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Pharmacologic class:乐动体育开户 Benzodiazepine
Therapeutic class: Anxiolytic
Controlled substance schedule IV
Pregnancy risk category D
乐动体育开户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):乐动体育开户 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):乐动体育开户 0.25 mg, 0.5 mg, 1 mg, 2 mg
Indications and dosages
➣乐动体育开户 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:乐动体育开户 Initially, 0.25 mg P.O. two or three times daily. Maximum dosage is 4 mg daily in divided doses.
➣乐动体育开户 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.
乐动体育开户• Hepatic impairment
乐动体育开户• Premenstrual syndrome
乐动体育开户• Hypersensitivity to benzodiazepines
• Narrow-angle glaucoma
• Labor and delivery
• Pregnancy or breastfeeding
乐动体育开户Use cautiously in:
乐动体育开户• hepatic dysfunction
• history of attempted suicide or drug dependence
• elderly patients.
乐动体育开户• Don't give with grapefruit juice.
乐动体育开户• Make sure patient swallows extended-release tablets whole without chewing or crushing.
乐动体育开户• Mix oral solution with liquids or semisolid foods and instruct patient to consume entire amount immediately.
• 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: 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:乐动体育开户 dermatitis, rash, pruritus, urticaria, increased sweating
Other: weight loss or gain, hiccups, fever, edema, psychological drug dependence, drug tolerance
Drug-drug. Antidepressants, antihistamines, opioids, other benzodiazepines: increased CNS depression
Barbiturates, rifampin:乐动体育开户 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: decreased antiparkinsonian effect
Theophylline: increased sedative effect
Tricyclic antidepressants (TCAs):乐动体育开户 increased TCA blood levels
Drug-diagnostic tests. Itraconazole, ketoconazole:乐动体育开户 increased alprazolam plasma level
Drug-food. Grapefruit juice:乐动体育开户 decreased drug metabolism and increased blood level
Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression
Drug-behaviors. Alcohol use: increased CNS depression
Smoking:乐动体育开户 decreased alprazolam efficacy
• Watch for excessive CNS depression if patient is concurrently taking antidepressants, other benzodiazepines, antihistamines, or opioids.
乐动体育开户• 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.
• Monitor vital signs and weight.
乐动体育开户• Report signs of drug abuse, including frequent requests for early refills.
乐动体育开户• Instruct patient to swallow extended- release tablets whole without crushing or chewing.
☞乐动体育开户 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.
乐动体育开户• 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.
• 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.