alprazolam: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
alprazolam: clinical details
Prescribing considerations
- Confirm that anxiety is severe and matches the licensed indication.
- Discuss dependence, addiction, tolerance and withdrawal, with an agreed exit strategy.
- Review psychiatric history, suicidality, substance misuse and all medicines.
- Use particular caution in older or debilitated people because sedation, ataxia and weakness increase falls risk.
- Assess renal, hepatic and respiratory impairment.
- Avoid or tightly justify concurrent opioids and other CNS depressants.
Contraindications and cautions
- Hypersensitivity to alprazolam, benzodiazepines or an excipient
- Myasthenia gravis
- Severe respiratory insufficiency
- Sleep apnoea syndrome
- Severe hepatic insufficiency
Monitoring
- Therapeutic response and continuing clinical need
- Sedation, cognition, coordination, falls and driving impairment
- Respiratory depression, especially with opioids or respiratory disease
- Tolerance, withdrawal, misuse, diversion or addiction
- Paradoxical agitation, aggression, hallucinations or mania
- Digoxin toxicity when co-prescribed
Clinical pharmacology
Alprazolam is a CYP3A4-metabolised benzodiazepine that potentiates GABA-mediated CNS inhibition.
alprazolam preparations and strengths
Tablet
Route: Oral
Strengths: 250 micrograms, 500 micrograms
alprazolam interactions
Tell the prescriber or pharmacist about all prescribed, non-prescribed and online medicines. Important interactions include:
Opioids
Additive sedation and respiratory depression can lead to coma or death.
Alcohol
Increases sedation, impaired coordination and breathing risk and should be avoided.
Other CNS depressants
Sleeping tablets, sedating antihistamines, antipsychotics, antiepileptics, anaesthetics and some antidepressants can increase drowsiness and impairment.
Azole antifungals
Ketoconazole, itraconazole and similar medicines can markedly increase alprazolam exposure; co-administration is not recommended.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.