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alprazolam

N05BA12

Forms & Strengths

Tablet: 0.25 mg, 0.5 mg, 1 mg, 2 mg
Tablet, extended-release (XR): 0.5 mg, 1 mg, 2 mg, 3 mg
Oral concentrate: 1 mg/mL
Orally disintegrating tablet (ODT): 0.25 mg, 0.5 mg, 1 mg, 2 mg

Adult Dosing

Anxiety: 0.25 mg to 0.5 mg PO TID; titrate to max 4 mg/day in divided doses
Panic disorder: 0.5 mg PO TID; titrate gradually (max 1 mg/day increase every 3-4 days); typical dose 1-10 mg/day (immediate-release) or max 6-10 mg/day (extended-release)
Geriatric/Debilitated: 0.25 mg PO BID to TID

Pediatric Dosing

Safety and efficacy not established in patients under 18 years of age

Indications

Management of generalized anxiety disorder (GAD)
Panic disorder with or without agoraphobia
Short-term relief of anxiety symptoms

Mechanism of Action

Binds to GABA-A receptors in the central nervous system
Enhances the inhibitory effects of gamma-aminobutyric acid (GABA)
Increases chloride ion conductance, resulting in neuronal hyperpolarization, reducing CNS excitability

Contraindications

Hypersensitivity to alprazolam or other benzodiazepines
Concomitant use with strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole)
Acute narrow-angle glaucoma

Adverse Reactions

Drowsiness, sedation, fatigue
Lightheadedness, dizziness, impaired coordination
Memory impairment, cognitive dysfunction
Dry mouth, constipation, increased appetite
Dependence, withdrawal symptoms, and rebound anxiety upon discontinuation

Drug Interactions

CNS depressants (opioids, alcohol, other sedatives): increase risk of severe sedation, respiratory depression, and death
CYP3A4 inhibitors (ketoconazole, fluconazole, erythromycin): significantly increase alprazolam plasma concentrations and toxicity
CYP3A4 inducers (rifampin, carbamazepine): decrease alprazolam efficacy
Opioids: FDA boxed warning regarding profound sedation, respiratory depression, coma, and death with concomitant use

Curated Content: Needs Vetting Before Put to Clinical Use