Alprazolam
Mechanism :
Alprazolam is a benzodiazepine. Benzodiazepines presumably exert their effects by binding at stereo specific receptors at several sites within the central nervous system at the GABA receptor complex. All benzodiazepines cause a dose-related central nervous system depressant activity.
Indication :
- Anxiety disorder
- Panic disorder
- Sedative
Contraindications :
Respiratory depression, especially seen with coexistent respiratory disease or myasthenia gravis.
There is potential for growing dependence, therefore only short-term use is recommended.
Acute porphyria.
Narrow-angle glaucoma.
Dosing :
Safety and efficacy of its use in children <18 years of age has not been established.
Anxiety:
≥7 years-18 years: 0.005 to 0.02 mg/kg/dose 3 times PO daily. Max: 3.5 mg/day.
Discontinuation of therapy
Abrupt discontinuation should be avoided. Daily dose must be gradually decreased no more frequently than every 3 days.
Adverse Effect :
Occurs are onset of therapy: drowsiness, ataxia, irritability, light-headedness, dysarthria and disinhibition. Withdrawal symptoms on long term usage: muscle cramps, tremor, irritability, convulsions and perceptual distortions.
Interaction :
CNS depressants: Enhanced effectiveness.
Fluoxetine: Coadministration with alprazolam increases the maximum plasma concentration of alprazolam.
Propoxyphene: Coadministration decreases the maximum plasma concentration of alprazolam.
Oral Contraceptives: Coadministration increases the maximum plasma concentration of alprazolam.
Antifungal Agents (Azole Derivatives, Systemic): May decrease the metabolism of Benzodiazepines (metabolized by oxidation).
Carbamazepine: May increase the metabolism of Benzodiazepines (metabolized by oxidation).
Cimetidine: May decrease the metabolism of Benzodiazepines (metabolized by oxidation).
Hepatic Dose :
Mild to moderate hepatic impairment: Use with caution. Consider initial dose reduction. Titrate as per clinical needs.
Severe hepatic impairment: Use is contraindicated.