Alprazolam

Alprazolam is a short-acting benzodiazepine that is used to treat anxiety disorders as well as to temporarily relieve acute alcohol withdrawal symptoms and anxiety symptoms. Alprazolam can be administered off-label for the treatment of a number of illnesses, including premenstrual syndrome, social anxiety, insomnia, and PTSD.
Federal and state laws limit alprazolam as an illicit substance because, like other benzodiazepines, it is susceptible to dependency and misuse. 

How does Alprazolam work? 

The way that alprazolam works pharmacologically in the brain at certain receptor locations may help to explain why it is such an excellent anxiety treatment. Receptors are certain areas on the membrane of nerve cells that receive signals from neurotransmitters, which are neurochemicals. A neurotransmitter attaches to the receptor and travels along the neuron to convert the neurochemical signal into an electrical or other chemical signal. These particular receptors are also referred to as benzodiazepine receptors. 

• The neurotransmitter γ-aminobutyric acid (GABA) in that area of the brain is facilitated in its inhibitory effect by the combined action of benzodiazepines on the receptors. 

It appears that benzodiazepines’ anxiolytic, sedative, and anticonvulsant effects are due to their interaction with GABA receptors. 

 What is the recommended dose of Alprazolam? 

When treating anxiety disorders, the recommended starting dose of alprazolam is 0.25–0.5 mg three times per day. An effective range of 1-4 mg/day may be reached by progressively increasing the dose. The daily maximum intake shouldn’t exceed 4 mg.

• panic disorders starting dose would be higher. 

The starting dosage is 0.5 mg three times a day, and it can be increased by no more than 1 mg per day at intervals of three to four days. While 6 mg/day is the typical dosage for treating panic disorder, some people may need to administer up to 8 mg/day in order to see significant effects. There are extended-release alprazolam pills that may be used once daily.

• Abruptly stopping alprazolam should be avoided in patients who have been taking it for more than a few months or at high dosages (4 mg/day or more), as they may be more vulnerable to withdrawal symptoms. 

There have also been reports of seizures linked to a sudden cessation of alprazolam. It seems that the risk of seizures peaks 24–72 hours after stopping. Lessening the daily dosage gradually lowers the chance of experiencing seizures and withdrawal symptoms. 

• A suggested tapering regimen involves reducing alprazolam by no more than 0.5 mg every three days. Should signs of withdrawal appear, the patient ought to be returned to the initial dosage. 

A significantly slower dose decrease spread out over many months or longer may be necessary for certain people.

What happens when you take an overdose of Alprazolam?

Oral benzodiazepine overdoses are rarely lethal. Benzodiazepines sometimes cause mortality when taken with other CNS depressants, particularly alcohol, narcotics, and barbiturates.   

• Drowsiness, confusion, somnolence, weariness, dropped coordination, clumsiness while walking (ataxia), and sluggish reflexes are some of the mild indications of benzodiazepine overdose.  

When taken alone, benzodiazepines hardly cause death. When some drugs participate in benzodiazepine overdose, severe symptoms such as trouble breathing, slowing heart rate, decreased blood pressure, lack of coordination, and loss of consciousness lead to coma and death. 

• Every potential overdose should be considered an emergency at the ER. The prescription bottle of the drug along with any extra drugs linked to the overdose should also be brought, as the data on the prescription label can help the treating physician estimate the quantity of pills consumed. 

What are the side effects of Alprazolam?

Sedation and drowsiness are the most often reported, particularly in the early stages of therapy. Other common symptoms include difficulty focusing and remembering things, a dissociative or “spacey” feeling, and trouble with coordination.  

• Constipation, dizziness, a change in appetite, and decreased interest in sexual intercourse. 
• Suicidal thoughts or behaviors, hyperventilation, change in consciousness, confusion, loss of memory, seizure, and, palpitations.

In some individuals, benzodiazepines may possess paradoxical effects. In susceptible individuals, the drug stimulates enthusiasm, aggression, hostility, uncontrolled behavior, and wrath, rather than the expected depressive effects. These reactions are especially common in the elderly, people with brain injuries, and people with personality and impulse control difficulties. 

• Dizziness, Headache, Nausea, Facial or muscle twitching, Muscle weakness, Balance disorder, Painful or difficult urination, Chills, slow heart rate, slow breathing and dark urine. 

What are the precautions of Alprazolam usage? 

Alprazolam, like other benzodiazepines, is categorized as a restricted substance due to its potential for misuse and dependence, according to state and federal laws.  

Since antacids may alter or inhibit the absorption of the drug, it is not recommended to take alprazolam with them. The dosages of alprazolam, and antacid should be given two to three hours apart.

•   Avoid consuming grapefruit juice while taking alprazolam since it may speed up the medication’s side effects and lower metabolism.
• The drug impairs awareness and coordination; therefore, patients should use caution when driving or performing other tasks that require alertness while taking this medicine.  

Seniors may be more vulnerable due to impaired coordination and reflexes, perhaps leading to falls and injuries.  

• Co-administration with other central nervous system (CNS) depressants such as alcohol, opioids, and barbiturates may exacerbate these CNS effects. So quit drinking while taking the drug.  
• Prolonged usage of benzodiazepines as Alprazolam could end in dependence. When the medicine is abruptly stopped, withdrawal symptoms may appear. Headaches, vomiting, decreased attention, confusion, tremors, muscle cramps, and seizures are among the withdrawal symptoms.  

Benzodiazepines such as Alprazolam are systemically acting depressants that might reduce breathing. This is especially challenging for people with chronic obstructive lung disease and emphysema. The respiratory depressive effect of benzodiazepines may further suppress respiratory drive in these patients, putting them at greater risk for respiratory depression and death.  

If you miss a dose, take it right away. If it is near the next planned dose, cancel the missed dose and resume your normal dosing schedule. Avoid taking double the prescribed dose. 

• Alprazolam can be taken before or after meals.  
• Keep the medication in the original labeled, light-resistant container, away from heat and moisture, to avoid drug degradation by them.  
• Keep Alprazolam away from your children. 

How does Alprazolam affect pregnancy and lactation?   

• Alprazolam is classified as pregnancy category D. 

Benzodiazepines and their metabolites are known to cross the placenta and accumulate in the fetal circulation.  

• They are associated with a risk of congenital malformations when used during pregnancy, causing cleft lip and heart deformities in the fetus.  

Benzodiazepines as alprazolam should be avoided during pregnancy, particularly in the first trimester. The use of benzodiazepines during pregnancy should be considered only when the need for the medication outweighs its risk and alternative therapies have failed.  

Nursing mothers should not take alprazolam because it will pass into breast milk and be ingested by the baby. If stopping the drug is not an alternative, breastfeeding should not be started or should be discontinued. 

What are the drugs contraindicated with Alprazolam?

Alprazolam is metabolized hepatically by cytochrome P450 by glucuronidation to give an inactive metabolite. 

• So coadministration of any Cytochrome P450 inhibitors, inducers, or metabolites could affect its excretion and concentration. 
• Antacids, carbamazepine, theophylline, and St. John’s wort can decrease its activity.

CNS depressants (alcohol, narcotics, barbiturates, and hypnotics) and antihistamines could affect coordination and breathing while increasing drowsiness. 

• Cimetidine, grape juice, Nefazodone, Erythromycin, Itraconazole, Ciprofloxacin, fluoxetine, ketoconazole, propranolol, divalproex sodium, propoxyphene, and disulfiram may inhibit the metabolism of Alprazolam, thus increasing the level and pharmacological effects of the drug and producing excessive sedation and other adverse CNS effects.