Alprazolam: Uses, adverse reactions & interactions!

Alprazolam is a short duration acting benzodiazepine drug that finds its use as an anti-anxiety & anti-convulsant drug.

USES

  • Generalized anxiety disorder (GAD)
  • Panic disorder
  • In nausea due to chemotherapy
  • Depression
  • Agoraphobia

DOSAGE FOR ALPRAZOLAM

Dosage forms available:

  • Tablet immediate release (IR): 0.25 mg, 0.5 mg, 1 mg, 2 mg
  • Extended release (XR) tablet: 0.5 mg, 1 mg, 2 mg, 3 mg
  • Oral disintegrating tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg
  • Oral solution: 1 mg/ml

Dosage guidelines: 

  • In anxiety disorder: (IR) tablet dose as follows;
  1. 0.25-0.5 mg orally once every 6-8 hours
  2. Titrate dosage to effect once ever 3-4 days; not to exceed 4 mg/day.
  • In Panic disorder: (XR) tablet dose as follows;
  1. Dose drug 0.5-1 mg orally once/day; may adjust once every 3-4 days by 1 mg or less/day
  2. Average drug dose: 3-6 mg orally once/day.
  • In anxiety associated with depression: 
  1. Immediate-release: Decrease initial dose to 0.25 mg orally once every 8-12 hours
  2. Extended-release: 0.5 mg orally once/day

Missed dose: Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

Overdose:
a) Maximum recommended daily dose is 10 mg.
b) Treatment of OD follows initially by administration of gastric lavage & whole bowel irrigation.
c) Hemodialysis
d) IV fluid administration & electrolyte supplementation.
e) Artificial respiration
f) Low blood pressure is managed and blood pressure is increased by drugs like norepinephrine.
g) Flumazenil is a drug that sticks to the benzodiazepine receptors & therefore acts as an antidote for benzodiazepine overdose/toxicity.
h) Overdose can be a case due to abuse of drug, recreational purposes, in suicide attempt, complicated interactions with other drugs, dependence on Alprazolam, etc.

SIDE EFFECTS

  • Drowsiness
  • Depression
  • Headache pain
  • Constipation/diarrhea
  • Dry mouth & decreased salivation
  • Impaired coordination
  • Increased or decreased appetite
  • Fatigue
  • Memory problems
  • Irritability
  • Insomnia

ADVERSE EFFECT ARISING FROM ALPRAZOLAM

Adverse effect usually rise due to overdose of Alprazolam:

  • Slurred speech
  • Loss of voluntary control of muscles
  • Delirium
  • Hallucinations
  • Seizure
  • Suicidal tendency
  • Low blood pressure
  • Shallow breathing
  • Respiratory depression
  • Low blood oxygen levels
  • Low body temperature
  • Decreased heart rate
  • Coma
  • Cardiac arrest 
  • Death.

Adverse effect due to withdrawal of Alprazolam are:

  • Anxiety & agitation
  • Depression & mood disorder
  • Hallucination, delusion & delirium
  • Chest pain & blurred vision
  • Elevated blood pressure
  • GIT disturbance
  • Loss of appetite & weight loss
  • Muscular spasm
  • Nightmares & paranoia
  • OCD
  • Psychosis
  • PTSD
  • Coma.

PRECAUTIONS & CONTRAINDICATIONS

Alprazolam is contraindicated & precaution is advised in patients with following conditions:

  • Children
  • Pregnant women
  • Elderly population
  • People with alcohol or drug dependency/addiction
  • Smokers
  • Psychiatric disorders
  • Borderline personality disorder
  • Myasthenia gravis
  • Acute narrow angle glaucoma
  • Liver cirrhosis
  • Kidney disorder/disease
  • Sleep apnea
  • Respiratory problems
  • Sensitivity or allergy to alprazolam.

INTERACTIONS OF ALPRAZOLAM

  • Alcohol & benzodiazepine drugs enhance each other’s effects which can lead to respiratory depression, low blood pressure & coma.
  • Alprazolam can enhance the adverse effects of clozapine.
  • Drugs that inhibit the CYP3A4 enzyme system like erythromycin, ketoconazole, cimetidine, etc can lead to accumulation of Alprazolam because it is metabolized by the enzyme system.
  • Oral contraceptive pills can increase the plasma concentration of Alprazolam.
  • Alprazolam can enhance the CNS depressant effects of oxycodone
  • Theophylline can decrease the therapeutic effects of benzodiazepines.
  • The therapeutic effect of alprazolam is decreased in the presence of yohimbine.

IN PREGNANCY, BREAST FEEDING & CHILDREN

  • Pregnancy: Alprazolam crosses the placenta barrier and can cause deformity in fetus.
  • Breast Feeding: Benzodiazepine drugs get excreted in the milk and is not recommended in breast feeding mothers.
  • Children: Alprazolam is not given to children.