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😄🤭😚 Pharmacologic class: Benzodiazepine
😄🤭😚 Therapeutic class: Anxiolytic
😄🤭😚 Controlled substance schedule IV
😄🤭😚 Pregnancy risk category D
😄🤭😚 Unclear. Thought to act at limbic, thalamic, and hypothalamic levels of CNS to produce sedative, anxiolytic, skeletal muscle relaxant, and anticonvulsant effects.
😄🤭😚 Solution: 1 mg/ml
😄🤭😚 Tablets (extended-release): 0.5 mg, 1 mg, 2 mg, 3 mg
😄🤭😚 Tablets (immediate-release): 0.25 mg, 0.5 mg, 1 mg, 2 mg
😄🤭😚 Tablets (orally disintegrating): 0.25 mg, 0.5 mg, 1 mg, 2 mg
Indications and dosages
😄🤭😚 ➣ Anxiety disorders
😄🤭😚 Adults: Initially, 0.25 to 0.5 mg P.O. t.i.d. Maximum dosage is 4 mg daily in divided doses.
😄🤭😚 Elderly patients: Initially, 0.25 mg P.O. two or three times daily. Maximum dosage is 4 mg daily in divided doses.
😄🤭😚 ➣ Panic disorders
😄🤭😚 Adults:Immediate-release or orally disintegrating tablets-Initially, 0.5 mg P.O. t.i.d. Extended-release tablets-Initially, 0.5 to 1 mg P.O. daily. Usual dosage is 3 to 6 mg daily, with a maximum dosage of 10 mg daily. For all dosage forms, increase by a maximum of 1 mg daily at intervals of 3 to 4 days, with a maximum of 10 mg daily in divided doses.
😄🤭😚 • Hepatic impairment
😄🤭😚 • Agoraphobia
😄🤭😚 • Depression
😄🤭😚 • Premenstrual syndrome
😄🤭😚 • Hypersensitivity to benzodiazepines
😄🤭😚 • Narrow-angle glaucoma
😄🤭😚 • Labor and delivery
😄🤭😚 • Pregnancy or breastfeeding
😄🤭😚 Use cautiously in:
😄🤭😚 • hepatic dysfunction
😄🤭😚 • history of attempted suicide or drug dependence
😄🤭😚 • elderly patients.
😄🤭😚 • Don't give with grapefruit juice.
😄🤭😚 • Make sure patient swallows extended-release tablets whole without chewing or crushing.
😄🤭😚 • Mix oral solution with liquids or semisolid foods and instruct patient to consume entire amount immediately.
😄🤭😚 • Administer orally disintegrating tablets by placing tablet on patient's tongue. If only one-half of scored tablet is used, discard unused portion immediately.
😄🤭😚 ☞ Don't withdraw drug suddenly. Seizures and other withdrawal symptoms may occur unless dosage is tapered carefully.
😄🤭😚 CNS: dizziness, drowsiness, depression, fatigue, light-headedness, disorientation, anger, hostility, euphoria, hypomanic episodes, restlessness, confusion, crying, delirium, headache, stupor, rigidity, tremor, paresthesia, vivid dreams, extrapyramidal symptoms
😄🤭😚 CV: bradycardia, tachycardia, hypertension, hypotension, palpitations, CV collapse
😄🤭😚 EENT: blurred or double vision, nystagmus, nasal congestion
😄🤭😚 GI: gastric disorders, dysphagia, anorexia, increased salivation, dry mouth
😄🤭😚 GU: menstrual irregularities, urinary retention, urinary incontinence, libido changes, gynecomastia
😄🤭😚 Hematologic: blood dyscrasias such as eosinophilia, agranulocytosis, leukopenia, and thrombocytopenia
😄🤭😚 Hepatic: hepatic dysfunction (including hepatitis)
😄🤭😚 Musculoskeletal: muscle rigidity, joint pain
😄🤭😚 Skin: dermatitis, rash, pruritus, urticaria, increased sweating
😄🤭😚 Other: weight loss or gain, hiccups, fever, edema, psychological drug dependence, drug tolerance
😄🤭😚 Drug-drug.Antidepressants, antihistamines, opioids, other benzodiazepines: increased CNS depression
😄🤭😚 Barbiturates, rifampin: increased metabolism and decreased efficacy of alprazolam
😄🤭😚 Cimetidine, disulfiram, erythromycin, fluoxetine, hormonal contraceptives, isoniazid, ketoconazole, metoprolol, propoxyphene, propranolol, valproic acid: decreased metabolism and increased action of alprazolam
😄🤭😚 Digoxin: increased risk of digoxin toxicity
😄🤭😚 Levodopa: decreased antiparkinsonian effect
😄🤭😚 Theophylline: increased sedative effect
😄🤭😚 Tricyclic antidepressants (TCAs): increased TCA blood levels
😄🤭😚 Drug-diagnostic tests.Itraconazole, ketoconazole: increased alprazolam plasma level
😄🤭😚 Drug-food.Grapefruit juice: decreased drug metabolism and increased blood level
😄🤭😚 Drug-herbs.Chamomile, hops, kava, skullcap, valerian: increased CNS depression
😄🤭😚 Drug-behaviors.Alcohol use: increased CNS depression
😄🤭😚 Smoking: decreased alprazolam efficacy
😄🤭😚 • Watch for excessive CNS depression if patient is concurrently taking antidepressants, other benzodiazepines, antihistamines, or opioids.
😄🤭😚 • If patient is taking TCAs concurrently, watch for increase in adverse TCA effects.
😄🤭😚 • Monitor CBC and liver and kidney function test results.
😄🤭😚 • Monitor vital signs and weight.
😄🤭😚 • Report signs of drug abuse, including frequent requests for early refills.
😄🤭😚 • Instruct patient to swallow extended- release tablets whole without crushing or chewing.
😄🤭😚 ☞ Tell patient that drug may make him more depressed, angry, or hostile. Urge him to contact prescriber immediately if he thinks he's dangerous to himself or others.
😄🤭😚 • Inform patient that drug may cause tremors, muscle rigidity, and other movement problems. Advise him to report these effects to prescriber.
😄🤭😚 ☞ Caution patient not to stop taking drug suddenly. Withdrawal symptoms, including seizures, may occur unless drug is tapered carefully.
😄🤭😚 • Advise patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
😄🤭😚 • As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.