Alprazolam

General
  • Type: Benzodiazepines
  • Dosage Forms: ODT Immediate Release - 0.25, 0.5, 1, 2mg tablets. Extended Release - 0.5, 1, 2, 3mg tablets, Oral liquid, 1mg/mL
  • Common Trade Names: Xanax, Xanax XR, Niravam

Adult Dosing
  • Anxiety: 0.25-0.5mg PO TID, Max: 4mg/day

Pediatric Dosing

<18 years old: Not recommended

Special Populations
  • Pregnancy Rating: D
  • Lactation risk: L3[1]
  • Renal Dosing: no adjustment
  • Hepatic Dosing:
    • Start at min dose, slowly up-titrate dose amount and frequency to max of 4mg/day

Contraindications
  • Allergy to class/drug
  • Sleep apnea
  • Concomitant Alcohol use
  • Concomitant CNS depressant use
  • Elderly
  • Abuse history
  • Hepatic disease (decreased clearance)

Adverse Reactions

Serious
  • Respiratory depression/arrest
  • Abuse
  • Hypotension
  • Syncope
  • Hepatotoxicity
  • Angioedema
  • Steven-Johnson Syndrome

Common
  • Altered mental status (drowsiness, fatigue, amnesia, impaired concentration, impaired coordination)
  • Urinary incontinence/retention

Pharmacology
  • Half-life: ~11hr
  • Metabolism: Hepatic via CYP450:3A4 substrate
  • Excretion: Urine
  • Mechanism of Action: Enhances GABA effects by binding to specific benzodiazepine receptor

References
  1. Armstrong C. "ACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation". Am Fam Physician. 2008 Sep 15;78(6):772-778.
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