DrugFriday: Alprazolam


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.


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



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

Panic Disorder
  1. 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]
  2. 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.


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.

Common Brand Names In India

Alprax, Restyl, Trika,Alzolam


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