Alprazolam

(al pray' zoe lam)

PCI  : Contraindicated in pregnancy

LCI  : Contraindicated in lactation

Molecule Info

 | See TERMINOLOGY & ABBREVIATIONS |
Indication(s) & Dosage Oral route
Short-term management of anxiety
Adult: 0.25-0.5 mg tid, increased to 3-4 mg daily if necessary.
Elderly: Initially, 0.25 mg bid/tid.
Hepatic impairment: Avoid in severe impairment. 

Panic attacks
Adult: Up to 10 mg daily.

Special Populations: Initial dose for short-term management of anxiety disorders in debilitated patients and those with advanced liver disease is 0.25 mg bid/tid.
Administration May be taken with or without food. Side effects eg sleepiness/drowsiness may be reduced if taken immediately after meals.
Overdosage Symptoms: Somnolence, confusion, impaired coordination, diminished reflexes and coma. Monitor respiration, pulse rate and BP. General supportive measures and immediate gastric lavage may be recommended. If hypotension occurs, it may be combated by the use of vasopressors. Dialysis is of limited value. Flumazenil may be used for complete or partial reversal of the sedative effects of benzodiazepines and may be used when an overdose with a benzodiazepine is known or suspected.
Contraindications Acute narrow-angle glaucoma, preexisting CNS depression or coma, resp depression, acute pulmonary insufficiency or sleep apnoea; severe hepatic impairment; pregnancy, lactation.
Special Precautions Dosage reduction or gradual withdrawal. Dependence. Geriatric or debilitated patients. Muscle weakness, impaired hepatic or renal function; arteriosclerosis; obesity; depression particularly suicidal tendency; chronic pulmonary insufficiency. May impair ability to drive or operate machinery. Children <18 yr.
Adverse Drug Reaction(s) Psychological and physical dependence, withdrawal syndrome; drowsiness, sedation, vertigo, headache, visual disturbances, GI disturbances, jaundice; fatigue, muscle weakness, ataxia, dizziness, confusion and depression.
Potentially Fatal: Blood dyscrasias.
Drug Interactions Potentiates action of alcohol and CNS depressants. Reduced conc with cigarette smoking by 50%.
Potentially Fatal: Cimetidine and fluoxetine reduce the clearance of alprazolam. Alprazolam enhances activity of imipramine and desipramine.

Pregnancy Category (FDA) Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
Storage Oral: Store below 25°C.
Pharmacology Alprazolam has anxiolytic, muscle-relaxant, anticonvulsant, antidepressant and sleep-modifying effects. It binds to the gamma aminobutyric acid (GABA)-specific sites throughout the CNS, leading to an increase in the inhibitory effect of GABA on neuronal excitability. Increased neuronal permeability to chloride ions thus results in hyperpolarisation and stabilisation.
Absorption: Well absorbed from the GIT (oral); peak plasma concentrations after 1-2 hrs.
Distribution: Protein-binding: 70-80%
Metabolism: Hepatic; converted to alpha-hydroxyalprazolam and benzophenone.
Excretion: Urine (as unchanged drug and metabolites); 11-15 hrs (elimination half-life).
ATC Classification N05BA12 - alprazolam; Belongs to the class of benzodiazepine derivatives anxiolytics. Used in the management of anxiety, agitation or tension.

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Brand/Product Info


Total Products : 12            
Brand Name Manufacturer/Marketer Composition Dosage Form Pack Size & Price
ALPAM Asiatic Laboratories Ltd. Alprazolam BP 0.25mg & 0.50mg Tablet 0.25mg x100's, 0.5mg x50's: 100.00 MRP
ALPRAX Opsonin Pharma Limited Alprazolam BP 0.25mg & 0.50mg Tablet 50's each: 50.00 & 100.00 MRP
ALPRAX XR Opsonin Pharma Limited Alprazolam BP 1mg & 2mg Tablet (extended release) 30's each: 120.00 & 240.00 MRP
ALZOLAM Sun Pharmaceutical (Bangladesh) Ltd. Alprazolam BP 0.25mg & 0.50mg Tablet 100's each: 112.00 & 203.00 MRP
ALZOLAM SR Sun Pharmaceutical (Bangladesh) Ltd. Alprazolam BP 1mg Tablet (sustained release) 100's: 400.00 MRP
NIXALO Square Pharmaceuticals Ltd. Alprazolam 0.5mg Tablet 10x10's: 200.00 MRP
SERELAM General Pharmaceuticals Ltd Alprazolam BP 0.25mg & 0.50mg Tablet 100's each: 100.00 & 201.00 MRP
XANAX Navana Pharmaceuticals Limited Alprazolam BP 0.25mg & 0.50mg Tablet 0.25mg x100's, 0.5mg x50's: 100.00, 100.50 IP
XOLAM XR Aristopharma Ltd. Alprazolam BP 0.25mg & 0.50mg Tablet (extended release) 50's each: 125.00 & 200.00 MRP
ZOLAX Beximco Pharmaceuticals Ltd Alprazolam USP 0.25 & 0.5mg Tablet 100's each: 100 & 200.00 MRP
Zolium 0.25 Incepta Pharmaceuticals Limited Alprazolam BP 0.25mg Tablet 10x10's:MRP 150 Tk
Zolium 0.5 Incepta Pharmaceuticals Limited Alprazolam BP 0.50mg Tablet 10x10's:MRP 300 Tk

Gen. MedInfo

Why is Alprazolam prescribed?

Alprazolam is used to treat anxiety disorders and panic disorder (sudden, unexpected attacks of extreme fear and worry about these attacks). Alprazolam is in a class of medications called benzodiazepines. It works by decreasing abnormal excitement in the brain.

How should Alprazolam be used?

Alprazolam comes as a tablet, an extended-release tablet, an orally disintegrating tablet (tablet that dissolves quickly in the mouth), and a concentrated solution (liquid) to take by mouth. The tablet, orally disintegrating tablet, and concentrated solution usually are taken two to four times a day. The extended-release tablet is taken once daily, usually in the morning. Follow the directions on your prescription label carefully, and ask your doctor to explain any part you do not understand. Take alprazolam exactly as directed.

To take the concentrated liquid, use only the dropper that came with your prescription. Draw into the dropper the amount prescribed for one dose. Squeeze the dropper contents into a liquid or semi-solid food such as water, juice, soda, applesauce, or pudding. Stir the liquid or food gently for a few seconds. The concentrated liquid will blend completely with the food. Drink or eat the entire mixture immediately. Do not store for future use.

Remove the orally disintegrating tablet from the bottle just before it is time for your dose. With dry hands, open the bottle, remove the tablet, and immediately place it on your tongue. The tablet will dissolve and can be swallowed with saliva. The orally disintegrating tablet can be taken with or without water.

Swallow the extended-release tablets whole; do not chew, crush, or break them.

Your doctor will probably start you on a low dose of alprazolam and gradually increase your dose, not more than once every 3 or 4 days.

Alprazolam can be habit-forming. Do not take a larger dose, take it more often, or take it for a longer period of time than prescribed by your doctor . Do not stop taking alprazolam or decrease your dose without talking to your doctor. If you suddenly stop taking alprazolam you may experience withdrawal symptoms such as seizures; shaking of a part of your body that you cannot control; headache; blurred vision; increased sensitivity to noise or light; change in sense of smell; sweating; difficulty falling asleep or staying asleep; difficulty concentrating; nervousness; depression; irritability; agressive behavior; muscle twitching or cramps; diarrhea; vomiting; pain, burning, numbness, or tingling in the hands or feet; a decrease in appetite; or weight loss. Your doctor will probably decrease your dose gradually.

Other uses for Alprazolam

Alprazolam is also sometimes used to treat depression, fear of open spaces (agoraphobia), and premenstrual syndrome. Talk to your doctor about the possible risks of using Alprazolam for your condition.

Alprazolam may be prescribed for other uses; ask your doctor for more information.

What special precautions to follow?

Before taking alprazolam,

  • inform your doctor if you are allergic to alprazolam, chlordiazepoxide, clonazepam, clorazepate, diazepam, estazolam, flurazepam, halazepam, lorazepam, oxazepam, prazepam, quazepam, temazepam, triazolam, or any other medications.
  • inform your doctor if you are taking itraconazole or ketoconazole (Nizoral). Your doctor willl probably tell you not to take alprazolam.
  • inform your doctor what other prescription and nonprescription medications, vitamins, and nutritional supplements, you are taking. Be sure to mention any of the following: amiodarone; antidepressants ('mood elevators') such as desipramine, imipramine, and nefazodone ; antifungals such as fluconazole, posaconazole, or voriconazole; antihistamines; cimetidine; clarithromycin; cyclosporine (Neoral, Sandimmune); diltiazem; ergotamine; erythromycin; isoniazid; medications for mental illness, chronic pain, and seizures; nicardipine; nifedipine; oral contraceptives (birth control pills); propoxyphene; selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, fluvoxamine, paroxetine, and sertraline; sedatives; sleeping pills; and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • inform your doctor what herbal products you are taking, especially St. John's wort.
  • inform your doctor if you have glaucoma (increased pressure in the eye that may cause loss of sight). Your doctor may tell you not to take alprazolam.
  • inform your doctor if you have or have ever had depression; if you have had thoughts of suicide or harming yourself; if you have alcoholism or if you drink or have ever drunk large amounts of alcohol;if you use or have ever used street drugs or have overused prescription medications;if you smoke; if you have had seizures;or if you have or have ever had lung, kidney, or liver disease.
  • inform your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. Alprazolam may harm the fetus. If you become pregnant while taking alprazolam, call your doctor .
  • talk to your doctor about the risks and benefits of taking Alprazolam if you are 65 years of age or older. Older adults should receive low doses of alprazolam because higher doses may not work better and may cause serious side effects.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking alprazolam.

  • you should know that alprazolam may make you drowsy. Do not drive a car or operate machinery until you know how Alprazolam affects you.

  • talk to your doctor about the safe use of alcohol while you are taking Alprazolam. Alcohol can make the side effects of alprazolam worse.

What special dietary instructions to follow?

Talk to your doctor about drinking grapefruit juice while taking Alprazolam.

What to do if I forget a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can Alprazolam cause?

Alprazolam may cause side effects. inform your doctor if any of these symptoms are severe or do not go away:

  • drowsiness

  • light-headedness

  • headache

  • tiredness

  • dizziness

  • irritability

  • talkativeness

  • difficulty concentrating

  • dry mouth

  • increased salivation

  • changes in sex drive or ability

  • nausea

  • constipation

  • changes in appetite

  • weight changes

  • difficulty urinating

  • joint pain

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

  • shortness of breath

  • seizures

  • seeing things or hearing voices that do not exist (hallucinating)

  • severe skin rash

  • yellowing of the skin or eyes

  • depression

  • memory problems

  • confusion

  • problems with speech

  • unusual changes in behavior or mood

  • thinking about harming or killing yourself or trying to do so

  • problems with coordination or balance

Alprazolam may cause other side effects. Consult your doctor if you have any unusual problems while taking Alprazolam.

 Ref: MedlinePlus, U.S. Natl. Library of Medicine


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