Skip to Main Content

++

INTRODUCTION

++

alprazolam (al-pray-zoe-lam)

Apo-Alpraz, Novo-Alprazol, Niravam, Nu-Alpraz, Xanax, Xanax XR

Classification

Therapeutic: antianxiety agents

Pharmacologic: benzodiazepines

Schedule IV

++
Indications
++

Treatment of Generalized anxiety disorder (GAD); Panic disorder; Management of anxiety associated with depression. Unlabeled Use: Management of symptoms of premenstrual syndrome (PMS). Insomnia, irritable bowel syndrome (IBS), and other somatic symptoms associated with anxiety. Used as an adjunct with acute mania, acute psychosis.

++
Action
++

Acts at many levels in the CNS to produce anxiolytic effect. May produce CNS depression. Effects may be mediated by GABA, an inhibitory neurotransmitter. Therapeutic Effects: Relief of anxiety.

++
Adverse Reactions/Side Effects
++

CNS: dizziness, drowsiness, lethargy, confusion, hangover, headache, mental depression, paradoxical excitation. EENT: blurred vision. GI: constipation, diarrhea, nausea, vomiting, weight gain. Derm: rashes. Misc: physical dependence, psychologic dependence, tolerance.

++

PHYSICAL THERAPY IMPLICATIONS

++
Examination and Evaluation
++

  • Monitor daytime drowsiness and “hangover” symptoms (headache, nausea, irritability, lethargy, dysphoria). Repeated or excessive symptoms may require change in dose or medication.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Report any behavioral or personality changes such as confusion, decreased mental acuity, or excessive excitation.

++
Interventions
++

  • Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall-prevention strategies, especially in older adults or if drowsiness and dizziness carry over into the daytime (See Appendix E).

  • Help patient explore nonpharmacologic methods to reduce anxiety and depression, such as relaxation techniques, exercise, counseling, support groups, and so forth.

++
Patient/Client-Related Instruction
++

  • Instruct patients on prolonged treatment to not discontinue medication without consulting their physician. Abrupt withdrawal can cause insomnia, unusual irritability or nervousness, and seizures.

  • Advise patient or family/caregivers about the potential risk of tolerance and physical/psychologic dependence. Emphasize that addiction is more likely during prolonged, excessive, or inappropriate use of this drug.

  • Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

  • Instruct patient to report other bothersome side effects such as severe or prolonged headache, blurred vision, rash, weight gain, or GI problems (nausea, vomiting, diarrhea, constipation).

++
Pharmacokinetics
++

Absorption: Well absorbed (90%) from the GI tract; absorption is slower with extended-release tablets.

++

Distribution: Widely distributed, crosses blood-brain barrier. Probably crosses the placenta and enters breast milk. Accumulation is minimal.

++

Metabolism and Excretion: Metabolized by the liver (CYP3A4 enzyme system) to an active compound that is subsequently rapidly metabolized.

++

Half-life: 12–15 hr.

++

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.