances may result in coma or death.9
alcohol, opioids, or other CNS depressants.
Overdose symptoms include:8,10
- Extreme drowsiness.
- Profound confusion.
- Loss of coordination.
- Loss of consciousness.
- Diminished reflexes.
- Slowed or stopped breathing.
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, accident, or injury while under the influence: 3
- Taking more Xanax than prescribed or taking prescribed doses more frequently than recommended.
- Crushing Xanax and snorting the powder.
- Drinking alcohol or using other substances such as heroin or prescription opioids with Xanax.
- Attempting to get multiple prescriptions for Xanax from several different doctors.
- Taking someone else’s medication.
Consistent misuse of Xanax may increase the likelihood of addiction development.3
Signs of a Xanax addiction may include:11
- Taking Xanax in larger amounts or for longer than originally intended.
- Using Xanax in dangerous situations, such as while driving.
- Trying to cut down on your use but not being successful.
- 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.
- Neglecting personal obligations in favor of using Xanax.
- Experiencing relationship conflicts because of your use of Xanax but continuing to use anyway.
- 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.
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.
Brand names for fluoxetine include:12
- Prozac Weekly.
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) medication. SSRIs are not controlled substances and most people who are prescribed these medications do not abuse them.13
Selective serotonin reuptake inhibitors (SSRIs) such as Prozac are the most widely prescribed antidepressant medications. They are thought to work by increasing the availability of serotonin in the brain which, over time, leads to additional therapeutic neural adaptations.14
Serotonin is an important neurotransmitter involved in diverse set of neural processes involved with mood, sleep, memory, learning, and sexual desire.15,16 An SSRI inhibits the reuptake or recycling of serotonin back in to presynaptic nerve terminals, meaning more serotonin is available to interact with nearby nerve cells.16
This increase in serotonergic action is associated with a reduction in depressive symptoms and decreased anxiety and may make a person more amenable to other treatment interventions such as behavioral therapy.16
Prozac may be prescribed to treat:17,18,19
- Major Depressive Disorder.
- Obsessive Compulsive Disorder.
- Bulimia Nervosa.
- Panic disorder.
- Premenstrual dysphoric disorder.
- Bipolar I depression (in combination with olanzapine therapy).
Off-label uses include the management of hot flashes, PTSD, and social anxiety disorder.
Prozac has a number of side effects, including:19
- Difficulty sleeping.
- Dry mouth.
- Loss of appetite and weight loss.
- Sexual dysfunction (e.g., anorgasmia, delayed ejaculation).
The above symptoms, although uncomfortable, are not typically dangerous. That said, some side effects are more serious, and could require additional medical attention: 19
- Extreme muscle stiffness
- Rapid or irregular heartbeat
- Shortness of breath
- Nausea or vomiting
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There are a number of situations that may make fluoxetine an unsafe medication for a patient. For example, Prozac may cause problems for newborns if the drug is taken in the last months of pregnancy. 19
Patients with a prolonged QT interval—a heart muscle conduction issue that could result in severe arrhythmia—or those with low potassium or magnesium levels in their blood may be at increased risk when taking Prozac. 19
Prozac is also associated with a risk of angle-closure glaucoma, which can cause a sharp increase in eye pressure and a sudden loss of vision. 19
Though rare, one of the more concerning risks of Prozac use is a potential increase in suicidal thoughts and behaviors among children, teens and young adults.20 If you or someone you know is experiencing suicidal thoughts while taking Prozac, seek help immediately.
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 Prozac, especially:19
- Alprazolam (Xanax).
- Seizure medications.
These are not the only medications that may interact negatively with fluoxetine. Be sure to discuss all potential medication interactions with your doctor.
Drinking alcohol while on Prozac may be dangerous in that it compounds the drowsiness caused by the medication.19 This may increase the potential for accidents and injuries.
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 effects are relatively benign. That said, there have been some instances of dangerous consequences associated with Prozac ingestion.20
Signs of Prozac overdose may include:19
- Profound confusion.
- Severe drowsiness.
- Nausea and vomiting.
- Rapid or irregular heart rate.
If you suspect an overdose in yourself or someone nearby, call 911 immediately.
Because the use of fluoxetine does not elicit a rewarding high, it is not generally associated with compulsive misuse, though there have been cases of people abusing this medication.21 Abuse of this medication may more easily result in overdose.
Prozac is not a DEA-controlled substance and is not associated with significant abuse liability; however, there have been some instances of people intentionally misusing this drug to achieve stimulant-like effects. Those who are most vulnerable to abusing fluoxetine are those with a prior history of substance abuse.12
In general, Xanax has a higher potential for abuse and addiction than fluoxetine. If you are suffering from symptoms that may be managed with either Xanax or Prozac, be sure to discuss the risks and benefits of these medications with your doctor.
If you are abusing any type of prescription drug and need help, treatment options exist that will help you address your substance.
Prescription Drug Categories
- Dunlop BW, Davis PG. Combination treatment with benzodiazepines and SSRIs for comorbid anxiety and depression: a review. Prim Care Companion J Clin Psychiatry. 2008;10(3):222–228.
- National Alliance on Mental Illness. (2019). Alprazolam (Xanax).
- National Institute on Drug Abuse. (2018). Prescription CNS Depressants.
- Comparison of Benzodiazepines. Retrieved May 13,2019 from http://www.vhpharmsci.com/vhformulary/tools/benzodiazepines-comparison.htm
- (2016). Xanax ® Alprazolam tablets, USP.
- Johnson B, Streltzer J. (2013). Risks associated with long-term benzodiazepine use. American Family Physician, 88(4), 224-6.
- Drug Enforcement Administration. (2013).
- S. National Library of Medicine. (2017). Alprazolam.
- (2016). XANAX® (alprazolam) tablets, CIV: Information for Patients.
- S. National Library of Medicine, TOXNET. (2017). Alprazolam.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
- S. Food & Drug Administration. (n.d.). Search Results for “fluoxetine”.
- Evans, E. A., & Sullivan, M. A. (2014). Abuse and misuse of antidepressants. Substance abuse and rehabilitation, 5, 107–120.
- Mayo Clinic. (2018). Selective serotonin reuptake inhibitors (SSRIs).
- University of Southern California. (n.d.). What is serotonin and why is it Important?
- (2018). Overview: Selective serotonin reuptake inhibitors (SSRIs).
- (2018). Fluoxetine (Prozac).
- S. Food and Drug Administration. (2017). Highlights of Prescribing Information.
- S. National Library of Medicine. (2018). Fluoxetine.
- Suchard J. R. (2008). Fluoxetine overdose-induced seizure. The western journal of emergency medicine, 9(3), 154–156.
- INSLEY, JOYCE A. et al. (1994). Fluoxetine Abuse. Mayo Clinic Proceedings , 69 (2) , 166 – 168