Benzodiazepine – Anxiolytic

Uses: anxiety w/wo depression; panic; dyspnea; agitation; restlessness; insomnia; muscle spasm

Pointers:

lower doses in Hepatic & Renal impairment

careful titration in respiratory depression & Myasthenia

metabolized by CYP450: Alprazolam is increased by CYP450 inhibitors: Cimetidine, Fluconazole, ketoconazole, Fluoxetine, miconazole

alprazolam decreased by CYP450 inducers : carbamazepine

additive effects by all sedative, alcohol,

inc / decrease Phenytoin

enhance GABA (inhibitory neurotransmitter)

onset 10-20 min; peak 1-2 hrs; HL 11-15 hrs

strongest anxiolytic followed by Lorazepam & Diazepam

Side effects:

drowsiness, fatigue, light-headedness, slurred speech, paradoxical hyper-excitation,

Supply: Tab 0.25, 0.5,1, 2 mg; Sol 1 mg/ml

Rx : 0.25 – 1 mg TID, increase 0.25 to 1 mg to desire effect. max 4 mg (may require up to 10 mg)