ALPRAZOLAM
GENERIC NAME: alprazolam
BRAND NAME: Alprazolam Intensol, Niravam,, Xanax, Xanax XR
DRUG CLASSES: Benzodiazepine, Anxiolytic
Pregnancy Category D
Controlled Substance C-IV
MECHANISM OF ACTION
The drug’s exact mechanisms of action not yet understood; however its main sites of action may be the limbic system and reticular formation; it increases the effects of gamma-aminobutyrate, an inhibitory neurotransmitter; and it has an anxiety blocking effects occur at doses well below those necessary to cause sedation, ataxia.
INDICATIONS
1. Management of anxiety disorders, short-term relief of symptoms of anxiety; anxiety associated with depression; and
2. Treatment of panic attacks with or without agoraphobia
CONTRAINDICATIONS
This drug is contraindicated with hypersensitivity to benzodiazepines, psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with depression of vital signs, pregnancy (crosses the placenta; risk of congenital malformations, neonatal withdrawal syndrome), labor and delivery ("floppy infant" syndrome), lactation (secreted in breast milk; infants become lethargic and lose weight). Use this drug cautiously with impaired liver or kidney function, debilitation.
ADVERSE EFFECTS
CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, light-headedness, disorientation, anger, hostility, restlessness, confusion, crying, headache, mild paradoxical excitatory reactions during first 2 wk of treatment, episodes of mania and hypomania, delirium, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness, difficulty in concentration, vivid dreams, psychomotor retardation, extrapyramidal symptoms.
CV: Bradycardia, tachycardia, CV collapse, hypertension, hypotension, palpitations, edema
Dermatologic: Urticaria, pruritus, rash, dermatitis
EENT: Visual and auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion
GI: Constipation, diarrhea, dry mouth, nausea, salivation, anorexia, vomiting, difficulty in swallowing, gastric disorders, hepatic dysfunction
GU: Incontinence, changes in libido, urinary retention, menstrual irregularities
Hematologic: Elevations of blood enzymes—LDH, alkaline phosphatase, AST, ALT; blood dyscrasias—agranulocytosis, leukopenia
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 months.
INTERACTIONS
Drug-drug
1. Increased CNS depression with alcohol, other CNS depressants, propoxyphene;
2. Increased effect with cimetidine, disulfiram, omeprazole, isoniazid, hormonal contraceptives, valproic acid;
3. Decreased effect with carbamazepine, rifampin, theophylline;
4. Possible increased risk of digitalis toxicity with digoxin;
5. Decreased antiparkinson effectiveness of levodopa with benzodiazepines; and
6. Contraindicated with ketoconazole, itraconazole; serious toxicity can occur
Drug-food
1. Decreased metabolism and risk of toxic effects if combined with grapefruit juice; avoid this combination;
2. Risk of coma if combined with kava therapy; and
3. Additive sedative effects with valerian root
NURSING CONSIDERATIONS
Assessment
History: Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication with depression of vital signs; labor and delivery; lactation; impaired liver or kidney function; debilitation
Physical: Skin color, lesions; T; orientation, reflexes, affect, ophthalmologic examination; P, BP; liver evaluation, abdominal examination, bowel sounds, normal output; CBC, LFTs, renal function tests
Interventions
1. Arrange to taper dosage gradually after long-term therapy, especially in epileptic patients;
2. Do not administer with grapefruit juice; and
3. Taper drug slowly; decrease by no more than 0.5 mg every 3 days.
Educative
1. Take this drug exactly as prescribed; take extended-release form once a day in the AM; place rapidly disintegrating tablet on top of tongue, where it will disintegrate and can be swallowed with saliva.
2. Do not drink grapefruit juice while on this drug.
3. Do not stop taking drug (in long-term therapy) without consulting health care provider.
4. Avoid alcohol, sleep-inducing, or over-the-counter drugs.
5. Patient may experience these side effects: Drowsiness, dizziness (these effects will be less pronounced after a few days, avoid driving a car or engaging in other dangerous activities if these occur); GI upset (take drug with food); fatigue; depression; dreams; crying; nervousness.
6. Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, difficulty voiding, palpitations, swelling in the extremities.
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