Drug monograph

Alprazolam Generic name: Alprazolam Brand names: Xanax Pharmacological category: Benzodiazepines Indications/uses: Treatment of anxiety disorder (GAD); panic disorder, with or without agoraphobia; anxiety associated with depression Mechanism of action: Binds to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron at several sites within the central nervous system, including the limbic system, reticular formation. Enhancement of the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions. This shift in chloride ions results in hyperpolarization (a less excitable state) and stabilization Adverse reactions: Central nervous system: Drowsiness, fatigue, ataxia, lightheadedness, memory impairment, dysarthria, irritability, Confusion, dizziness, disinhibition, akathisia, increased libido Dermatologic: Rash, Dermatitis Endocrine & metabolic: Decreased libido, menstrual disorders Cardiovascular: Hypotension Gastrointestinal: Increased salivation Xerostomia, decreased salivation, increased or decreased appetite, weight gain or loss Genitourinary: Micturition difficulties, Sexual dysfunction, incontinence Neuromuscular & skeletal: Rigidity, tremor, muscle cramps Otic: Tinnitus Respiratory: Nasal congestion

Warnings/precautions: Use caution in patients with depression, Rebound or withdrawal symptoms, including seizures may occur Dose reductions or tapering must be approached with extreme caution. Between dose, anxiety may also occur Use with caution in patients receiving concurrent CYP3A4 inhibitors, Benzodiazepines have been associated with anterograde amnesia. Paradoxical reactions, including hyperactive or aggressive behavior, have been reported with benzodiazepines, particularly in adolescent/pediatric or psychiatric patients. Does not have analgesic, antidepressant, or antipsychotic properties. Pregnancy category: D Contraindications: Hypersensitivity to this drug or any component of its formulation (cross-sensitivity with other benzodiazepines may exist); narrow angle glaucoma; concurrent use of ketoconazole and itraconazole; pregnancy Dose: Adult: Anxiety: 0.5-4 mg/day in divided dose Reference: lexi-comp Drug Guide