DrugFriday: Alprazolam

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Alprazolam is an anti anxiety medication belonging to the class of drugs called Benzodiazepines.

Mechanism of Action:

Alprazolam acts by binding to a number of sites in the brain, augmenting the inhibitory effects of the neurotransmitter called GABA (gamma amino benzoic acid) which stabilizes neuronal membranes.

Uses:

Alprazolam is mainly used for treatment of anxiety disorder and anxiety associated with depression.
It may also be used for treatment of premenstrual syndrome.

Dosing:

Anxiety

0.25-0.5 mg PO q6-8hr, dose is gradually increased, not to exceed 4 mg/day

Panic Disorder

Immediate-release
0.5 mg PO q8hr; may increase every 3-4Days by ≤1 mg/day
Average dose: 5-6 mg/day PO [May require up to 10 mg/day PO divided 8 hourly]
Extended-release
0.5-1 mg PO qDay; may increase q3-4Days by ≤1 mg/day
Average dose: 3-6 mg PO qDay

Anxiety Associated With Depression

1-4 mg/day PO divided q8hr

Premenstrual Syndrome (Off-Label)

0.25 mg PO q6-12hr; initiate treatment on day 16-18 of menses (not to exceed 3-4 mg/day); taper dose over 2-3 days once menses occurs.
In kidney failure, dosage is given cautiously. In severe liver impairment, dosage is suitably adjusted.

Adverse Effects:

For 4mg Dose

Drowsiness (41%)
Depression (10-15%)
Headache (10-15%)
Constipation (10-15%)
Diarrhea (10-15%)
Dry mouth (10-15%)

For (10mg Dose)

Drowsiness (77%)
Impaired coordination (40-50%)
Increased appetite (30-35%)
Fatigue (30-35%)
Memory impairment (30-35%)
Irritability (30-35%)
Decreased salivation (30-35%)
Cognitive disorders (20-30%)
Insomnia (20-30%)

Drug Interactions:

Co-administration of drugs such as Fluconazole, Ketoconazole, Itraconazole is absolutely contraindicated with Alprazolam.
Drugs such as some anti-epileptics, anti TB drugs, anti viral drugs , antibiotics like Erythromycin are cautiously given with Alprazolam.

Use in Pregnancy:

Alprazolam is a category D drug in pregnancy, used only if no alternative is available in life threatening emergency.

Use in lactation:

Alprazolam is secreted in breast milk hence it is contraindicated in lactating mothers.

Warning:

Alprazolam has a high dependency potential. It is strictly to be taken only on medical advice. Over the counter use of this drug is dangerous and is strongly discouraged.