Drug ID: 1d00000064
Drug Name: Alprazolam
Generic Names: Tenrid (0.25mg) | FAD SR (0.5mg) | Alzopax XR (1mg) | Zolipax SR (1.5mg) | Tenolam Plus | Zam (0.5mg) | Anilam (0.25mg) | Zotam (0.25mg) | Alprocontin (1mg) | L Peez (0.5mg) | Calm (0.50mg) | Aleez (0.25mg) | Somnirest (0.5mg) | ALP -FTD | Shanti (0.25mg) | Ambulax | Tensfree (0.25mg) | Besquil (0.5mg) | Alone | Allam | Balzam SR (0.5mg) | Avizolem (0.25mg) | Alsert | Zolorest FX | Anilam (0.5mg) | Altrex (0.25mg) | Alzocum SR (0.5mg) | Azolam (0.5mg) | Somnia (0.25mg) | Alam SR (0.5mg) | Xanax | Xanax XR | Niravam | More
Category: Anxiolytics, Sedatives And Hypnotics
Legal Status: Non Opioid Prescription only drug
Indication for Mother: Category D
There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Recommended Dose: The starting dose for treating anxiety is 0.25-0.5 mg, 3 times daily using immediate release tablets.
The dose may be increased every 3-4 days to a maximum dose of 4 mg daily.
The starting dose for treating panic attacks is 0.5 mg, 3 times daily. Doses can be increased every 3-4 days but by no more than 1 mg daily. The effective dose for preventing panic attacks may be as high as 6 mg daily.
Recommended In: This medication is a benzodiazepine, prescribed for anxiety and panic disorders. It reduces the nervous tension by slowing down the movement of chemicals in the brain.
Directions For Use: It comes as a tablet to take by mouth, with or without food.
Storage: Store it at room temperature and in an airtight container. Keep away from light and children.
Dosage Forms: Tablet
Side Effects: Central Nervous System - Drowsiness, lightheadedness, depression, headache, confusion, sleeplessness, nervousness, fainting, dizziness and tiredness.
Gastrointestinal - Dry mouth, constipation, diarrhea, nausea/vomiting and increased salivation.
Heart - Fast heart rate and low blood pressure.
Eye - Blurred vision.
Musculoskeletal - Rigidity and tremor.
Skin - Skin inflammation and allergy.
Miscellaneous - Nose congestion and weight gain/loss.
In Case of Overdose: Manifestations of alprazolam overdosage include somnolence, confusion, impaired coordination, diminished reflexes and coma. Death has been reported in association with overdoses of alprazolam by itself, as it has with other benzodiazepines. In addition, fatalities have been reported in patients who have overdosed with a combination of a single benzodiazepine, including alprazolam, and alcohol; alcohol levels seen in some of these patients have been lower than those usually associated with alcohol-induced fatality.
Animals could be resuscitated with positive mechanical ventilation and the intravenous infusion of norepinephrine bitartrate.
Animal experiments have suggested that forced diuresis or hemodialysis are probably of little value in treating overdosage.
Overdosage reports with XANAX Tablets are limited. As in all cases of drug overdosage, respiration, pulse rate, and blood pressure should be monitored. General supportive measures should be employed, along with immediate gastric lavage. Intravenous fluids should be administered and an adequate airway maintained. If hypotension occurs, it may be combated by the use of vasopressors. Dialysis is of limited value. As with the management of intentional overdosing with any drug, it should be borne in mind that multiple agents may have been ingested.
Flumazenil, a specific benzodiazepine receptor antagonist, is indicated for the complete or partial reversal of the sedative effects of benzodiazepines and may be used in situations when an overdose with a benzodiazepine is known or suspected. Prior to the administration of flumazenil, necessary measures should be instituted to secure airway, ventilation and intravenous access. Flumazenil is intended as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. Patients treated with flumazenil should be monitored for re-sedation, respiratory depression, and other residual benzodiazepine effects for an appropriate period after treatment. The prescriber should be aware of a risk of seizure in association with flumazenil treatment, particularly in long-term benzodiazepine users and in cyclic antidepressant overdose.
Avoid If: Caution should be exercised in patients with history of asthma or other respiratory diseases, kidney or liver impairment, depression, suicidal thoughts, alcohol addiction, increased eye pressure, who are taking other medications, any allergy, elderly, children, during pregnancy and breastfeeding.
It may decrease alertness and coordination. Do not drive a car or operate dangerous machinery while taking this medication.
Avoid alcohol consumption.
Avoid grape fruit or grape fruit juice consumption while taking this medication.
Contraindicated in patients with increased eye pressure, who are taking itraconazole or ketoconazole and hypersensitivity.
Drug Interaction: Use with Other CNS Depressants
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. The benzodiazepines, including alprazolam, produce additive CNS depressant effects when co-administered with other psychotropic medications, anticonvulsants, antihistaminics, ethanol and other drugs which themselves produce CNS depression.
Use with Digoxin
Increased digoxin concentrations have been reported when alprazolam was given, especially in elderly ( > 65 years of age). Patients who receive alprazolam and digoxin should therefore be monitored for signs and symptoms related to digoxin toxicity.
Use with Imipramine and Desipramine
The steady state plasma concentrations of imipramine and desipramine have been reported to be increased an average of 31% and 20%, respectively, by the concomitant administration of XANAX Tablets in doses up to 4 mg/day.
Drugs That Inhibit Alprazolam Metabolism Via Cytochrome P450 3A
The initial step in alprazolam metabolism is hydroxylation catalyzed by cytochrome P450 3A (CYP3A). Drugs which inhibit this metabolic pathway may have a profound effect on the clearance of alprazolam.
Drugs Demonstrated To Be CYP3A Inhibitors:
Fluoxetine— Coadministration of fluoxetine with alprazolam increased the maximum plasma concentration of alprazolam by 46%, decreased clearance by 21%, increased half-life by 17%, and decreased measured psychomotor performance.
Propoxyphene— Coadministration of propoxyphene decreased the maximum plasma concentration of alprazolam by 6%, decreased clearance by 38%, and increased half-life by 58%.
Oral Contraceptives— Coadministration of oral contraceptives increased the maximum plasma concentration of alprazolam by 18%, decreased clearance by 22%, and increased half-life by 29%.
Drugs And Other Substances Demonstrated To Be CYP 3A Inhibitors:
Available data from clinical studies of benzodiazepines other than alprazolam suggest a possible drug interaction with alprazolam for the following: diltiazem, isoniazid, macrolide antibiotics such as erythromycin and clarithromycin, and grapefruit juice. Data from in vitro studies of alprazolam suggest a possible drug interaction with alprazolam for the following: sertraline and paroxetine. Data from in vitro studies of benzodiazepines other than alprazolam suggest a possible drug interaction for the following: ergotamine, cyclosporine, amiodarone, nicardipine, and nifedipine. Caution is recommended during the coadministration of any of these with alprazolam.
Drugs Demonstrated To Be Inducers Of CYP3A
Carbamazepine can increase alprazolam metabolism and therefore can decrease plasma levels of alprazolam.