alprazolam/propranolol

Action and Spectrum

Actions and Spectrum: 

Action: 

alprazolam 

alprazolam is a medication primarily classified as a benzodiazepine. Its primary function is to amplify the influence of gamma-aminobutyric acid (GABA), a neurotransmitter in the brain to restrain excessive brain activity. alprazolam increases GABA’s inhibitory effects, leading to a calming and sedative effect on the central nervous system. This makes it useful for the management of anxiety and panic disorders. 

propranolol 

propranolol is a beta-blocker medication that primarily works by blocking the effects of adrenaline (epinephrine) on beta-adrenergic receptors. Doing so reduces the heart rate, blood pressure, and force of heart contractions. 

Spectrum: 

alprazolam 

alprazolam finds its primary application in the management of anxiety disorders and panic disorders. Additionally, it is occasionally employed as a supplementary treatment for depression or certain sleep-related conditions. It is not typically prescribed for other medical conditions because of its potential for dependence and withdrawal symptoms when used long-term.  

propranolol 

Hypertension: It is commonly prescribed to lower high blood pressure. 

Angina Pectoris: propranolol can relieve the chest pain associated with angina. 

Drug Interaction

Adverse Reaction

Frequency not defined  

Slow heart rate 

Tiredness 

Drowsiness 

Cold extremities 

Confusion 

Memory impairment 

Black Box Warning

Black Box Warning:  

None

Contraindication / Caution

Contraindication/Caution:  

Severe respiratory issues: The combination may further depress respiration, so it should be avoided in individuals with severe respiratory problems. 

Bradycardia or heart block: The combination can slow the heart rate, so it should be used cautiously in individuals with pre-existing heart conditions. 

Hypotension: The combination may lead to dangerously low blood pressure, especially in individuals prone to hypotension. 

Hypersensitivity: Do not take this combination medication if you are allergic to the medication or any of its ingredients. 

Pregnancy and Breastfeeding: This combination of medications is typically discouraged during pregnancy, particularly in the initial trimester, as it could elevate the likelihood of congenital abnormalities. 

Pregnancy / Lactation

Pregnancy warnings:     

Pregnancy category: N/A 

Lactation: Excreted into human milk is unknown 

Pregnancy Categories:         

Category A: Studies that were well-controlled and met expectations revealed no risk to the fetus in either the first or second trimester. 

Category B: There were a lack of studies on pregnant women and no evidence of risk to the fetus in animal experiments.   

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.   

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category

Pharmacology

Pharmacology:  

alprazolam belongs to the class of drugs known as benzodiazepines; propranolol is a beta-blocker. 

Pharmacodynamics:  

alprazolam 

alprazolam functions by increasing the influence of a neurotransmitter GABA within the brain. GABA, an inhibitory neurotransmitter, diminishes the activity of nerve cells, ultimately resulting in a soothing and sedative outcome. alprazolam attaches itself to distinct receptors in the brain, specifically the GABA-A receptors, thereby augmenting the inhibitory impact of GABA. 

propranolol 

propranolol functions by inhibiting the actions of adrenaline (also known as epinephrine) and various stress-related hormones on the beta-adrenergic receptors within the body. Doing so reduces heart rate, blood pressure, and the force of heart contractions, making it particularly useful in managing cardiovascular conditions and reducing anxiety symptoms. 

Pharmacokinetics: 

Absorption 

alprazolam is well-absorbed after oral administration. 

propranolol is well-absorbed after oral administration. 

Distribution 

alprazolam is distributed throughout the body, including the brain, due to its lipophilic nature. 

propranolol is distributed throughout the body, including the heart and central nervous system. 

Metabolism 

alprazolam undergoes hepatic metabolism, primarily by the enzyme CYP3A4, forming active metabolites. 

propranolol undergoes hepatic metabolism, primarily by the enzyme CYP2D6. 

Excretion and Elimination 

alprazolam and its metabolites are eliminated primarily through the kidneys. 

propranolol is eliminated through the kidneys. 

Adminstartion

Administration:  

The route of administration is oral. A healthcare provider may adjust the dosing based on the patient’s response and tolerance. 

The combination should be taken exactly as prescribed by a healthcare professional. It’s important not to exceed or use the recommended dosage longer than prescribed. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: alprazolam/propranolol 

Why do we use alprazolam/propranolol?  

The combination is effective in treating different types of anxiety disorders. alprazolam and propranolol are often prescribed together to relieve the anxiety symptoms and physiological manifestations of anxiety, including tremors, palpitations, and perspiration.  

The combination is effective in panic disorder. 

propranolol may be recommended with alprazolam to alleviate the physical manifestations of panic attacks, including heightened heart rate and tremors.