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Pharmacologic class: Benzodiazepine
Therapeutic class:乐动体育开户 Anxiolytic
Controlled substance schedule IV
Pregnancy risk category D
Unclear. Thought to act at limbic, thalamic, and hypothalamic levels of CNS to produce sedative, anxiolytic, skeletal muscle relaxant, and anticonvulsant effects.
Solution: 1 mg/ml
Tablets (extended-release): 0.5 mg, 1 mg, 2 mg, 3 mg
Tablets (immediate-release): 0.25 mg, 0.5 mg, 1 mg, 2 mg
Tablets (orally disintegrating): 0.25 mg, 0.5 mg, 1 mg, 2 mg
Indications and dosages
➣ Anxiety disorders
Adults: Initially, 0.25 to 0.5 mg P.O. t.i.d. Maximum dosage is 4 mg daily in divided doses.
Elderly patients: Initially, 0.25 mg P.O. two or three times daily. Maximum dosage is 4 mg daily in divided doses.
➣ Panic disorders
Adults: Immediate-release or orally disintegrating tablets-Initially, 0.5 mg P.O. t.i.d. Extended-release tablets-Initially, 0.5 to 1 mg P.O. daily. Usual dosage is 3 to 6 mg daily, with a maximum dosage of 10 mg daily. For all dosage forms, increase by a maximum of 1 mg daily at intervals of 3 to 4 days, with a maximum of 10 mg daily in divided doses.
• Hepatic impairment
• Premenstrual syndrome
• Hypersensitivity to benzodiazepines
• Narrow-angle glaucoma
乐动体育开户• Labor and delivery
乐动体育开户• Pregnancy or breastfeeding
Use cautiously in:
乐动体育开户• hepatic dysfunction
乐动体育开户• history of attempted suicide or drug dependence
• elderly patients.
• Don't give with grapefruit juice.
• Make sure patient swallows extended-release tablets whole without chewing or crushing.
• Mix oral solution with liquids or semisolid foods and instruct patient to consume entire amount immediately.
乐动体育开户• Administer orally disintegrating tablets by placing tablet on patient's tongue. If only one-half of scored tablet is used, discard unused portion immediately.
☞ Don't withdraw drug suddenly. Seizures and other withdrawal symptoms may occur unless dosage is tapered carefully.
CNS: dizziness, drowsiness, depression, fatigue, light-headedness, disorientation, anger, hostility, euphoria, hypomanic episodes, restlessness, confusion, crying, delirium, headache, stupor, rigidity, tremor, paresthesia, vivid dreams, extrapyramidal symptoms
CV: bradycardia, tachycardia, hypertension, hypotension, palpitations, CV collapse
EENT: blurred or double vision, nystagmus, nasal congestion
GI:乐动体育开户 gastric disorders, dysphagia, anorexia, increased salivation, dry mouth
GU: menstrual irregularities, urinary retention, urinary incontinence, libido changes, gynecomastia
Hematologic: blood dyscrasias such as eosinophilia, agranulocytosis, leukopenia, and thrombocytopenia
Hepatic: hepatic dysfunction (including hepatitis)
Musculoskeletal:乐动体育开户 muscle rigidity, joint pain
Skin: dermatitis, rash, pruritus, urticaria, increased sweating
Other:乐动体育开户 weight loss or gain, hiccups, fever, edema, psychological drug dependence, drug tolerance
Drug-drug. Antidepressants, antihistamines, opioids, other benzodiazepines:乐动体育开户 increased CNS depression
Barbiturates, rifampin: increased metabolism and decreased efficacy of alprazolam
Cimetidine, disulfiram, erythromycin, fluoxetine, hormonal contraceptives, isoniazid, ketoconazole, metoprolol, propoxyphene, propranolol, valproic acid: decreased metabolism and increased action of alprazolam
Digoxin: increased risk of digoxin toxicity
Levodopa:乐动体育开户 decreased antiparkinsonian effect
Theophylline:乐动体育开户 increased sedative effect
Tricyclic antidepressants (TCAs): increased TCA blood levels
Drug-diagnostic tests. Itraconazole, ketoconazole:乐动体育开户 increased alprazolam plasma level
Drug-food. Grapefruit juice: decreased drug metabolism and increased blood level
Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression
Drug-behaviors. Alcohol use:乐动体育开户 increased CNS depression
Smoking: decreased alprazolam efficacy
• Watch for excessive CNS depression if patient is concurrently taking antidepressants, other benzodiazepines, antihistamines, or opioids.
• If patient is taking TCAs concurrently, watch for increase in adverse TCA effects.
乐动体育开户• Monitor CBC and liver and kidney function test results.
乐动体育开户• Monitor vital signs and weight.
• Report signs of drug abuse, including frequent requests for early refills.
• Instruct patient to swallow extended- release tablets whole without crushing or chewing.
☞ Tell patient that drug may make him more depressed, angry, or hostile. Urge him to contact prescriber immediately if he thinks he's dangerous to himself or others.
• Inform patient that drug may cause tremors, muscle rigidity, and other movement problems. Advise him to report these effects to prescriber.
☞乐动体育开户 Caution patient not to stop taking drug suddenly. Withdrawal symptoms, including seizures, may occur unless drug is tapered carefully.
乐动体育开户• Advise patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
乐动体育开户• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.