Alprazolam

DEA Class;  Rx

Common Brand Names; Xanax, Niravam, Xanax XR

Documented hypersensitivity

Acute narrow angle glaucoma

Concomitant use with CYP3A4 inhibitors (itraconazole, ketoconazole)

>10% (4 mg dose)

• Drowsiness (41%)
• Depression (10-15%)
• Headache (10-15%)
• Constipation (10-15%)
• Diarrhea (10-15%)
• Dry mouth (10-15%)

>10% (10 mg dose)

• Drowsiness (77%)
• Impaired coordination (40-50%)
• Increased appetite (30-35%)
• Fatigue (30-35%)
• Memory impairment (30-35%)
• Irritability (30-35%)
• Decreased salivation (30-35%)
• Cognitive disorders (20-30%)
• Insomnia (20-30%)
• Dcreased appetite (20-30%)
• Headache (20-30%)
• Lightheadedness (20-30%)
• Dysarthria (20-30%)
• Diarrhea, constipation, and nausea/vomiting (20-30%)
• Weight change (20-30%)
• Nasal congestion (15-20%)
• Decreased or increased libido (10-15%)
• Menstrual disorder (10-15%)
• Difficult micturition (10-15%)

1-10% (4 mg dose)

• Tachycardia (5-10%)
• Confusion (5-10%)
• Insomnia (5-10%)
• Nausea/vomiting (5-10%)
• Blurred vision (5-10%)
• Nasal congestion (5-10%)
• Hypotension (1-5%)
• Syncope (1-5%)
• Akathisia (1-5%)
• Dizziness (1-5%)
• Increased salivation (1-5%)
• Nervousness (1-5%)
• Tremor (1-5%)
• Weight change (1-5%)

1-10% (10 mg dose)

• Increased salivation (5-10%)
• Talkativeness (1-5%)
• Incontinence (1-5%)

Anterograde amnesia reported with benzodiazepine use

Use caution in elderly patients

Use caution in debilitated patients

Use caution in severe respiratory depression; if signs and symptoms of respiratory depression, hypoventilation, or apnea occur, discontinue

Use caution in patients who recently received other respiratory depressants

Use caution in patients who are at risk of falls

May have prolonged effects in obese patients when discontinued; use caution

Not for us in acute alcohol intoxication

Use with caution in patients with hepatic or renal impairment

Myasthenia gravis (allowable in limited circumstances)

Use caution in cases of respiratory disease (COPD), sleep apnea, renal/hepatic disease, open-angle glaucoma (questionable), depression, suicide ideation, drug abuse

CNS depressant; may impair ability to perform hazardous tasks

Paradoxical reactions, including hyperactive or aggressive behavior reported

Cigarette smoking may decrease alprazolam concentration up to 50%

Mania and hypomania episodes reported in depressed patients

There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to drug during pregnancy

Limited data from published literature reports the presence of the drug in human breast milk; there are reports of sedation and withdrawal symptoms in breastfed neonates and infants exposed to alprazolam; effects of alprazolam on lactation are unknown