Alprazolam

Indications
Oral
Short-term management of anxiety
Adult: 0.25-0.5 mg tid, increased to 3-4 mg daily if necessary.
Elderly: Initially, 0.25 mg bid/tid.
Hepatic impairment: Avoid in severe impairment.
Oral
Panic attacks
Adult: Up to 10 mg daily.

Special Populations: Initial dose for short-term management of anxiety disorders in debilitated patients and those with advanced liver disease is 0.25 mg bid/tid.
Contraindications
Acute narrow-angle glaucoma, preexisting CNS depression or coma, resp depression, acute pulmonary insufficiency or sleep apnoea; severe hepatic impairment; pregnancy, lactation.
Warnings / Precautions
Dosage reduction or gradual withdrawal. Dependence. Geriatric or debilitated patients. Muscle weakness, impaired hepatic or renal function; arteriosclerosis; obesity; depression particularly suicidal tendency; chronic pulmonary insufficiency. May impair ability to drive or operate machinery. Children <18 yr.
Adverse Reactions
Psychological and physical dependence, withdrawal syndrome; drowsiness, sedation, vertigo, headache, visual disturbances, GI disturbances, jaundice; fatigue, muscle weakness, ataxia, dizziness, confusion and depression.
Potentially Fatal: Blood dyscrasias.
Overdose Reactions
Symptoms: Somnolence, confusion, impaired coordination, diminished reflexes and coma. Monitor respiration, pulse rate and BP. General supportive measures and immediate gastric lavage may be recommended. If hypotension occurs, it may be combated by the use of vasopressors. Dialysis is of limited value. Flumazenil may be used for complete or partial reversal of the sedative effects of benzodiazepines and may be used when an overdose with a benzodiazepine is known or suspected.
Drug Interactions
Potentiates action of alcohol and CNS depressants. Reduced conc with cigarette smoking by 50%.
Potentially Fatal: Cimetidine and fluoxetine reduce the clearance of alprazolam. Alprazolam enhances activity of imipramine and desipramine.
See Below for More alprazolam Drug Interactions
Mechanism of Actions
Alprazolam has anxiolytic, muscle-relaxant, anticonvulsant, antidepressant and sleep-modifying effects. It binds to the γ aminobutyric acid (GABA)-specific sites throughout the CNS, leading to an increase in the inhibitory effect of GABA on neuronal excitability. Increased neuronal permeability to chloride ions thus results in hyperpolarisation and stabilisation.
Absorption: Well absorbed from the GIT (oral); peak plasma concentrations after 1-2 hrs.
Distribution: Protein-binding: 70-80%
Metabolism: Hepatic; converted to α-hydroxyalprazolam and benzophenone.
Excretion: Urine (as unchanged drug and metabolites); 11-15 hrs (elimination half-life).
Administration
May be taken with or without food. (Side effects eg sleepiness/drowsiness may be reduced if taken immediately after meals.)
Storage Conditions
Oral: Store below 25°C.
ATC Classification
N05BA12 - alprazolam ; Belongs to the class of benzodiazepine derivatives anxiolytics. Used in the management of anxiety, agitation or tension.
Storage
Oral: Store below 25°C.
Available As
  • Alprazolam 0.125 mg
  • Alprazolam 0.25 mg
  • Alprazolam 0.5 mg
  • Alprazolam 0.50 mg
  • Alprazolam 0.75 mg
  • Alprazolam 1 mg
  • Alprazolam 1.5 mg
  • Alprazolam 10 mg
  • Alprazolam 25 mg
  • Alprazolam 250 mg
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