Alprazolam

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Drugs Dictionary: Alprazolam

Alprazolam

Trade Name

Xanax (immediate-release), Xanax XR (extended-release); generic alprazolam

Classification

Benzodiazepine; anxiolytic, sedative-hypnotic; Schedule IV controlled substance

Dosage/Route

* Dosage:
- – Immediate-release (IR): 0.25 mg, 0.5 mg, 1 mg, 2 mg tablets
- – Extended-release (XR): 0.5 mg, 1 mg, 2 mg, 3 mg tablets
* Route: Oral (PO)

Usual Dosage

* Anxiety: IR: 0.25-0.5 mg PO 2-3 times daily (BID-TID); max 4 mg/day
* Panic Disorder: IR: 0.5 mg PO TID, titrate to 1-10 mg/day; XR: 3-6 mg PO once daily
* Elderly/Debilitated: Start 0.25 mg PO BID-TID; lower max doses
* Short-term use (≤8-12 weeks); taper to discontinue

Mechanism of Action

Enhances GABA activity by binding to benzodiazepine receptors on the GABA-A complex in the CNS. Increases inhibitory neurotransmission, producing anxiolytic, sedative, and anticonvulsant effects

Side Effects & Adverse Effects

* Side Effects: Drowsiness, dizziness, fatigue, dry mouth
* Adverse Effects:
- – Dependence/withdrawal (boxed warning; seizures, agitation if stopped abruptly)
- – Respiratory depression (esp. with opioids/alcohol)
- – Memory impairment, confusion (esp. elderly)
- – Paradoxical excitation (rare; agitation)

Nursing Management (Implications & Teachings)

* Implications:
- – Assess sedation level, fall risk (esp. elderly)
- – Monitor for abuse/dependence (Schedule IV); track refills
- – Avoid with CNS depressants (e.g., opioids—boxed warning)
- – Taper dose if stopping (e.g., reduce 0.5 mg q3 days)
* Teachings:
- – Take as prescribed; don’t increase dose
- – Avoid alcohol/driving (impairs alertness)
- – Report worsening anxiety, confusion, or breathing issues
- – Don’t stop suddenly—consult provider for taper