Alprazolam Con 1mg/ml Solution

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

• Opioids (increased risk of respiratory depression, profound sedation, coma, and death)
• Other CNS depressants (e.g., alcohol, barbiturates, sedating antihistamines, other anxiolytics, antipsychotics, tricyclic antidepressants) - increased CNS depression
• Moderate CYP3A4 inhibitors (e.g., fluvoxamine, cimetidine, erythromycin, diltiazem, fluoxetine, propoxyphene, oral contraceptives) - increased alprazolam levels
• Digoxin (increased digoxin levels)

• Imipramine, desipramine (increased plasma levels of these antidepressants)
• Grapefruit juice (may inhibit CYP3A4, increasing alprazolam levels)
• St. John's Wort (may induce CYP3A4, decreasing alprazolam levels)
• Theophylline (may antagonize benzodiazepine effects)

• Not available

• Excessive sedation
• Dizziness
• Ataxia
• Confusion
• Memory impairment
• Slurred speech
• Respiratory depression (especially with concomitant opioids)
• Paradoxical excitation (rare)
• Signs of withdrawal (e.g., rebound anxiety, insomnia, irritability, tremors, seizures, psychosis) upon discontinuation or dose reduction.

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. There is evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Alprazolam is excreted into breast milk. The American Academy of Pediatrics considers it a drug for which the effect on nursing infants is unknown but may be of concern. Use with caution, monitor infant for sedation, poor feeding, and weight gain. Consider alternative agents or temporary discontinuation of breastfeeding.

Safety and efficacy have not been established in pediatric patients (under 18 years of age). Use is generally not recommended.

Elderly patients may be more sensitive to the effects of benzodiazepines, including alprazolam. They are at increased risk for sedation, dizziness, falls, and cognitive impairment. Initial doses should be lower (e.g., 0.25 mg two or three times daily) and titrated slowly. Monitor closely for adverse effects.

• Alprazolam oral solution (1 mg/ml) allows for flexible and precise dosing, especially for titration or tapering.
• Due to its relatively short half-life, alprazolam may be associated with more pronounced inter-dose withdrawal symptoms or rebound anxiety compared to longer-acting benzodiazepines.
• Always emphasize the importance of a slow taper when discontinuing alprazolam to minimize severe withdrawal symptoms, including seizures.
• Educate patients about the significant risks of concomitant use with opioids and alcohol.
• Consider the patient's history of substance abuse before prescribing due to the high potential for abuse and dependence.
• Paradoxical reactions (e.g., agitation, aggression, hallucinations) can occur, especially in pediatric or elderly patients, or those with underlying psychiatric conditions.

• Other benzodiazepines (e.g., lorazepam, clonazepam, diazepam)
• SSRIs (e.g., escitalopram, sertraline, fluoxetine) for anxiety and panic disorders (first-line for long-term management)
• SNRIs (e.g., venlafaxine, duloxetine) for anxiety disorders
• Buspirone (for generalized anxiety disorder)
• Hydroxyzine (for short-term anxiety)
• Beta-blockers (e.g., propranolol) for performance anxiety or physical symptoms of anxiety
• Cognitive Behavioral Therapy (CBT) and other psychotherapies