Alprazolam

Alprazolam is a sedative drug that belongs to benzodiazepines. Here we will discuss its pharmacology
and nursing considerations.

As a nurse, you should not confuse ALPRAZOLam with LORazepam or Xanax with Tenex or
Zantac.

Alprazolam is a benzodiazepine schedule IV drug, which means they have a risk for dependence,
hence drug abuse.

Uses

The clinical uses of alprazolam are:

● For the management of generalized anxiety disorders (GAD)

● Short-term relief of symptoms of anxiety, and panic disorder, with or without agoraphobia
● For anxiety associated with depression.

The off-label uses of alprazolam are:

● Anxiety in children
● Preoperative anxiety

Contraindications

Alprazolam is contraindicated in the following scenarios:

● Hypersensitivity to alprazolam
● Acute narrow angle-closure glaucoma
● Concurrent use with ketoconazole or itraconazole, or other potent CYP3A4 inhibitors.

As a nurse, you should exercise caution with alprazolam use in the following scenarios:

● Renal or hepatic impairment

● Predisposition to urate nephropathy
● Obese patients
● Concurrent use of CYP3A4 inhibitors/inducers and major CYP3A4 substrates
● Debilitated patients
● Respiratory disease
 ● Depression, especially in patients with suicidal risk
● Elderly because of the increased risk of severe toxicity
● History of substance abuse

Action

Alprazolam increases the effects of the inhibitory neurotransmitter GABA (gamma amino butyric
acid) in the brain. Hence, due to its CNS depressant effects, it produces anxiolytic effects.

Alprazolam is well absorbed from the gastrointestinal tract, has a protein binding of 80%, and is
metabolized in the liver. It is primarily excreted in the urine.

The half-life of alprazolam is 6–27 hrs.

Abrupt or too-rapid withdrawal may result in;

● Restlessness
● Irritability
● Insomnia
● Hand tremors
● Abdominal and muscle cramps
● Diaphoresis
● Vomiting
● Seizures

Alprazolam overdose results in drowsiness, confusion, diminished reflexes, coma, and blood
dyscrasias. To treat that, flumazenil is used as an antidote.

Nursing Considerations

With alprazolam therapy, you must keep the following nursing considerations in your mind.

Nursing Assessment

● Assess the degree of anxiety

● Asses for drowsiness, dizziness, and light-headedness
● Asses motor and autonomic responses
● Initiate fall precautions
 ● Check if the patient has agitation, trembling, cold and clammy hands with diaphoresis.

Nursing Interventions and Evaluation

● In patients receiving long-term alprazolam therapy, monitor hepatic and renal function tests.
Also, order their complete blood count test periodically.
● Assess the patient for paradoxical reactions, particularly during early therapy.
● Evaluate for therapeutic responses such as calm facial expression, decreased restlessness, and
insomnia. Monitor the patient’s respiratory and cardiovascular status.

Patient/Family Teaching

With alprazolam therapy, teach the patient and his family members about the following things:

● Benzodiazepines relieve anxiety symptoms for a short time. However, they do not cure it.
Therefore you must seek counseling therapy or psychotherapy that can help lower
nervousness and anxiety and assist with sleep, preventing insomnia.
● With drug therapy, also use other methods to calm and relax your mind, such as physical
exercise, stress-management techniques, and relaxation techniques.
● Identify triggers for anxiety, such as caffeine, cold medications, and appetite suppressant
consumption. Avoiding their intake might help prevent anxiety, nervousness, and insomnia.
● Tell other healthcare providers that you take benzodiazepines so that they prescribe
accordingly and no drug interaction occurs.
● Avoid doing hazardous activities that require alertness and psychomotor coordination until
you know about the central nervous system effects of alprazolam.
● Smoking reduces drug effectiveness. Therefore avoid smoking with alprazolam therapy.
● Avoid alcohol intake with benzodiazepines because they both can depress your central
nervous system, leading to life-threatening consequences.
● Do not take other drugs, over-the-counter products, or
● herbal remedies without first consulting the prescriber or
● a pharmacist with alprazolam therapy.
● Take the drug as your physician has prescribed. Please do not stop taking it abruptly. Doing
that can lead to life-threatening withdrawal symptoms. Always stop taking it with the
approval of your prescriber.
● If you take the drug for a long time, dependence might occur.
● Take the drug at night or later in the day to prevent drowsiness in the daytime.
● If dizziness occurs, change positions slowly from recumbent to sitting position before
standing.
● Alprazolam may cause dry mouth. It can be relieved by sour hard candy, gum, and sips of
water.
Administration/Handling of Alprazolam

For oral administration of immediate-release preparations of alprazolam:

● Give without regard to food.

● You can crush the tablets.
● Give them sublingually if oral intake is not possible.

For oral administration of extended-release preparations of alprazolam:

● Administer once daily.

● Do not break, crush, dissolve, or divide them. Instead, swallow whole.

For oral administration of orally disintegrating preparations of alprazolam:

● Place the tablet on the tongue, and allow it to dissolve. And swallow with saliva.
● Administration with water is not necessary.
● If using half the tablet, discard the remaining half.

That completes the pharmacological review and nursing considerations of alprazolam.