Alprazolam

Introduction

Alprazolam is a commonly prescribed benzodiazepine that is used to treat a variety of anxiety and panic disorder related conditions. It is also used for treatment of insomnia and irritability. Alprazolam works by calming the brain and nerves, resulting in a feeling of relaxation.

Uses

Alprazolam is used to treat a variety of anxiety and panic disorder related conditions including: Generalized Anxiety Disorder (GAD), Panic Disorder, Social Anxiety Disorder, Post-Traumatic Stress Disorder, and Acute Stress or Severe Depression.

Brand Name	Alprazolam
Type
Weight
Generic	Alprazolam
Manufacturer
Available in	English বাংলা

Mechanism of Action

Alprazolam works by increasing the level of the inhibitory neurotransmitter GABA in the brain. This results in a calming effect on the central nervous system, helping to reduce symptoms of anxiety and panic. Alprazolam also binds to a receptor in the brain called the GABA-A receptor, which increases the effects of GABA and causes sedation.

How Long Does It Take to Work?

Depending on the dose and individual response, Alprazolam typically begins to take effect within 45 minutes to 1 hour. Peak effects are achieved with 2-3 hours. The effects of Alprazolam can last between 4-6 hours and may persist for up to 12 hours after a single dose.

Absorption

Alprazolam is rapidly and completely absorbed from the gastrointestinal tract after oral administration. Peak plasma concentrations of Alprazolam are achieved within 1-2 hours.

Route of Elimination

Alprazolam is excreted in both urine and feces. Approximately 60% of the drug is excreted in the urine and the remainder in the feces.

Dosage

Treatment should be initiated with a dose of 0.25 to 0.5 mg three times daily. Depending on the response, dose may be increased at intervals of 3 to 4 days in increments of no more than 1 mg/day. The maximum dose should not exceed 4 mg/day. Occasional patients with panic disorder may need as much as 10 mg a day to achieve a successful response and in these cases periodic reassessment and consideration of dosage adjustment is required.

Dosage should be individualized for maximum beneficial effect with the lowest possible dose. If side-effects occur at starting dose, dose may be lowered. When discontinuing therapy, dosage should be reduced gradually by no more than 0.5 mg every three days.

In elderly patients or in patients with advanced liver disease, the usual starting dose is 0.25 mg, two or three times daily and may be gradually increased if needed and tolerated.

Alprazolam 1 mg should be administered once daily, preferably in the morning by patients who are on multiple dosage regimens of Alprazolam 0.25/0.5 mg. The tablets should be taken intact, they should not be chewed, crushed, or broken.

Alprazolam is available in oral tablet, immediate-release oral tablet, extended-release oral tablet , orally disintegrating tablet, and oral solution forms. The recommended initial dosage of Alprazolam for anxiety in adults is 0.25-0.5mg (0.25mg is the minimum effective dose) taken 3 times daily. The dose can be increased in 0.25-0.5mg increments every three days, up until the maximum dose of 4mg per day in divided doses. Higher doses may be needed for panic disorder.

Administration

Alprazolam should be taken with a full glass of water and may be taken with or without food. It can be taken with doses of other medicines if prescribed, however, Alprazolam should not be taken with alcohol or products containing alcohol. Alprazolam should be taken exactly as prescribed by the doctor; it should not be taken in larger or smaller doses than prescribed.

Side Effects

Common side effects of Alprazolam include: drowsiness, tiredness, confusion, memory problems, coordination problems, headaches, slurred speech, nausea, changes in appetite, and diarrhea. In more serious cases, severe injection site reactions, decreased libido, decreased energy levels, tremor, irritability, suicidal thoughts or behavior, and seizures have been reported.

Toxicity

Chronic use of Alprazolam can lead to tolerance, dependence, and addiction. Alprazolam should not be used for more than 4 weeks without consulting the doctor. Long-term use of Alprazolam can lead to physical and psychological dependence, and a withdrawal syndrome if stopped abruptly. High doses or long-term use can be both dangerous and potentially fatal.

Precaution

Alprazolam should be used with caution in patients with a known sensitivity to other benzodiazepines, as well as those taking other CNS depressants, opioids, antipsychotics, antihistamines and antidepressants. Alprazolam should not be used in patients with narrow-angle glaucoma, acute myeloid leukemia, or in pregnant women unless absolutely necessary.

Interactions

Alprazolam may interact with other medications such as sedatives, hypnotics, antidepressants, anti-opioid medications, drugs used to treat high blood pressure, opioid pain medications, and antifungal and antiviral drugs. Alprazolam should not be used with alcohol or drugs that contain alcohol.

Disease Interactions

Alprazolam should be used with caution in patients with a history of narrow-angle glaucoma, acute myeloid leukemia, liver or kidney disease, depression, suicidal thoughts, and alcohol or drug abuse. Alprazolam may make existing medical conditions worse so caution should be used in those with a history of heart disease, lung disease, sleep apnea, glaucoma, or breathing problems.

Drug Interactions

Food Interactions

Alprazolam should be taken with food if it causes stomach upset or nausea. It may interact with grapefruit and grapefruit juice, which may increase the drug's level in the body. Alprazolam should also be avoided or taken with extreme caution with alcohol, as it can increase the level of effects and drowsiness.

Pregnancy Use

Alprazolam should be used with caution in pregnant women, as there is a potential risk of birth defects and other fetal harm. Breastfeeding mothers should also be cautious when using Alprazolam ; the drug is detectable in breastmilk and can cause side effects in the nursing infant.

Lactation Use

Alprazolam is detectable in breastmilk and can cause adverse effects in nursing infants. Therefore, breastfeeding mothers should either avoid taking Alprazolam or monitor their infant for any unusual signs.

Acute Overdose

An overdose of Alprazolam can cause extreme drowsiness, breathing problems, confusion, coma, and death. Emergency medical treatment is necessary if an overdose is suspected.

Contraindications

Alprazolam should not be taken by patients with a known allergy to benzodiazepines or who are taking other CNS depressants, opioids, antipsychotics, antihistamines or antidepressants. Alprazolam should also not be taken in patients with narrow-angle glaucoma, acute myeloid leukemia, or in pregnant women unless absolutely necessary.

Use Directions

Alprazolam should always be taken as directed by the doctor. It should be taken with a full glass of water, with or without food. To reduce the risk of adverse reactions, the suggested initial dosage should not be exceeded. It is important to take the prescribed dose exactly and not increase the dosage or frequency of dosing without consulting a doctor.

Storage Conditions

Alprazolam should be stored at room temperature in a tightly closed container away from light and moisture. It should be kept out of reach of children.

Volume of Distribution

Alprazolam has a volume of distribution of 0.71 L/kg. This means that, on average, 0.71 liters of Alprazolam is distributed throughout the body.

Half Life

The half-life of Alprazolam is 12 hours. This means that, on average, only half of the drug will be eliminated from the system after 12 hours.

Clearance

The elimination half-life of Alprazolam is 0.47-12 hours. This means that, on average, it takes 0.47-12 hours for the body to clear half of the drug from the system.

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