Actions and Spectrum: 

alprazolam has a broad spectrum of activity and is effective in treating a variety of conditions, including: 

• Anxiety disorders: alprazolam is commonly used to treat generalized anxiety disorder, panic disorder, and social anxiety disorder. 
• Insomnia: alprazolam may be used to treat insomnia or other sleep disorders, although it is not recommended for long-term use. 
• Seizure disorders: alprazolam may be used as an adjunctive treatment for some types of seizures. 
• Muscle spasms: alprazolam may be used to treat muscle spasms and stiffness. 

The onset of action for alprazolam is rapid, with effects typically felt within 15-30 minutes of administration. The duration of action is relatively short, typically lasting 4-6 hours. 

DRUG INTERACTION

Contraindicated  

Serious Use Alternative  

Monitor Closely  

Minor  

1-10% 

Drowsiness  

Depression  

Headache  

Constipation  

Diarrhea  

Dry mouth  

Increased salivation  

Talkativeness  

Incontinence

Black Box Warning  

The black box warning for alprazolam states that: 

• Concomitant use of benzodiazepines, including alprazolam, and opioids may result in profound sedation, respiratory depression, coma, and death. 
• Alprazolam is a Schedule IV controlled substance and can lead to addiction, abuse, and misuse. 
• The use of benzodiazepines, including alprazolam, may lead to withdrawal symptoms such as seizures, anxiety, and insomnia upon discontinuation of the medication. 
• Benzodiazepines, including alprazolam, should be used with caution in patients with a history of substance abuse or addiction. 

Contraindication/Caution: 

• Respiratory depression: alprazolam can cause respiratory depression, especially when used in combination with other central nervous system depressants. 
• Severe hepatic impairment: alprazolam is metabolized by the liver, and patients with severe hepatic impairment may have reduced metabolism and clearance of the drug. 
• Renal impairment: alprazolam is primarily excreted by the kidneys, and patients with renal impairment may have reduced clearance of the drug. 
• Depression or suicidal tendencies: alprazolam can exacerbate depression and increase the risk of suicidal thoughts and behaviors. 
• Substance abuse: alprazolam has a potential for abuse and dependence and should be used with caution in patients with a history of substance abuse. 
• Elderly patients: Elderly patients may be more sensitive to the effects of alprazolam and may experience more pronounced sedation and cognitive impairment. 

Pregnancy consideration:  

Benzodiazepines cross the placenta during gestation and may cause respiratory distress or sedation to the fetus.  

Consult the physician before taking the medication 

Breastfeeding warnings: lactating females should not breastfeed during the treatment. 

Continue breastfeeding after the two half-lives of the last dose. 

Pregnancy category: 

• Category A: Satisfactory and well-controlled studies show no risk to the fetus in the first or later trimester. 
• Category B: There is no affirmation of risk to the fetus found in animal reproduction studies, and there are not enough studies on pregnant women. 
• Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for a product in humans; Pregnant women must take care of the potential risks. 
• Category D: There is adequate data available with sufficient evidence of human fetal risk from various platforms. However, despite potential dangers may be used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh risks over benefits. The drug is not for pregnant women. 
• Category N: No data is available for the drug under this category. 

Pharmacology: 

• alprazolam is a benzodiazepine medication that acts on the central nervous system by enhancing the activity of the neurotransmitter gamma-aminobutyric acid (GABA). GABA is an inhibitory neurotransmitter that slows down the activity of nerve cells in the brain, leading to a calming effect. 
• alprazolam binds to specific benzodiazepine receptors located on the GABA receptor complex, leading to an increase in GABA activity. This leads to a decrease in anxiety, muscle relaxation, and sedation. 
• alprazolam has a rapid onset of action, with effects typically felt within 15-30 minutes of administration. The duration of action is relatively short, typically lasting 4-6 hours. The drug is metabolized in the liver by cytochrome P450 enzymes, primarily CYP3A4, and is excreted primarily in the urine. 
• alprazolam is available in oral tablet formulations in doses ranging from 0.25 mg to 2 mg. The drug has a high potential for abuse and dependence, and its use should be limited to the shortest duration possible and at the lowest effective dose.
• Withdrawal symptoms can occur upon abrupt discontinuation of the medication, and patients should be gradually tapered off the drug under the guidance of a healthcare provider. 

Administration: 

alprazolam is usually administered orally, in tablet form, with or without food. The dosage and duration of treatment depend on the patient’s medical condition, age, and response to treatment. The usual starting dose for anxiety disorders is 0.25-0.5 mg administered orally 3 times a day, with gradual dose increases as needed and tolerated up to a maximum daily dose of 4 mg.

The usual starting dose for panic disorder is 0.5 mg administered orally 3 times a day, with gradual dose increases as needed and tolerated up to a maximum daily dose of 10 mg. Elderly patients, patients with hepatic or renal impairment, and patients with other medical conditions may require lower doses of alprazolam. alprazolam should only be used for the shortest duration possible and at the lowest effective dose.

Abrupt discontinuation of the medication can lead to withdrawal symptoms, and the dose should be gradually tapered off under the guidance of a healthcare provider. alprazolam has a potential for abuse and dependence, and its use should be carefully monitored. Patients should not take more than the prescribed dose and should not share their medication with others. 

Patient information leaflet 

Generic Name: alprazolam 

Pronounced: al-prah-zoh-laam 

Why do we use alprazolam? 

alprazolam is primarily used to treat anxiety disorders, including generalized anxiety disorder (GAD) and panic disorder. It is also sometimes used to treat other conditions, such as insomnia and depression. 

Anxiety disorders are characterized by excessive and persistent feelings of fear, worry, and tension that interfere with daily activities. alprazolam can help to reduce these symptoms by enhancing the activity of the neurotransmitter GABA in the brain, leading to a calming effect and a reduction in anxiety. 

Panic disorder is a type of anxiety disorder characterized by recurrent and unexpected panic attacks. alprazolam can help to reduce the frequency and severity of panic attacks, as well as the associated symptoms such as palpitations, sweating, and trembling.