alprazolam

(al prah' zoe lam)

Apo-Alpraz (CAN), Novo-Alprazol (CAN), Nu-Alpraz (CAN), Xanax, Xanax TS
(CAN), Xanax XR

Pregnancy Category D
Controlled Substance C-IV

Drug classes
Benzodiazepine
Antianxiety drug

Therapeutic actions
Exact mechanisms of action not understood; main sites of action may be the limbic
system and reticular formation; increases the effects of gamma-aminobutyrate, an
inhibitory neurotransmitter; anxiety blocking effects occur at doses well below those
necessary to cause sedation, ataxia.

Indications
• Management of anxiety disorders, short-term relief of symptoms of anxiety;
anxiety associated with depression.
• Treatment of panic attacks with or without agoraphobia
• Unlabeled uses: Social phobia, premenstrual syndrome, depression

Contraindications and cautions

• Contraindicated with hypersensitivity to benzodiazepines, psychoses, acute
narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with
depression of vital signs, pregnancy (crosses the placenta; risk of congenital
malformations, neonatal withdrawal syndrome), labor and delivery ("floppy
infant" syndrome), lactation (secreted in breast milk; infants become lethargic and
lose weight).
• Use cautiously with impaired liver or kidney function, debilitation.

Available forms
Tablets—0.25, 0.5, 1, 2 mg; XR tablets—0.5, 1, 2, 3 mg; oral solution—0.5 mg/5 mL;
intensol solution—1 mg/mL

Dosages
Individualize dosage; increase dosage gradually to avoid adverse effects.
ADULTS
• Anxiety disorders: Initially, 0.25–0.5 mg PO tid; adjust to maximum daily dose of
4 mg/day in divided doses or extended-release form once per day in the AM once
dosage is established.
• Panic disorder: Initially, 0.5 mg PO tid; increase dose at 3- to 4-day intervals in
increments of no more than 1 mg/day; ranges of 1–10 mg/day have been needed;
extended-release form once per day in AM once dosage is established.
 • Social phobia: 2–8 mg/day PO.
• Premenstrual syndrome: 0.25 mg PO tid.
GERIATRIC PATIENTS OR PATIENTS WITH DEBILITATING DISEASE
Initially, 0.25 mg bid–tid PO; gradually increase if needed and tolerated.

Pharmacokinetics
Route Onset Peak Duration
Oral 30 min 1–2 hr 4–6 hr

Metabolism: Hepatic; T1/2: 6.3–26.9 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy,
fatigue, light-headedness, disorientation, anger, hostility, episodes of mania and
hypomania, restlessness, confusion, crying, delirium, headache, slurred speech,
dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness,
difficulty in concentration, vivid dreams, psychomotor retardation, extrapyramidal
symptoms; mild paradoxical excitatory reactions during first 2 weeks of
treatment
• CV: Bradycardia, tachycardia, cardiovascular collapse, hypertension,
hypotension, palpitations, edema
• Dermatologic: Urticaria, pruritus, rash, dermatitis
• EENT: Visual and auditory disturbances, diplopia, nystagmus, depressed hearing,
nasal congestion
• GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting,
difficulty in swallowing, gastric disorders, hepatic dysfunction
• GU: Incontinence, urinary retention, changes in libido, menstrual irregularities
• Hematologic: Elevations of blood enzymes—LDH, alkaline phosphatase, AST,
ALT; blood dyscrasias—agranulocytosis, leukopenia
• Other: Hiccups, fever, diaphoresis, paresthesias, muscular disturbances,
gynecomastia; drug dependence with withdrawal syndrome when drug is
discontinued; more common with abrupt discontinuation of higher dosage used
for longer than 4 mo

Interactions
Drug-drug
• Increased CNS depression with alcohol, other CNS depressants, propoxyphene
• Increased effect with cimetidine, disulfiram, omeprazole, isoniazid, hormonal
contraceptives, valproic acid
• Decreased effect with carbamazepine, rifampin, theophylline
• Possible increased risk of digitalis toxicity with digoxin
• Decreased antiparkinson effectiveness of levodopa with benzodiazepines
• Contraindicated with ketoconazole, itraconazole; serious toxicity can occur
Drug-food
• Decreased metabolism and risk of toxic effects if combined with grapefruit juice;
avoid this combination.
Drug-alternative therapy
• Risk of coma if combined with kava therapy
• Additive sedative effects with valerian root

Nursing considerations
CLINICAL ALERT!
Name confusion has occurred among Xanax (alprazolam), Celexa
(citalopram), and Cerebyx (fosphenytoin), and between alprazolam and
lorazepam; use caution.

Assessment
• History: Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle
glaucoma; shock; coma; acute alcoholic intoxication with depression of vital
signs; labor and delivery; lactation; impaired liver or kidney function; debilitation
• Physical: Skin color, lesions; T; orientation, reflexes, affect, ophthalmologic
exam; P, BP; liver evaluation, abdominal exam, bowel sounds, normal output;
CBC, liver and renal function tests

Interventions
• Arrange to taper dosage gradually after long-term therapy, especially in epileptic
patients.

Teaching points
• Take this drug exactly as prescribed; take extended-release form once daily in the
AM.
• Do not drink grapefruit juice while on this drug.
• Do not stop taking drug (long-term therapy) without consulting health care
provider.
• Avoid alcohol, sleep-inducing, or over-the-counter drugs.
• These side effects may occur: Drowsiness, dizziness (less pronounced after a few
days, avoid driving a car or engaging in other dangerous activities if these occur);
GI upset (take drug with food); fatigue; depression; dreams; crying; nervousness.
• Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions,
difficulty voiding, palpitations, swelling in the extremities.

Adverse effects in Italic are most common; those in Bold are life-threatening.