ALPRAZOLAM
(al-pray'zoe-lam)
Niravam, Xanax, Xanax XR
Classifications: central nervous system agent; anxiolytic; sedative-hypnotic; benzodiazepine
Prototype: Lorazepam
Pregnancy Category: D
Controlled Substance: Schedule IV
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0.25 mg, 0.5 mg, 1 mg, 2 mg tablets; 0.5 mg, 1 mg, 2 mg, 3 mg sustained-release tabs; 0.5 mg/5 mL, 1 mg/mL oral solution; 0.25 mg, 0.5 mg, 1 mg, 2 mg orally disintegrating tabs
CNS depressant. Mode of action not known, but appears to act at the limbic, thalamic, and hypothalamic levels of the CNS.
It is associated with significantly less drowsiness.
Drug has antidepressant as well as antianxiety actions.
Management of anxiety disorders or for short-term relief of anxiety symptoms. Also used as adjunct in management of anxiety
associated with depression and agitation, and for panic disorders, such as agoraphobia.
Alcohol withdrawal.
Sensitivity to benzodiazepines; acute narrow angle glaucoma; pulmonary disease; use alone in primary depression or psychotic
disorders; during pregnancy (category D), lactation; children <18 y.
Impaired hepatic function; history of alcoholism; geriatric and debilitated patients. Effectiveness for long-term treatment
(>4 mo) not established.
Anxiety Disorders
Adult: PO 0.25–0.5 mg t.i.d. (max: 4 mg/d)
Geriatric: PO 0.125–0.25 mg b.i.d.
Panic Attacks
Adult: PO 1–2 mg t.i.d. (max: 8 mg/d); sustained release: initiate with 0.5 mg to 1 mg once/d. Depending on the response, the dose
may be increased at intervals of 3 to 4 days in increments of no more than 1 mg/d. Target range 3–6 mg/d (max: 10 mg/d).
Hepatic Impairment
Reduce dose by 50% in hepatic impairment.
Do not discontinue abruptly.
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Oral
- Reduce drug gradually when discontinuing drug.
- Store in light-resistant containers at 15°–30° C (59°–86° F), unless otherwise directed.
CNS:
Drowsiness, sedation, light-headedness, dizziness, syncope, depression, headache, confusion, insomnia, nervousness, fatigue, clumsiness, unsteadiness,
rigidity, tremor, restlessness, paradoxical excitement, hallucinations. CV: Tachycardia, hypotension, ECG changes. Special Senses: Blurred vision. Respiratory: Dyspnea.
Drug:
Alcohol and other cns depressants, anticonvulsants, antihistamines, barbiturates, narcotic analgesics, benzodiazepines, compound CNS depressant effects; cimetidine,
disulfiram, fluoxetine, [tricyclic antidepressants] increase alprazolam levels (decreased metabolism); oral contraceptives may increase or decrease alprazolam effects. Herbal:
Kava-kava,
valerian may potentiate sedation; St. John's wort decreases serum level of alprazolam. Cigarette smoking may decrease serum level of alprazolam by 50%.
Absorption: Rapidly absorbed. Peak: 1–2 h. Distribution: Crosses placenta. Metabolism: Oxidized in liver to inactive metabolites. Elimination: Renal elimination. Half-Life: 12–15 h.
Assessment & Drug Effects
- Monitor for S&S of drowsiness and sedation, especially in older adults or the debilitated; they may require supervised ambulation
and/or side rails.
- Lab tests: Monitor periodic blood counts, urinalyses, and blood chemistry studies, particularly during continuing therapy.
Patient & Family Education
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Note: Adverse reactions that may occur during early high-dose therapy. These usually disappear with continuing therapy, but dosage
adjustments may be indicated.
- Make position changes slowly and in stages to prevent dizziness.
- Do not use alcohol, other CNS depressants, or OTC medications containing antihistamines (e.g., sleep aids, cold, hay fever,
or allergy remedies) without consulting physician.
- Do not drive or engage in potentially hazardous activities until response to drug is known.
- Taper dosage following continuous use; abrupt discontinuation of drug may cause withdrawal symptoms: nausea, vomiting, abdominal
and muscle cramps, sweating, confusion, tremors, convulsions.
- Do not breast feed while taking this drug.
1%)
Canadian drug name; 
Prototype drug