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Back to Psychiatry Drug Index

Back to Benzodiazipines

Name: Alprazolam

Pregnancy Category D C-IV drug

Drug classes

  • Benzodiazepine
  • Antianxiety drug

Therapeutic actions

Exact mechanisms of action not understood; main sites of action may be the limbic system and reticular formation; increases the effects of gamma-aminobutyrate, an inhibitory neurotransmitter; anxiety blocking effects occur at doses well below those necessary to cause sedation, ataxia.

Indications

Management of anxiety disorders or for short-term relief of symptoms of anxiety; anxiety associated with depression also is responsive.

Treatment of panic attacks with or without agoraphobia

Unlabeled uses: social phobia, premenstrual syndrome, depression

Contraindications/cautions

Contraindicated in the presence of hypersensitivity to benzodiazepines, psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with depression of vital signs, pregnancy (crosses the placenta; increased risk of congenital malformations, neonatal withdrawal syndrome), labor and delivery ("floppy infant" syndrome reported when mothers were given benzodiazepines during labor), lactation (secreted in breast milk; has caused infants to become lethargic and lose weight).

Use caution in the presence of impaired liver or kidney function, debilitation.

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Adverse effects

  • CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, lightheadedness, disorientation, anger, hostility, episodes of mania and hypomania, restlessness, confusion, crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness, difficulty in concentration, vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild paradoxical excitatory reactions, during first 2 weeks of treatment
  • GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, gastric disorders, hepatic dysfunction
  • CV: Bradycardia, tachycardia, cardiovascular collapse, hypertension, hypotension, palpitations, edema
  • Hematologic: Elevations of blood enzymes-LDH, alkaline phosphatase, SGOT, SGPT; blood dyscrasias-agranulocytosis, leukopenia
  • GU: Incontinence, urinary retention, changes in libido, menstrual irregularities
  • Dermatologic: Urticaria, pruritus, skin rash, dermatitis
  • EENT: Visual and auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion
  • Other: Hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomastia. Drug dependence with withdrawal syndrome when drug is discontinued; more common with abrupt discontinuation of higher dosage used for longer than 4 mo.
 

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