ALPRAZOLAM

Indications & Dose:

Short-term use in anxiety

•  BY MOUTH

Adult: 250–500 micrograms 3 times a day, increased if necessary up to 3 mg daily, for debilitated patients, use elderly dose

Elderly: 250 micrograms 2–3 times a day, increased if necessary up to 3 mg daily.

• Panic disorder:

0.5 mg tid; increase dose q3-4 days in 1 mg/ day increments to 10 mg/day

• Geriatric:

0.25 mg bid-tid

Children: Not recommended. 

Contraindications:

 Untreated narrow angle glaucoma, psychosis, concurrent treatment with itraconazole, ketaconazole, nefazadone.

Side Effects:

Cautions:

Precautions:

Elderly, debilitated, hepatic disease, renal disease, suicidal patients 

Interaction:

Drugs

Cimetidine: Cimetidine inhibits metabolism, increases plasma levels

Digoxin: Inconsistently raises dig levels

Erythromycin, clarithromycin, troleandomycin: Possible increased sedation

Ethanol: Enhanced adverse psychomotor effects; difficulty performing tasks that require alertness

Fluoxetine, fluvoxamine, ketoconazole, itraconazole, nefazadone (see contraindications: Increases alprazolam plasma concentrations; increases in psychomotor impairment

Grapefruit juice: Increased alprazolam levels due to inhibition of presystemic (intestinal) enzyme CYP34A

Phenytoin,carbamazepine: Decreased benzodiazepine effect 

Warnings:

Adverse Effects:

Lactations:

Children born of a mother receiving benzodiazepines may be at risk for withdrawal symptoms; neonatal flaccidity and respiratory problems have been reported; chronic administration of diazepam to nursing mothers has been reported to cause infants to become lethargic and lose weight 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Anxiety, ataxia, confusion, depress n, dizziness, drowsiness, fatigue, hallucinations, headache, insomnia, stimulation, tremors

CV: Bradycardia, hypertension, orthostatic hypotension, tachycardia

SENT: Blurred vision, mydriasis, tinnitus 

GI: Anorexia, constipation, diarrhea, dry mouth, hepatic dysfunction, nausea, vomiting

SKIN: Dermatitis, itching, rash 

Patient And Carer Advice: