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
• 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