Alprazolam 0.25mg Tablets

• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin, ritonavir, nelfinavir, indinavir) due to significant increase in alprazolam plasma concentrations and prolonged effects.

• Opioids (e.g., hydrocodone, oxycodone, morphine): Increased risk of profound sedation, respiratory depression, coma, and death. Concomitant use should be avoided unless benefits outweigh risks, and patients should be monitored closely.
• Other CNS depressants (e.g., alcohol, barbiturates, sedating antihistamines, other benzodiazepines, tricyclic antidepressants, antipsychotics): Additive CNS depressant effects, leading to increased sedation, respiratory depression, and psychomotor impairment.
• Moderate CYP3A4 inhibitors (e.g., fluoxetine, fluvoxamine, nefazodone, cimetidine, erythromycin, diltiazem, verapamil): May increase alprazolam plasma concentrations, requiring dose reduction of alprazolam.

• Oral contraceptives: May inhibit alprazolam metabolism, leading to increased alprazolam levels.
• Digoxin: Alprazolam may increase serum digoxin concentrations; monitor digoxin levels.
• Imipramine, desipramine: Alprazolam may increase steady-state plasma concentrations of these antidepressants.

• Not available

• Excessive drowsiness or sedation
• Dizziness or lightheadedness
• Confusion or disorientation
• Slurred speech
• Difficulty breathing or shallow breathing
• Impaired coordination or ataxia
• Paradoxical reactions (e.g., agitation, aggression, hallucinations)
• Signs of withdrawal upon dose reduction or discontinuation (e.g., rebound anxiety, insomnia, irritability, tremors, seizures)

Alprazolam is classified as Pregnancy Category D. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Alprazolam and its active metabolites are excreted into breast milk. Use during breastfeeding is generally not recommended, or should be done with extreme caution and close infant monitoring.

Safety and efficacy have not been established in pediatric patients. Use is generally not recommended due to potential for adverse effects and lack of data. If used, it should be under strict specialist supervision for specific indications.

Elderly patients are more sensitive to the effects of benzodiazepines and may experience increased risk of sedation, dizziness, cognitive impairment, and falls. Lower initial doses (e.g., 0.25 mg BID or TID) are recommended, and titration should be done slowly with close monitoring. The half-life of alprazolam may be prolonged in the elderly.

• Alprazolam has a relatively short half-life among benzodiazepines, which can lead to inter-dose withdrawal symptoms or rebound anxiety, especially with higher doses or less frequent dosing.
• Due to its rapid onset of action and high potency, alprazolam has a significant potential for abuse, misuse, and physical dependence. It is a Schedule IV controlled substance.
• Physical dependence can develop even with therapeutic doses and short-term use. Tapering off the medication slowly is crucial to minimize withdrawal symptoms, which can include seizures.
• Not typically recommended as first-line for long-term generalized anxiety disorder; often used for acute anxiety or panic attacks, or as an adjunct to other therapies (e.g., antidepressants).
• Patients should be educated about the risks of concomitant use with alcohol and other CNS depressants, including opioids, due to the risk of severe respiratory depression and death.

• Other benzodiazepines (e.g., lorazepam, clonazepam, diazepam) for anxiety/panic disorders.
• Selective Serotonin Reuptake Inhibitors (SSRIs) or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) as first-line long-term treatment for anxiety and panic disorders.
• Buspirone (for generalized anxiety disorder, non-addictive).
• Hydroxyzine (antihistamine with anxiolytic properties).
• Beta-blockers (e.g., propranolol) for somatic symptoms of anxiety.
• Cognitive Behavioral Therapy (CBT) and other psychotherapies.
• Lifestyle modifications (e.g., exercise, mindfulness, stress management techniques).