Alprazolam

1. Introduction

Alprazolam is a short-acting benzodiazepine used for the treatment of anxiety disorders, panic disorder, and insomnia. It works by enhancing gamma-aminobutyric acid (GABA) activity, which has a calming effect on the brain.

2. Indications

  • Generalised Anxiety Disorder (GAD)
  • Panic Disorder (With or Without Agoraphobia)
  • Short-Term Treatment of Insomnia (Off-Label Use)
  • Adjunct in Depression & Anxiety-Related Symptoms

3. Dosage

Adults:

  • Generalised Anxiety Disorder (GAD):
    • Initial dose: 0.25–0.5 mg three times daily
    • Maintenance dose: 1–4 mg/day (divided doses)
    • Max dose: 4 mg/day
  • Panic Disorder:
    • Initial dose: 0.5 mg three times daily
    • Maintenance dose: 1–10 mg/day
    • Max dose: 10 mg/day
  • Insomnia (Short-Term, Off-Label):
    • 0.25–0.5 mg at bedtime

Elderly (>65 years) or Debilitated Patients:

  • Start with 0.25 mg twice daily
  • Max dose: 2 mg/day

Renal Impairment:

  • No major dose adjustment required, but start at lower doses.

Hepatic Impairment:

  • Use lower doses (max 2 mg/day) due to risk of sedation and accumulation.

4. Administration

  • Take with or without food.
  • Do not crush or chew extended-release tablets.
  • Take at the same times daily to maintain steady levels.

5. Forms Available

  • Immediate-Release Tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg
  • Extended-Release (XR) Tablets: 0.5 mg, 1 mg, 2 mg, 3 mg
  • Oral Disintegrating Tablets (ODT): 0.5 mg, 1 mg, 2 mg
  • Oral Solution: 1 mg/mL

6. Side Effects

6.1 Common Side Effects:

  • Drowsiness
  • Dizziness
  • Memory impairment
  • Dry mouth
  • Fatigue

6.2 Less Common Side Effects:

  • Slurred speech
  • Blurred vision
  • Constipation

6.3 Rare but Serious Side Effects:

  • Respiratory depression (especially in overdose or with other CNS depressants)
  • Paradoxical reactions (e.g., agitation, aggression, hallucinations)
  • Dependence and withdrawal syndrome

7. Warnings

  • Risk of Dependence & Addiction:
    • Use for short-term treatment only (2–4 weeks preferred).
    • Taper gradually if discontinuing to avoid withdrawal symptoms.
  • Withdrawal Symptoms (if stopped suddenly):
    • Seizures
    • Insomnia
    • Anxiety
    • Sweating
    • Tremors
  • Respiratory Depression Risk:
    • Increased with opioids, alcohol, or other CNS depressants.
  • Elderly Patients:
    • Increased fall risk and cognitive impairment.
    • Consider alternative treatments like SSRIs for long-term anxiety management.

8. Precautions

  • Avoid alcohol—increases sedation & overdose risk.
  • Use with caution in depression—may worsen suicidal thoughts.
  • Not recommended for long-term use due to risk of dependence.
  • Avoid in patients with a history of substance abuse.

9. Interactions

  • Opioids (e.g., morphine, oxycodone): Increased risk of fatal respiratory depression.
  • Alcohol: Severe CNS depression, coma risk.
  • CYP3A4 Inhibitors (e.g., ketoconazole, erythromycin, fluoxetine): Increase alprazolam levels—risk of overdose.
  • CYP3A4 Inducers (e.g., rifampin, phenytoin): Decrease effectiveness of alprazolam.
  • Antidepressants (e.g., SSRIs, TCAs): May increase sedation.

10. Monitoring Parameters

  • Mental status and anxiety symptoms (every 4–6 weeks).
  • Signs of dependence or abuse.
  • Respiratory function (especially if using opioids or in elderly patients).

11. Use in Children

  • Not recommended for routine use in children.
  • Rarely used for severe anxiety or panic disorders under specialist supervision.

12. Use in Pregnancy

  • Category D:
    • Not recommended—risk of fetal malformations and withdrawal symptoms in newborns.
    • If used, taper off before delivery to prevent neonatal withdrawal.

13. Use in Elderly

  • Increased sedation, fall risk, and memory impairment.
  • Use lower doses (0.25 mg twice daily) and avoid long-term use.

14. Use in Kidney Disease

  • No major dose adjustments required but use cautiously in severe renal impairment.

15. Use in Liver Disease

  • Start at lower doses (0.25 mg twice daily) due to risk of accumulation and sedation.

16. Patient Counselling Points

  • Take exactly as prescribed—do not increase dose without medical advice.
  • Do not stop suddenly—taper off gradually under medical supervision.
  • Avoid alcohol and other sedatives—increases risk of overdose.
  • Can cause drowsiness—avoid driving or operating machinery.
  • Report mood changes or suicidal thoughts immediately.

17. Table of Brand Names, Manufacturer, and Prices in USD

Brand NameManufacturerStrength/Dosage FormPrice (USD)
XanaxPfizer0.25 mg, 0.5 mg, 1 mg, 2 mg Tablets$60 (30 tabs)
NiravamUCB Pharma0.5 mg, 1 mg, 2 mg ODT$80 (30 tabs)
Generic AlprazolamVarious0.25 mg, 0.5 mg, 1 mg, 2 mg Tablets$30 (30 tabs)

18. 15 FAQs (Frequently Asked Questions)

1. What is Alprazolam used for?
It is used for anxiety, panic disorder, and short-term insomnia treatment.

2. How does Alprazolam work?
It enhances GABA activity, producing a calming effect.

3. How long does it take for Alprazolam to work?
It works within 30–60 minutes, with peak effects in 1–2 hours.

4. How long does Alprazolam stay in the system?
It has a half-life of 12–15 hours, so it stays in the body for up to 24 hours.

5. Can I stop taking Alprazolam suddenly?
No, stopping suddenly can cause withdrawal symptoms—taper off gradually.

6. Is Alprazolam addictive?
Yes, long-term use leads to dependence—it should be used short-term only.

7. Can I take Alprazolam with alcohol?
No, alcohol increases overdose risk and respiratory depression.

8. Can I take Alprazolam with antidepressants?
Yes, but monitor for increased sedation.

9. Does Alprazolam cause weight gain?
No, but weight changes due to appetite changes may occur.

10. Can I drive while taking Alprazolam?
No, it impairs alertness and reaction time.

11. Can I take Alprazolam every day?
Only if prescribed—daily use increases dependence risk.

12. How should Alprazolam be stored?
Store at room temperature, away from moisture.