Alprazolam 1mg Tablets

• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, nefazodone)

• Opioids (e.g., hydrocodone, oxycodone, morphine) - increased risk of respiratory depression, profound sedation, coma, and death.
• Other CNS depressants (e.g., alcohol, barbiturates, other benzodiazepines, sedating antihistamines, tricyclic antidepressants) - additive CNS depression.
• Protease inhibitors (e.g., ritonavir, indinavir) - significant increase in alprazolam levels.
• Macrolide antibiotics (e.g., erythromycin, clarithromycin) - increased alprazolam levels.

• Moderate CYP3A4 inhibitors (e.g., fluoxetine, fluvoxamine, diltiazem, verapamil, grapefruit juice) - increased alprazolam levels.
• Oral contraceptives - may increase alprazolam levels.
• Digoxin - may increase digoxin levels (rare).

• Caffeine - may reduce anxiolytic effects.
• Theophylline - may reduce anxiolytic effects.

• Excessive sedation
• Dizziness
• Ataxia
• Confusion
• Slurred speech
• Memory impairment
• Paradoxical reactions (e.g., agitation, aggression, hallucinations)
• Respiratory depression
• Signs of withdrawal upon dose reduction or discontinuation (e.g., rebound anxiety, insomnia, tremors, seizures, psychosis)

Alprazolam is classified as Pregnancy Category D. It should not be used during pregnancy due to evidence of fetal risk. Use only if the potential benefit justifies the potential risk to the fetus.

Alprazolam is excreted into breast milk. Use is generally not recommended due to potential for sedation, feeding difficulties, and withdrawal symptoms in the breastfed infant.

Safety and efficacy have not been established in pediatric patients (<18 years of age). Use is generally not recommended due to lack of data and potential for adverse effects.

Geriatric patients may be more sensitive to the effects of benzodiazepines, including alprazolam. They are at increased risk for sedation, dizziness, ataxia, falls, and cognitive impairment. Lower initial doses (e.g., 0.25 mg 2-3 times daily) and slower titration are recommended. Monitor closely for adverse effects.

• Alprazolam has a relatively short half-life compared to other benzodiazepines, which can lead to more pronounced inter-dose withdrawal symptoms and a higher potential for dependence.
• Due to its rapid onset of action and high potency, alprazolam has a significant potential for abuse and physical dependence. Prescribe for the shortest duration possible.
• Tapering off alprazolam must be done very slowly to minimize withdrawal symptoms, which can include seizures, psychosis, and severe rebound anxiety. A reduction of no more than 0.5 mg every 3 days is often recommended, but slower tapers may be necessary.
• Paradoxical reactions (e.g., agitation, aggression, hallucinations) can occur, especially in pediatric, geriatric, or psychiatric patients. Discontinue if these occur.
• Avoid concomitant use with opioids due to the black box warning regarding severe respiratory depression and death.

• Other benzodiazepines (e.g., lorazepam, clonazepam, diazepam) for anxiety/panic disorders (consider differences in half-life and potency).
• SSRIs (e.g., escitalopram, sertraline, fluoxetine) - first-line for long-term management of anxiety and panic disorders.
• SNRIs (e.g., venlafaxine, duloxetine) - also effective for anxiety disorders.
• Buspirone - non-benzodiazepine anxiolytic, slower onset of action.
• Beta-blockers (e.g., propranolol) - for somatic symptoms of anxiety.
• Cognitive Behavioral Therapy (CBT) - highly effective non-pharmacological treatment for anxiety and panic disorders.