Controlled Substance Schedule IV
Pregnancy Risk Category D
How supplied
Tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg
Oral solution: 0.5 mg/5 ml, 1 mg/ml (concentrate)
Action
Unknown. A benzodiazepine that probably potentiates the effects of gamma-aminobutyric acid, an inhibitory neurotransmitter, and depresses the CNS at the limbic and subcortical levels of the brain.
Indications & dosage
Anxiety--
Adults: usual initial dose, 0.25 to 0.5 mg P.O. t.i.d. Maximum dose is 4 mg daily in divided doses.
Elderly: usual initial dose, 0.25 mg P.O. b.i.d. or t.i.d. Maximum dose is 4 mg daily in divided doses.
Panic disorders--
Adults: 0.5 mg P.O. t.i.d., increased at intervals of 3 to 4 days in increments of no more than 1 mg. Maximum dose is 10 mg daily in divided doses.
Adjust-a-dose:
For debilitated patients or those with advanced hepatic disease, usual initial dose is 0.25 mg P.O. b.i.d. or t.i.d. Maximum dose is 4 mg daily in divided doses.
Adverse reactions
CNS: drowsiness, light-headedness, headache, confusion, tremor, dizziness, syncope, depression, insomnia, memory impairment, nervousness, minor changes in EEG patterns.
CV: hypotension, tachycardia.
EENT: blurred vision, nasal congestion.
GI: dry mouth, nausea, vomiting, diarrhea, constipation, increased salivation.
Hepatic: elevated liver function tests.
Metabolic: weight gain or loss.
Musculoskeletal: muscle rigidity.
Skin: dermatitis.
Interactions
Drug-drug. Cimetidine: decreased alprazolam clearance with potential for increased adverse reactions. Monitor patient carefully.
CNS depressants: increased CNS depression. Avoid concomitant use.
Digoxin: may increase serum digoxin levels, increasing toxicity. Monitor patient closely.
Tricyclic antidepressants (TCAs): increased plasma levels of TCAs. Monitor for toxicity.
Drug-herb. Kava: may cause coma. Avoid concomitant use.
Drug-lifestyle. Alcohol use: increased CNS depression. Avoid concomitant use.
Smoking: decreased effectiveness of benzodiazepines. Monitor patient closely.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients with hypersensitivity to drug or other benzodiazepines and in those with acute angle-closure glaucoma.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING