Alprazolam

INTRODUCTION

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.