Monitor therapy, Triazolam: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Triazolam. They affect the muscles in the walls of the arteries and veins, preventing the muscles from tightening and the walls from narrowing. Avoid combination, Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Monitor therapy, Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Alprazolam is used for the treatment of anxiety disorders and panic attacks. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Label "shake well" and "refrigerate". Protect from moisture. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs. Monitor therapy, Flibanserin: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Flibanserin. The bioavailability of oral alprazolam averages 80 to 100%. Lastly, benzodiazepines may have negative effects, such as panic disorders, increased suicide incidence, and episodes of mania/hypomania, in patients suffering from depression.4,7,18,19, Neurotransmission relies on excitatory and inhibitory signalling. Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane. Consider therapy modification, Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. J Psychiatr Res. 2023 Apr 29. Disclaimer. Monitor therapy, Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Avoid alcohol. Alprazolam is a short-acting benzodiazepine that attenuates tremors in ET. Fall risk: Use with extreme caution in patients who are at risk of falls; benzodiazepines have been associated with falls and traumatic injury (Nelson 1999). Consider therapy modification, Yohimbine: May diminish the therapeutic effect of Antianxiety Agents. Review our medical disclaimer. Drug Metab Dispos. Like other benzodiazepines, it has a good ratio of efficacy to side effects; its most common side effect, mild sedation, occurs early in treatment. Management: The maximum recommended dosage of lemborexant is 5 mg, no more than once per night, when coadministered with weak CYP3A4 inhibitors. The Journal of clinical endocrinology and metabolism. Epub [PubMed PMID: 28777203], . Patient/caregiver was instructed upon alprazolam and mechanism of action of alprazolam as follows: Neurotransmitters in the brain and spinal cord are chemical messengers that help the nerve cells to communicate with each other. Management: Patients on lomitapide 5 mg/day may continue that dose. [, Engin E, Benham RS, Rudolph U: An Emerging Circuit Pharmacology of GABAA Receptors. Consider therapy modification, Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Hester, J.B., Jr.; US. Monitor therapy, Bromperidol: May enhance the CNS depressant effect of CNS Depressants. Discuss to the patient how taking alprazolam may cause drowsiness and sedation, so they should not drive, operate dangerous machinery, or perform any other activity or task that requires optimal attention. [, Ait-Daoud N, Hamby AS, Sharma S, Blevins D: A Review of Alprazolam Use, Misuse, and Withdrawal. Alprazolam, sold under the brand name Xanax, among others, is a fast-acting, potent tranquilizer of medium duration in the triazolobenzodiazepine (TBZD) class, which are benzodiazepines (BZDs) fused with a triazole ring. Alprazolam has also been misused for recreational purposes because of its disinhibition, euphoria, and anxiolytic effects. PLoS One. Anxiety disorders are characterized by: Drug abuse: Use with caution in patients with a history of drug abuse or acute alcoholism; potential for drug dependency exists. Disclosure: Tobin George declares no relevant financial relationships with ineligible companies. Binds to sterospecific benzodiazepine receptors on the postsynaptic GABA neuron at several sites within CNS. Monitor therapy, Erdafitinib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). [, FDA Approved Drug Products: XANAX (Alprazolam) tablets [, FDA Approved Drug Products: XANAX (alprazolam) tablets [, FDA Approved Drug Products: XANAX XR (alprazolam) extended-release tablets [, Ivax pharmaceuticals inc sub teva pharmaceuticals usa, Murfreesboro Pharmaceutical Nursing Supply, Riss J, Cloyd J, Gates J, Collins S: Benzodiazepines in epilepsy: pharmacology and pharmacokinetics. Avoid combination, Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Mix the dose with 30 mL of juice or other liquid or semi-solid foods (eg, applesauce, pudding). Oxazepam: 5-11 hours. Patients with pre-existing impaired respiratory function are at increased risk of adverse effects including death during treatment with benzodiazepines. Anxiety disorders (immediate release tablet, oral concentrate, orally-disintegrating tablets): Treatment of generalized anxiety disorder (GAD), short-term anxiety and anxiety association with depression, Panic disorder (extended-release tablets, oral solution, orally-disintegrating tablets, immediate-release tablets): Treatment of panic disorder, with or without agoraphobia. Review the adverse effects of alprazolam to identify the signs of benzodiazepine toxicity. This receptor is comprised of five subunits, e.g., alpha, beta, gamma, delta, epsilon, rho, etc. Alprazolam, known by various trade names, is the most commonly prescribed psychotropic medication in the United States. Appropriate use: Does not have analgesic, antidepressant, or antipsychotic properties. If combined, limit the dosages and duration of each drug. Alprazolam exerts its effect for the acute treatment of generalized anxiety disorder and panic disorder through binding to the benzodiazepine site of gammaaminobutyric acid-A (GABA A) receptors in the brain and enhances GABA-mediated synaptic inhibition. Management: Clinicians should generally avoid concurrent use of methadone and benzodiazepines when possible; any combined use should be undertaken with extra caution. Generic Name Alprazolam DrugBank Accession Number DB00404 Background. [, Hirota N, Ito K, Iwatsubo T, Green CE, Tyson CA, Shimada N, Suzuki H, Sugiyama Y: In vitro/in vivo scaling of alprazolam metabolism by CYP3A4 and CYP3A5 in humans. This receptor is comprised of five subunits, e.g., alpha, beta, gamma, delta, epsilon, rho, etc. Get emergency medical help if you have signs of an allergic reaction to alprazolam: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Immediate release tablets: Store at 20C to 25C (68F to 77F). Alprazolam exerts its effect for the treatment of panic disorder through binding to the benzodiazepine site of gamma aminobutyric acid-A (GABA A) receptors in the brain and enhances GABA-mediated synaptic inhibition. This medicine is available only with your doctor's prescription. These agents should only be combined if alternative treatment options are inadequate. Alprazolam is frequently prescribed to manage panic and anxiety disorders. Consider therapy modification, Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Paradoxical reactions: Paradoxical reactions, including hyperactive or aggressive behavior, have been reported with benzodiazepines; risk may be increased in adolescent/pediatric patients, geriatric patients, or patients with a history of alcohol use disorder or psychiatric/personality disorders (Mancuso 2004). Switching from immediate release to extended release: Administer the same total daily dose, but give once daily; if effect is not adequate, titrate dose as above. Chronic use of this agent may increase the perioperative benzodiazepine dose needed to achieve desired effect. The incidence of premature birth and low birth weights may be increased following maternal use of benzodiazepines; hypoglycemia and respiratory problems in the neonate may occur following exposure late in pregnancy. Tolerance does not develop to the anxiolytic effects (Vinkers 2012). Monitor therapy, Doxylamine: May enhance the CNS depressant effect of CNS Depressants. Epub 2018 Jun 11. Alprazolam can slow or stop your breathing, especially if you have recently used an opioid medication or alcohol. The most common side effects are dizziness, sleepiness, nausea, difficulty falling . Epub 2019 May 23. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. Canadian labeling: Additional contraindications (not in US labeling): Myasthenia gravis; severe hepatic insufficiency; severe respiratory insufficiency; sleep apnea. PMC Panic disorder: Adolescents 18 years: Oral: Immediate release: Initial: 0.5 mg 3 times daily; titrate dose upward as needed every 3 to 4 days in increments 1 mg/day; mean dose used in controlled trials: 5 to 6 mg/day; maximum daily dose: 10 mg/day (rarely required), Extended release: Initial: 0.5 to 1 mg once daily; titrate dose upward as needed every 3 to 4 days in increments 1 mg/day; usual dose: 3 to 6 mg/day; maximum daily dose: 10 mg/day (rarely required). Monitor therapy, Droperidol: May enhance the CNS depressant effect of CNS Depressants. Food increases the Cmax of extended release alprazolam by 25%, but the AUC and half life are not affected. Alprazolam has also been misused for recreational purposes because of its disinhibition, euphoria, and anxiolytic effects. Orally disintegrating tablets: Using dry hands, place tablet on top of tongue and allow to disintegrate. Dangkoob F, Housaindokht MR, Asoodeh A, Rajabi O, Rouhbakhsh Zaeri Z, Verdian Doghaei A: Spectroscopic and molecular modeling study on the separate and simultaneous bindings of alprazolam and fluoxetine hydrochloride to human serum albumin (HSA): with the aim of the drug interactions probing. Consider therapy modification, Nabilone: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy, Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. J Biol Chem. Readily absorbed; Extended release: Slower relative to immediate release formulation resulting in a concentration that is maintained 5 to 11 hours after dosing; rate increased following night time dosing (versus morning dosing), Immediate release: Vd: 0.84 to 1.42 L/kg (Greenblatt 1993). [, Verster JC, Volkerts ER: Clinical pharmacology, clinical efficacy, and behavioral toxicity of alprazolam: a review of the literature. The effects of binding at sites 2-4 are not fully understood and likely impart greater complexity to benzodiazepine pharmacological action.9,10, Alprazolam administered orally is rapidly absorbed in the gastrointestinal tract, reaching Cmax in about 1.8 (1-2) hours. A 1 mg oral dose results in a Cmax of 12-22 g/L.2,18, The extended-release formulation of alprazolam (XANAX XR) has similar absorption, bioavailability, and pharmacokinetics as the standard release, with the exception that the Tmax is ~10 hours compared to 1-2 hours. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Consider therapy modification, Central nervous system: Drowsiness (immediate-release: 41% to 77%; extended-release: 23%), fatigue (immediate-release: 49%; extended-release: 14%), sedation (extended-release: 45%), ataxia (immediate-release: 40%; extended-release: 7% to 9%), memory impairment (immediate-release: 33%; extended-release: 15%), irritability (immediate-release: 33%; extended-release: 1%), cognitive dysfunction (immediate-release: 29%), dysarthria (immediate-release: 23%; extended-release: 11%), dizziness (immediate-release: 2% to 21%; extended-release: 1%), depression (extended-release: 1% to 12%), Dermatologic: Skin rash (immediate-release: 11%; extended-release: <1%), Endocrine & metabolic: Weight gain (immediate-release: 27%; extended-release: 5%), weight loss (immediate-release: 23%), decreased libido (6% to 14%), Gastrointestinal: Increased appetite (immediate-release: 33%; extended-release: 7%), decreased appetite (immediate-release: 28%), constipation (immediate-release: 26%; extended-release: 8%), xerostomia (immediate-release: 15%), Genitourinary: Difficulty in micturition (immediate-release: 12%; extended-release: 1%), Cardiovascular: Hypotension (immediate-release: 5%; extended-release: <1%), chest pain (extended-release: 1%), palpitations (extended-release: 1%), Central nervous system: Confusion (immediate-release: 10%; extended-release: 2%), altered mental status (extended-release: 7%), disinhibition (immediate-release: 3%), disturbance in attention (extended-release: 3%), equilibrium disturbance (extended-release: 3%), akathisia (immediate-release: 2%), disorientation (extended-release: 2%), lethargy (extended-release: 2%), talkativeness (immediate-release: 2%), derealization (1% to 2%), agitation (extended-release: 1%), depersonalization (extended-release: 1%), headache (extended-release: 1%), insomnia (extended-release: 1%), malaise (extended-release: 1%), nervousness (extended-release: 1%), nightmares (extended-release: 1%), restlessness (1%), vertigo (extended-release: 1%), anxiety (extended-release: 1%), feeling hot (immediate-release: 1%; extended-release: <1%), hypersomnia (extended-release: 1%), hypoesthesia (extended-release: 1%), dystonia, Dermatologic: Allergic skin reaction (4%), dermatitis (immediate-release: 4%), diaphoresis (extended-release: 1%), pruritus (extended-release: 1%), Endocrine & metabolic: Menstrual disease (immediate-release: 10%; extended-release: 2%), increased libido (immediate-release: 8%; extended-release: 1%), change in libido (immediate-release: 7%), hot flash (extended-release: 2%), Gastrointestinal: Nausea (extended-release: 6%), sialorrhea (immediate-release: 4% to 6%; extended-release: 1%), anorexia (extended-release: 2%), abdominal pain (extended-release: 1%), diarrhea (extended-release: 1%), dyspepsia (extended-release: 1%), vomiting (extended-release: 1%), Genitourinary: Sexual disorder (immediate-release: 7%; extended-release: 2%), dysmenorrhea (extended-release: 4%), urinary incontinence (immediate-release: 2%; extended-release: <1%), Neuromuscular & skeletal: Arthralgia (extended-release: 2%), dyskinesia (extended-release: 2%), myalgia (extended-release: 2%), back pain (extended-release: 1%), muscle cramps (extended-release: 1%), muscle twitching (extended-release: 1%), tremor (extended-release: 1%), weakness (extended-release: 1%), limb pain (extended-release: 1%), Ophthalmic: Blurred vision (extended-release: 1%), Respiratory: Dyspnea (extended-release: 2%), hyperventilation (extended-release: 1%), nasal congestion (extended-release: 1%), allergic rhinitis (extended-release: 1%), Central nervous system: Drug dependence, drug withdrawal, <1%, postmarketing, and/or case reports: Abnormal dreams, aggressive behavior, amnesia, angioedema, apathy, chest tightness, choking sensation, clumsiness, cold and clammy skin, diplopia, dysgeusia, dysphagia, edema, emotional lability, epistaxis, euphoria, falling, fever, galactorrhea, gastrointestinal disease, gynecomastia, hallucination, hangover effect, hepatic failure, hepatitis, homicidal ideation, hyperprolactinemia, hypomania, hypotonia, impaired consciousness, impulse control disorder, increased energy, increased liver enzymes, increased serum bilirubin, increased thirst, intoxicated feeling, jaundice, jitteriness, mania, mydriasis, otalgia, outbursts of anger, paraplegia, peripheral edema, photophobia, psychomotor retardation, relaxation, rhinorrhea, rigors, seizure, sensation of cold, sinus tachycardia, skin photosensitivity, sleep apnea, sleep talking, Stevens-Johnson syndrome, stupor, suicidal ideation, syncope, tinnitus, urinary frequency, urticaria, voice disorder. 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