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Summary
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Suicidal tendencies may be present in patients with emotional disorders, particularly when depressed and that protective measures and appropriate treatment may be necessary and should be instituted without delay.
Benzodiazepines may potentiate or interact with effects of other CNS acting drugs such as alcohol, narcotics, barbiturates, nonbarbiturate hypnotics, antihistamines, phenothiazines, butyrophenones, MAO inhibitors, tricyclic antidepressants and anticonvulsants. Therefore, if alprazolam is to be combined with other drugs acting on the CNS, careful consideration should be given to the pharmacology of the agent involved because of the possible additive or potentiating effects. Patients should also be advised against the simultaneous use of other CNS depressant drugs and should be cautioned not to take alcohol during the administration of alprazolam.
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Increased and decreased blood sugar levels..
Contraindications To top
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Hematologic:
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Experiments in animals have indicated that cardiopulmonary collapse can occur with massive i.v. doses of alprazolam. This could be reversed with positive mechanical respiration and the i.v. infusion of levarterenol.
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Treatment:
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Adults:
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Benzodiazepine anxiolytic. Anxiety disorders: Adults, initially, 0.25 mg 2 or 3 times daily. Increase dosage by 0.25 mg increments, if required. Maximum: 3 mg/day in divided doses.
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Myasthenia gravis, acute narrow angle glaucoma..
Treatment:
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Hematologic:.
Some patients may require up to 10 mg/day. Discontinue alprazolam slowly by decreasing the daily dosage by no more than 0.5 mg every 3 days. A decrease of 0.5 mg every 2-3 weeks is more appropriate when a dose of 6 mg daily or more has been administered even for only a few months. Once a dose of 2 mg daily is achieved, decrease the dose by 0.25 mg per 2 to 3 weeks.
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Incontinence, change in libido.
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Drowsiness, dizziness, coordination difficulties. Release of hostility and other paradoxical effects such as irritability and hallucinations may occur with benzodiazepines.
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Manifested as an extension of alprazolam's pharmacologic activity. Varying degrees of CNS depressant effects such as somnolence and hypnosis can occur. Other manifestations may include muscle weakness, ataxia, dysarthria and particularly in children paradoxical excitement. In more severe cases diminished reflexes, confusion and coma may ensue. It should be remembered when treating an overdose that multiple agents may have been ingested. Fatalities with benzodiazepines rarely occur except when other drugs, alcohol or aggravating factors are involved.
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Animal experiments with alprazolam and related compounds have suggested that hemodialysis and forced diuresis are probably of little value.
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Alprazolam is not recommended for use in patients whose primary diagnosis is psychosis or depression.
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Pharmacology
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Alprazolam, a triazolo 1,4 benzodiazepine analog, binds with high affinity to the GABA benzodiazepine receptor complex. Considerable evidence suggest that the central pharmacologic/therapeutic actions of alprazolam are mediated via interaction with this receptor complex.
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