alprazolam

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alprazolam

 [al-pra´zo-lam]

alprazolam

Apo-Alpraz (CA), Niravam, Novo-Alprazol (CA), Nu-Alpraz (CA), Xanax, Xanax TS (CA), Xanax XR

Pharmacologic class: Benzodiazepine

Therapeutic class: Anxiolytic

Controlled substance schedule IV

Pregnancy risk category D

Action

Unclear. Thought to act at limbic, thalamic, and hypothalamic levels of CNS to produce sedative, anxiolytic, skeletal muscle relaxant, and anticonvulsant effects.

Availability

Solution: 1 mg/ml

Tablets (extended-release): 0.5 mg, 1 mg, 2 mg, 3 mg

Tablets (immediate-release): 0.25 mg, 0.5 mg, 1 mg, 2 mg

Tablets (orally disintegrating): 0.25 mg, 0.5 mg, 1 mg, 2 mg

Indications and dosages

Anxiety disorders

Adults: Initially, 0.25 to 0.5 mg P.O. t.i.d. Maximum dosage is 4 mg daily in divided doses.

Elderly patients: Initially, 0.25 mg P.O. two or three times daily. Maximum dosage is 4 mg daily in divided doses.

Panic disorders

Adults:Immediate-release or orally disintegrating tablets-Initially, 0.5 mg P.O. t.i.d. Extended-release tablets-Initially, 0.5 to 1 mg P.O. daily. Usual dosage is 3 to 6 mg daily, with a maximum dosage of 10 mg daily. For all dosage forms, increase by a maximum of 1 mg daily at intervals of 3 to 4 days, with a maximum of 10 mg daily in divided doses.

Dosage adjustment

• Hepatic impairment

Off-label uses

• Agoraphobia
• Depression
• Premenstrual syndrome

Contraindications

• Hypersensitivity to benzodiazepines
• Narrow-angle glaucoma
• Labor and delivery
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• hepatic dysfunction
• history of attempted suicide or drug dependence
• elderly patients.

Administration

• Don't give with grapefruit juice.
• Make sure patient swallows extended-release tablets whole without chewing or crushing.
• Mix oral solution with liquids or semisolid foods and instruct patient to consume entire amount immediately.
• Administer orally disintegrating tablets by placing tablet on patient's tongue. If only one-half of scored tablet is used, discard unused portion immediately.

Don't withdraw drug suddenly. Seizures and other withdrawal symptoms may occur unless dosage is tapered carefully.

Adverse reactions

CNS: dizziness, drowsiness, depression, fatigue, light-headedness, disorientation, anger, hostility, euphoria, hypomanic episodes, restlessness, confusion, crying, delirium, headache, stupor, rigidity, tremor, paresthesia, vivid dreams, extrapyramidal symptoms

CV: bradycardia, tachycardia, hypertension, hypotension, palpitations, CV collapse

EENT: blurred or double vision, nystagmus, nasal congestion

GI: gastric disorders, dysphagia, anorexia, increased salivation, dry mouth

GU: menstrual irregularities, urinary retention, urinary incontinence, libido changes, gynecomastia

Hematologic: blood dyscrasias such as eosinophilia, agranulocytosis, leukopenia, and thrombocytopenia

Hepatic: hepatic dysfunction (including hepatitis)

Musculoskeletal: muscle rigidity, joint pain

Skin: dermatitis, rash, pruritus, urticaria, increased sweating

Other: weight loss or gain, hiccups, fever, edema, psychological drug dependence, drug tolerance

Interactions

Drug-drug.Antidepressants, antihistamines, opioids, other benzodiazepines: increased CNS depression

Barbiturates, rifampin: increased metabolism and decreased efficacy of alprazolam

Cimetidine, disulfiram, erythromycin, fluoxetine, hormonal contraceptives, isoniazid, ketoconazole, metoprolol, propoxyphene, propranolol, valproic acid: decreased metabolism and increased action of alprazolam

Digoxin: increased risk of digoxin toxicity

Levodopa: decreased antiparkinsonian effect

Theophylline: increased sedative effect

Tricyclic antidepressants (TCAs): increased TCA blood levels

Drug-diagnostic tests.Itraconazole, ketoconazole: increased alprazolam plasma level

Drug-food.Grapefruit juice: decreased drug metabolism and increased blood level

Drug-herbs.Chamomile, hops, kava, skullcap, valerian: increased CNS depression

Drug-behaviors.Alcohol use: increased CNS depression

Smoking: decreased alprazolam efficacy

Patient monitoring

• Watch for excessive CNS depression if patient is concurrently taking antidepressants, other benzodiazepines, antihistamines, or opioids.
• If patient is taking TCAs concurrently, watch for increase in adverse TCA effects.
• Monitor CBC and liver and kidney function test results.
• Monitor vital signs and weight.
• Report signs of drug abuse, including frequent requests for early refills.

Patient teaching

• Instruct patient to swallow extended- release tablets whole without crushing or chewing.

Tell patient that drug may make him more depressed, angry, or hostile. Urge him to contact prescriber immediately if he thinks he's dangerous to himself or others.
• Inform patient that drug may cause tremors, muscle rigidity, and other movement problems. Advise him to report these effects to prescriber.

Caution patient not to stop taking drug suddenly. Withdrawal symptoms, including seizures, may occur unless drug is tapered carefully.
• Advise patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.

alprazolam

/al·pra·zo·lam/ (al-pra´zo-lam) a benzodiazepine used as an antianxiety agent.

alprazolam

(ăl-prā′zə-lăm′)
n.
A benzodiazepine drug, C17H13ClN4, used to treat panic disorder and other anxiety disorders.

alprazolam

[alpraz′ələm]
a benzodiazepine antianxiety agent.
indications It is prescribed in the treatment of anxiety disorders or the short-term relief of the symptoms of anxiety.
contraindications Acute narrow-angle glaucoma or known sensitivity to this drug or other benzodiazepines prohibits its use. It is contraindicated with ketoconazole and itraconazole. Pregnancy is also a contraindication.
adverse effects Among the most serious adverse reactions are drowsiness, lightheadedness, and tolerance or physical dependence.

alprazolam

Neuropharmacology A benzodiazepine used to manage cholecystokinin related anxiety-panic disorders and CNS depression Adverse effects Drowsiness, loss of coordination, mood swings Toxic range > 75 µg/L

alprazolam

A benzodiazepine anti-anxiety drug. A brand name is Xanax.

al·pra·zo·lam

(al-prāzō-lam)
A benzodiazepine used to manage anxiety disorders and panic attack; tolerance, habituation, or dependency may result from increased dosage.

alprazolam (alprāz´əlam´),

n brand names: Xanax, Apo-Alpraz, Novo-Alprazol, Nu-Alpraz;
drug class: benzodiazepine (Controlled Substance Schedule IV);
action: produces CNS depression;
uses: anxiety, panic disorders, anxiety with depressive symptoms.

alprazolam

a benzodiazepine tranquilizer used as an anxiolytic.