Class: Benzodiazepine, Short or Intermediate. C-IV
Dosage Forms. Tablet: 0.25 mg, 0.5 mg, 1 mg, 2 mg; Tablet, Disintegrating: 0.25 mg, 0.5 mg, 1 mg, 2 mg; Tablet, Extended Release: 0.5 mg, 1 mg, 2 mg, 3 mg; Solution: 1 mg/mL
Common FDA Label Indication, Dosing, and Titration.
1. Anxiety: immediate-release or orally disintegrating tablet, 0.25-0.5 mg po tid; max daily dose, 4 mg in divided doses
2. Panic disorder, with or without agoraphobia: immediate-release or orally disintegrating tablets, 0.5 mg po tid, extended-release 3-6 mg po daily
1. Alcohol withdrawal syndrome: 0.5-1 mg po bid × 7-10 d
MOA. Enhances the postsynaptic effect of the inhibitory neurotransmitter, γ-aminobutyric acid (GABA).
Drug Characteristics: Alprazolam
Medication Safety Issues: Alprazolam
Drug Interactions: Alprazolam
Adverse Reactions: Alprazolam
Efficacy Monitoring Parameters. Reduction of anxiety symptoms.
Toxicity Monitoring Parameters. Seek medical attention if severe drowsiness, slow or rapid heartbeat or skipped beats, thoughts of suicide.
Key Patient Counseling Points. May cause drowsiness; avoid driving or other tasks requiring motor coordination. Do not crush or break extended release product. Oral disintegrating tablet may be divided, but are unstable after breaking. If only 1/2 tablet taken, discard the other half. Allow oral disintegrating tablet to dissolve on your tongue. Avoid alcohol.
Clinical Pearls. Not for use in children. Consider reduced dose of benzodiazepines in hepatic impairment. Avoid use in elderly, appear more sensitive to the effects. Use CNS depressants with caution, may have additive effects. Avoid abrupt discontinuation after chronic use, may cause seizures.