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Alprazolam (Xanax) is a benzodiazepine and anxiolytic used for the management of anxiety disorders.

alprazolam (al prah’ zoe lam) Alprazolam Intensol, Apo-Alpraz (CAN), Niravam, Novo-Alprazol (CAN), Nu-Alpraz (CAN), Xanax, Xanax TS (CAN), Xanax XR Pregnancy Category D Controlled Substance C-IV Drug classes  Benzodiazepine  Anxiolytic Therapeutic actions  Exact mechanisms of action not understood; main sites of action may be the limbic system and reticular formation; increases the effects of GABA, 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 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 extendedrelease form once per day in the AM once dosage is established (immediate release, intensol solution).  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 (Xanax products, Niravam). UNLABELED USES  Social phobia: 2–8 mg/day PO.  PMS: 0.25 mg PO tid. 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 wk of treatment  CV: Bradycardia, tachycardia, CV 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 impairment  GU: Incontinence, changes in libido, urinary retention, 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 Contraindications 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. Nursing considerations

decrease by no more than 0. weakness.25-0. avoid driving a car or engaging in other dangerous activities if these occur). depression. and can require higher dosages of alprazolam. acute alcoholic intoxication with depression of vital signs. . Anxiety disorders are characterized by unrealistic worry and apprehension. Tablets (Orally disintegrating): 0.  Carbamazepine (Tegretol. 1 and 2 mg. exaggerated startle responses. and insomnia. Tablets ER (extended release): 0. drowsiness that persists. BP. Assessment  History: Hypersensitivity to benzodiazepines. normal output. CBC. coma. sleep-inducing. liver evaluation. Panic attacks occur either unexpectedly or in certain situations (for example. driving). Xanax XR. sweating. cimetidine (Tagamet). barbiturates. the same family that includes diazepam(Valium).25.nefazodone (Serzone). It is believed that excessive activity in the brain may cause anxiety or other psychiatric disorders. Equetro.  Do not administer with grapefruit juice. The effective dose for preventing panic attacks may be as high as 10 mg daily for some patients. Tegretol XR. Alprazolam and other benzodiazepines act by enhancing the effects of gamma-aminobutyric acid (GABA) in the brain. lightheadedness. trembling.5 mg every 3 days. rash or skin lesions. and narcotics) that suppress activity in the brain by suppressing activity more and causing sedation. crying. GABA is a neurotransmitter (a chemical that nerve cells use to communicate with each other) that inhibits activity in the brain.CLINICAL ALERT!  Name confusion has occurred among Xanax (alprazolam).5 mg 3 to 4 times daily using immediate release tablets. smothering sensation. abdominal examination. acute narrow-angle glaucoma. Teaching points  Take this drug exactly as prescribed.  PRESCRIBED FOR: Alprazolam is used for the treatment of anxiety disorders and panic attacks. itraconazole (Sporanox). difficulty voiding. palpitations.  Report severe dizziness.  DOSING: Alprazolam may be taken with or without food. flurazepam (Dalmane). Doses can be increased every 3-4 days but by no more than 1 mg daily. and fluvoxamine (Luvox) increase concentrations in the blood of alprazolam and therefore may increase the side effects of alprazolam. shortness of breath. The dose may be increased every 3-4 days to a maximum dose of 4 mg daily.  The starting dose for treating panic attacks is 0. T. 15 C to 30 C (59 F to 86 F).  The starting dose for treating anxiety is 0. psychoses. Solution: 1 mg/ml  STORAGE: Alprazolam should be stored at room temperature. renal function tests Interventions  Arrange to taper dosage gradually after long-term therapy.5 mg 3 times daily. The FDA approved alprazolam in October 1981. ophthalmologic examination. lesions. Alprazolam interacts with alcohol and medications (for example. Carbatrol) and rifampin reduce the effect of alprazolam by increasing metabolism and elimination of alprazolam in the liver. fatigue. 1 and 2 mg.  You may experience these side effects: Drowsiness. LFTs. 1. take extended-release form once a day in the morning. 0.5. dizziness (these effects will be less pronounced after a few days. especially in epileptic patients. place rapidly disintegrating tablet on top of tongue. causing symptoms of restlessness.  Avoid alcohol. cold clammy hands. use caution. The starting dose when using extended release tablets to treat panic disorder is 0. and between alprazolam and lorazepam. and Cerebyx (fosphenytoin).25. 0. reflexes. orientation.5. swelling in the extremities. or over-the-counter drugs. bowel sounds.5. clonazepam (Klonopin). 2 and 3 mg. lactation. impaired liver or kidney function. Niravam  DRUG CLASS AND MECHANISM: Alprazolam is an anti-anxiety medication in the benzodiazepine family. shock. Celexa (citalopram). affect. nervousness. GI upset (take drug with food). problems concentrating.  Do not drink grapefruit juice while on this drug. palpitations.5 mg once daily and the average dose is 3-6 mg once daily. flushing. lorazepam (Ativan).  Do not stop taking drug (in long-term therapy) without consulting health care provider.  Taper drug slowly.  DRUG INTERACTIONS: Ketoconazole (Nizoral). labor and delivery.  GENERIC NAME: alprazolam  BRAND NAME: Xanax. drug should not be stopped suddenly. aches. where it will disintegrate and can be swallowed with saliva.  PRESCRIPTION: Yes  GENERIC AVAILABLE: Yes  PREPARATIONS: Tablets: 0. dreams. debilitation  Physical: Skin color. P. and others.

Amiodarone is also associated with heart block. Side effects of higher dosages (those used for panic attacks) include fatigue.headaches. and fatigue.) Although amiodarone has many side effects. Therefore. or certain calcium channel blockers. such as alprazolam. eye deposits. followed by 600800 mg daily for 1 month. Among its most important electrical effects are: 1. cardiac arrest. sweating. nausea. blue skin discoloration. lightheadedness. Tiazac). speech problems. Because of this effect. resulting in an excessively slow heart rate or a block in the conduction of the electrical impulse through the heart. it should not be used by women who are nursing. low blood pressure. which probably reflect the normal actions of the drug. Some experts recommend that the doses of these other drugs be reduced when amiodarone is started. and worsening arrhythmias may occur as a result. can cause fetal abnormalities and should not be used in pregnancy. SIDE EFFECTS: The most frequent side effects of alprazolam taken at lower doses are drowsiness or lightheadedness. SIDE EFFECTS: Amiodarone has many side effects and several that are serious. PRESCRIPTION: Yes GENERIC AVAILABLE: Yes PREPARATIONS: Tablets: 200 mg. 2. Amiodarone increases the blood levels of digoxin (Lanoxin) when the two drugs are given together. a prolongation in the electrical phase during which the heart's muscle cells are electrically stimulated (action potential). vomiting. Amiodarone is considered a "broad spectrum" antiarrhythmic medication. a delay in the rate at which the heart's electrical system "recharges" after the heart contracts (repolarization). it also may be of benefit in patients withcongestive heart failure. nausea. Amiodarone was discovered in 1961 and approved by the FDA in December 1985. especially at high doses over prolonged periods of time. Symptoms of phenytoin toxicity including unsteady eye movement (temporary and reversible). PRESCRIBED FOR: Amiodarone is approved for recurrent ventricular fibrillation and hemodynamically unstable ventricular tachycardia. a slowing of conduction through various specialized electrical pathways (called accessory pathways) which can be responsible for arrhythmias. and visual changes. a slowing of the speed of electrical conduction (how fast each individual impulse is conducted through the heart's electrical system). and changes in appetite with resultant changes in weight. some of which are severe and potentially fatal. tremor.    PREGNANCY: Benzodiazepines. Additive electrical effects occurs with these combinations. it has been successful in treating many arrhythmias when other antiarrhythmic drugs have failed. constipation. patients on alprazolam for extended periods of time should slowly taper the medication under a doctor's supervision rather than abruptly stopping the medication. and cardiogenic shock. Amiodarone may be administered once daily or given twice daily with meals to minimize stomach upset which is seen more frequently with higher doses. 5. it has multiple and complex effects on the electrical activity of the heart which is responsible for the heart's rhythm. It is recommended that the dose of digoxin be cut by 50% when amiodarone therapy is started. heart failure. DOSING: The recommended dosing schedule is an initial loading dose of 800-1600 mg daily for 1 to 3 weeks. Covera-HS) or diltiazem (Cardizem. anxiety. propranolol (Inderal). 20-25 C (68-77 F). Consequently. Isoptin. such as verapamil (Calan. Amiodarone can result in phenytoin (Dilantin) toxicity because it causes a two. pulmonary fibrosis (scarring of the lungs). hypo or hyperthyroidism. that is. Common side effects include fatigue. Response should be closely monitored and dosing is individualized for each patient. vomiting. Quinaglute) concentrations increase by 30%-50% during the first week of amiodarone therapy. (It is an antiarrhythmic medication. Abrupt discontinuation of alprazolam after prolonged use can lead to symptoms of withdrawal such as insomnia. tiredness and unsteady gait. This effect can result in a drop in blood pressure.or three-fold increase in blood concentrations of phenytoin. Flecainide (Tambocor) blood concentrations increase by more than 50% with amiodarone. Verelan. Alprazolam can lead to addiction (dependency).dizziness. In addition to being an antiarrhythmic medication. This is only a partial list. 4. 3. unsteady gait. liver failure. DRUG INTERACTIONS: Amiodarone may interact with beta-blockers such as atenolol (Tenormin). Procainamide(Procan-SR. Injection: 50 mg/ml STORAGE: Tablets and injection should be kept at room temperature. Seizures can occur in more severe cases of withdrawal. a reduction in the rapidity of firing of the normal generator of electrical impulses in the heart (the heart's pacemaker). NURSING MOTHERS: Alprazolam is excreted in breast milk and can affect nursing infants. amiodarone also causes blood vessels to dilate (enlarge). constipation. metoprolol (Lopressor). Pronestyl) and quinidine (Quinidex. . then 400 mg daily for maintenance. Dilacor. weight loss. DRUG CLASS AND MECHANISM: Amiodarone is an oral and injectable drug that is used to correct abnormal rhythms of the heart. memory problems.

The mechanism of action of betahistine is not known. It is readily absorbed from the gastrointestinal tract. Tinnitus 4. 16mg. The importance of this observation in the action against Meniere’s syndrome or vestibular vertigo. 24 mg 1 tab. Urticaria 2. Route & Dosage Adult: 8mg 1-2 tab. in about 3 days. however. bronchial asthma. 6. If you missed one. In pharmacological studies. Meniere’s Disease 2.html . Mild gastric complaints 4. Adverse effects: 1. This drug should be taken with food. 5. Most of a dose is excreted in the Vertigo 3. Insomnia Patient & Family Education 1. pregnancy and lactation. 3. Swallow tablet whole with one full glass of water. To be taken TID. in the form of the metabolites. Source: http://home. Sensorineural deafness. Do not give this medication to children. betahistine was found to have weak H1 receptor agonistic and considerable H3 antagonistic properties in the central nervous system and autonomic nervous system. Advise relatives to support patient’s ambulation.Brand Name: Serc Generic Name: Betahistine Dihydrochloride Classification: Antiemetic and Antivertigo Availability: Tablet: 8mg. Never take a double dose if you missed one medication. Contraindications: Previous hypersensitive reaction to the drug components. Cautious Use: Pheochromocytoma. Pharmacological testing in animals has shown that the blood circulation in the striae vascularis of the inner ear improves. remains unclear. peptic ulcer. Pruritus 3. 4. 2. probably by means of a relaxation of the precapillary sphincters of the microcirculation of the inner ear. To be taken BID. Betahistine was also found to have a dose dependent inhibiting effect on spike generation of neurons in lateral and medial vestibular nuclei. False heartbeat 5. Indication: 1. 24mg Action: It has a histamine-like action. 16 mg ½-1 tab. It is converted to two metabolites and peak concentrations in blood of the two metabolites are achieved within 3 to 5 hours.intekom. take medication immediately. Protect medication from moisture.