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alprazolam
Apo-Alpraz†, Kalma‡,
Novo-Alprazol†, Nu-Alpraz†, Ralozam‡, Xanax

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

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