Alprazolam information from DrugsUpdate
L - Contraindicated in lactation
FI - Food *
LI - Lab *
Alprazolam is in a group of drugs called benzodiazepines . It works by slowing down the movement of chemicals in the brain that may become unbalanced. This results in a reduction in nervous tension (anxiety). Alprazolam is used to treat anxiety disorders, panic disorders, and anxiety caused by depression.
Pharmacodynamics
Pharmacokinetics
Absorption
Readily absorbed; T max is 1 to 2 h; C max is 8 to 37 ng/mL (0.5 to 3 mg doses).
Distribution
80% protein bound. Crosses the placenta and is excreted in breast milk.
Metabolism
Metabolized in the liver to alpha-hydroxy-alprazolam (activity is approximately 50% that of alprazolam) and a benzophenone derivative (inactive).
Elimination
The t ½ is approximately 16.3 h. Excreted in the urine.
Special Populations
Hepatic Function Impairment
The t ½ is approximately 19.7 hours in those with alcoholic liver disease.
Elderly
The t ½ is approximately 16.3 hours.
Obese
The t ½ is approximately 21.8 hours.
Alprazolam Indications / Alprazolam Uses
Information Not Available
Alprazolam Adverse Reactions / Alprazolam Side Effects
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.
Precautions
If Alprazolam tablets are to be combined with other psychotropic agents or anticonvulsant drugs, careful consideration should be given to the pharmacology of the agents to be employed, particularly with compounds which might potentiate the action of benzodiazepines.
As with other psychotropic medications, the usual precautions with respect to administration of the drug and size of the prescription are indicated for severely depressed patients or those in whom there is reason to expect concealed suicidal ideation or plans.
It is recommended that the dosage be limited to the smallest effective dose to preclude the development of ataxia or oversedation which may be a particular problem in elderly or debilitated patients. The usual precautions in treating patients with impaired renal, hepatic or pulmonary function should be observed. There have been rare reports of death in patients with severe pulmonary disease shortly after the initiation of treatment with Alprazolam tablets. A decreased systemic Alprazolam elimination rate (e.g., increased plasma half-life) has been observed in both alcoholic liver disease patients and obese patients receiving Alprazolam tablets.
Episodes of hypomania and mania have been reported in association with the use of Alprazolam tablets in patients with depression.
Alprazolam has a weak uricosuric effect. Although other medications with weak uricosuric effect have been reported to cause acute renal failure, there have been no reported instances of acute renal failure attributable to therapy with Alprazolam tablets.
Special Precautions
Dosage reduction or gradual withdrawal. Dependence. Geriatic or deliliatated patients. Muscle weakness, impaired hepatic or renal fucntion; arteriosclerosis; obestity; depression particularly suicidal tendency; chronic pulmonary insufficieny. May impair ability to drive or operate machinery. Children <18 years.
Other Drug Interactions
Cimetidine & fluxetine reduce the clearance of alprazolam. Alprazolam enhances activity of imipramine & despramine.
Other Interactions
Poteniateaction of alcohol & CNS depressants. Reduced concentration with cigarette smoking by 50%
Dosage
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.
Food(before/after)
May be taken with or without food. (Side effects such as sleepiness/ drowsiness may be reduced if taken immediately after meals.)
List of Contraindications
Alprazolam and Pregnancy
Teratogenic Effects: Pregnancy Category D:
Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
Alprazolam and Lactation
Contraindicated in lactation
Alprazolam and Children
Children <18 years
Alprazolam and Geriatic
Take special precautions
Alprazolam and Other Contraindications
Alprazolam tablets are contraindicated in patients with known sensitivity to this drug or other benzodiazepines. Alprazolam tablets may be used in patients with open angle glaucoma who are receiving appropriate therapy, but is contraindicated in patients with acute narrow angle glaucoma.
Alprazolam tablets are contraindicated with ketoconazole and itraconazole, since these medications significantly impair the oxidative metabolism mediated by cytochrome P450 3A (CYP 3A)
Storage
Store below 25°C.
Lab interference
Store below 25°C.
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