TABLE OF CONTENTS

Alprazolam (Xanax, Xanax XR, Apo-Alpraz, Niravam).................................................................................................... 1

ALPRAZOLAM (XANAX, XANAX XR, APO -ALPRAZ,
NIRAVAM)
THERAPETUIC CLASSIFICATION: ANTIANXIETY/
SEDATIVE/ HYPNOTIC
PHARMACOLOGIC CLASSIFICATION: BENZODIAZEPINE,
SHORT/INTERMEDIATE ACTING
INDICATIONS: ANXIETY WITH OR WITHOUT DEPRESSIVE
SYMPTOMS, PANIC DISORDERS WITH OR WITHOUT
AGORAPHOBIA 1 .
UNL ABELED USES: PREMENSTRUAL DYSPHORIC
DISORDER 2 , INSOMNIA, PMS, ALCOHOL WITHDRAWAL
SYNDROME
ACTION: DEPRESSES SUBCORTICAL LEVELS OF CNS,
INCLUDING LMBIC SYSTEM, RETICUL AR FORMATION.
DOSAGE AND ROUTES:
o Anxiety: PO 0.25-0.5 mg TID (increase Q3-4 days if
needed, max 4mg/day)
o Panic Disorder:
PO 0.5 mg TID (increase 1 mg/day for Q3-4 days,
max 10 mg/day)
Extended Release (Xanax XR) initial dosage 0.5-1
mg PO daily in AM. Maintenance 3-6 mg PO daily in
AM.
o Premenstrual Dysphoric Disorder (UNLABELED
USE): PO 0.25 mg BID-QID beginning on 16-18 day of
menses cycle3, taper over 2-3 days when menses
occurs, max 4 mg/day.
o Hepatic Dose: Reduce
1 A panic attack caused when the individual feel trapped.
2 A severe form of PMS.
o Insomnia (UNLABLED USE): PO 0.25-0.5 mg at
bedtime.
PO ORAL
DISINTEGRATING
ONSET 1 HR
PEAK 1-2 HR 1.5-2 HR.
NURSING IMPLICATIONS:
Common Side Effects: Dry Mouth, Dizziness, Drowsiness,
Orthostatic Hypotension, Blurred Vision.
Adverse Effects: Suicide, ECG Changes, Tachycardia.
Interactions: CNS depression: chamomile, kava, melatonin,
St. Johns Wort, valerian. Avoid Grapefruit it increases
product level.
Altered Lab Values (Long Term Use): Increases ALT, AST,
bilirubin, creatinine LDH, and alkaline Phosphatase
(indicates renal dysfunction, monitor I&O). May cause: blood
dycrasias4, decrease HCT, and neutropenia.
Administration: Should be given with food or milk to avoid
GI symptoms. However, high-fat meals impede absorption.
Can be crushed. Place oral disintegrating TABS on the
tongue. When discontinuing reduce by 0.5 mg Q3 Days.
Give extended release tabs in the AM. Use sugarless gum,
hard candy, or sips of water for dry mouth.
Assessment:
o Mental status (especially in geriatrics): mood, sensorium,
anxiety, affect, sleeping, drowsiness, dizziness.
3 A cycle is counted from the first day of 1 period to the first
day of the next period.
4 A pathologic condition of the cellular elements of blood.
o Assess dependency and withdrawal symptoms: vomiting,
cramping, tremors, seizures. Rapid decrease in dose can
cause withdrawal seizures.
o Assess anxiety, panic attacks, agitation, seizures,
headache, nausea, vomiting, muscle pain, weakness,
and suicidal tendencies.
o Monitor for Orthostatic Hypotension, if BP drops 20 mm
Hg hold.
o Pregnancy category D avoid breastfeeding.
Patient Education:
o Avoid using for everyday stress, doubling or skipping
doses, or using longer than 4 mo. (unless prescribed).
One sign of long term use is memory impairment.
Discontinue the medication slowly to avoid withdrawal
symptoms (see above).
o Avoid OTC drugs unless approved, alcohol and CNS
depressants can increase depression.
o Avoid activities that require alertness, may cause
drowsiness.
o Rise slowly to prevent fainting (Orthostatic Hypotension)
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