ALPRAZOLAM

Benzodiazepine medicine.

Dosage Forms

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Tablet

0.5 mg
0.25 mg

Uses

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  • Short-term treatment of anxiety

Dose and Duration

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Anxiety
Adult > 18 years: 0.25–0.5 mg every 8 hours; increase if necessary to maximum 3 mg per day for up to 4 weeks, then review patient, and extend treatment up to a maximum of 8–12 weeks. If longer duration is required, re-evaluate patient and consider risk of dependence
Elderly: 0.25 mg every 8–12 hours increased gradually if required

Contraindications

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  • Known hypersensitivity to benzodiazepines
  • Myasthenia gravis
  • Severe respiratory insufficiency
  • Sleep apnoea syndrome
  • Severe hepatic insufficiency
  • Children < 18 years

Side Effects

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  • Sedation, dizziness, headache, hypersomnia, insomnia, fatigue, irritability, lethargy, memory impairment
  • Confusion, disorientation, anxiety, depression
  • Dysarthria (difficult or unclear articulation of speech)
  • Balance disorder, abnormal coordination, tremor, ataxia
  • Decreased appetite
  • Decreased or increased libido, sexual dysfunction
  • Blurred vision
  • Nausea
  • Skin irritation
  • Weight loss or gain

Interactions

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  • Clozapine (serious adverse events when used concomitantly)
  • Indinavir, ritonavir (plasma concentration of alprazolam possibly increased)

Patient Instructions

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  • Ensure that you have 7–8 hours of uninterrupted sleep after taking alprazolam
  • Do not drive or operate dangerous machinery until you know how this medication affects you

Pregnancy

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  • Do not use (see caution)

Breastfeeding

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  • Do not use (see caution)

⚠️ Caution

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  • Do not withdraw medication abruptly. Reduce doses off gradually i.e. not more than 0.5 mg every 3 days
  • Only use in pregnancy if the clinical condition of the patient requires treatment with alprazolam
  • Give with caution in renal and hepatic impairment. May precipitate coma in hepatic impairment.
  • Do not use alprazolam alone in treatment of depression as it may precipitate or increase risk of suicide
  • Use with caution in patients with a history of alcohol or drug abuse
  • May induce retrograde amnesia; patients should plan to have 7–8 hours of uninterrupted sleep after ingestion
  • Discontinue use if patient develops agitation, irritability, aggressiveness, delusion, rages, nightmares, hallucinations or other adverse psychological effects