Xanax (alprazolam)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Alprazolam is a benzodiazepine.
USES: Alprazolam is used to treat anxiety and panic disorders. Alprazolam belongs to a class of medications called benzodiazepines. It works by calming the brain and nerves.
Generic name: alprazolam
Pronunciation: (al-PRA-zoe-lam)
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Xanax
Indications
The following indications are listed for Xanax:
- Anxiety
- Anxiety With Depression
- Generalized Anxiety Disorder
- Panic Disorder
Also known as: Anxiety Associated With Depression, Mixed Anxiety And Depressive Disorder, Panic Reaction, Panic-Like Sensation.
Dosing
Dosage of alprazolam must be individualized, and the smallest effective dosage should be used (especially in geriatric or debilitated patients and in those with liver disease, low serum albumin, or obesity) to avoid oversedation. If early morning anxiety occurs or emergence of symptoms occurs between doses of an immediate-release preparation in patients previously stabilized, the need for dosage adjustment or maintenance of the same daily dosage but divided and administered at more frequent intervals should be considered.
Immediate-release preparations of alprazolam (i.e., conventional and orally disintegrating tablets, oral solution concentrate) are administered orally in divided doses. Because concomitant oral administration of grapefruit juice with other similarly metabolized benzodiazepines has been reported to increase the bioavailability of these drugs, caution is advised if grapefruit juice is ingested concomitantly with alprazolam. (See Drug Interactions: Grapefruit Juice under Drug Interactions in the Benzodiazepines General Statement 28:24.08.)
When alprazolam oral concentrate is used, the dose should be added to 30 mL or more of diluent (e.g., water, juices, carbonated or soda-like beverages) or to semi-solid foods (e.g., applesauce, pudding) just before administration.
The orally disintegrating tablets should be administered immediately after the tablet is removed from the container by the patient; if only half a tablet is administered, the unused portion should be discarded immediately since it may not remain stable. The orally disintegrating tablet should be removed with a dry hand and placed on the tongue, where it disintegrates rapidly in saliva, and then subsequently can be swallowed with or without water. Any cotton that is present in the container when initially opened should be discarded, and the container should be resealed tightly to prevent the introduction of moisture, which might cause tablet disintegration. Although peak plasma concentrations are achieved 15 minutes sooner when the orally disintegrating tablets are administered with water, the peak concentration and oral bioavailability are not affected by administration with water. Administration of the orally disintegrating tablets with a high-fat meal does not affect the extent of absorption but may delay and reduce peak plasma concentrations of the drug by about 2 hours and 25%, respectively. If the orally disintegrating tablets are used in the presence of conditions or in conjunction with drugs that increase gastric pH or cause dry mouth, disintegration or dissolution of the tablets might be slower, potentially resulting in reduced or slower absorption of alprazolam.
Alprazolam extended-release tablets are administered once daily, preferably in the morning. When the extended-release tablets are administered at night rather than in the morning, peak plasma concentrations are about 30% higher and occur about 1 hour sooner. The extended-release tablets should be swallowed whole and should not be chewed, crushed, or broken. The relative oral bioavailability of alprazolam when administered as extended-release tablets is 100% that of conventional (immediate-release) tablets; however, the rate of GI absorption is slower. The slower absorption rate results in a relatively constant plasma concentration of the drug that is maintained between 5-11 hours after dosing. Multiple-dose studies indicate that the metabolism and elimination of the drug are similar with the immediate- and extended-release tablets. Food affects the rate but not the extent of absorption of alprazolam extended-release tablets. Peak plasma concentrations are increased by 25% when alprazolam extended-release tablets are administered within 2 hours after a high-fat meal; time to peak plasma concentrations may be reduced by about one-third if the dose is administered immediately after a meal but may be increased by about one-third if administered 1 hour or more before a meal.
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Drug interactions
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There are no contraindication interactions for this drug.
There are no severe interactions for this drug.
There are no moderate interactions for this drug.
Contraindications
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There are no contraindication contraindications for this drug.
There are no severe contraindications for this drug.
There are no moderate contraindications for this drug.
Adverse reactions
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There are no severe adverse reactions for this drug.
There are no less severe adverse reactions for this drug.
Precautions
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ICD codes
No ICD codes are available for this drug.
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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