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Alprazolam is a benzodiazepine. It promotes the binding of the major inhibitory neurotransmitter γ-aminobutyric acid (GABA) to the GABAA subtype of GABA receptors, which is a ligand-gated chloride channel, thereby enhancing the GABA-induced ionic currents through these channels. It is available for oral use as a tablet and solution.(1)

Treatment of generalized anxiety disorder. Treatment of panic disorder, with or without agoraphobia.(2,3)

Acute narrow angle glaucoma. Respiratory depression. Marked neuromuscular respiratory weakness including unstable myasthenia gravis. Acute pulmonary insufficiency. Sleep apnoea syndrome. Severe hepatic impairment. Narrow angle glaucoma. Hypersensitivity to alprazolam or any of its components.(2,3)

Drowsiness and lightheadedness on the next day. Confusion and ataxia (especially in the elderly). Amnesia. Dependence. Paradoxical increase in aggression. Muscle weakness.(2,3)

CYP3A inhibitors (e.g., ketoconazole and itraconazole): increase the serum concentration of alprazolam. Psychotropic medications, anticonvulsants, antihistaminics, alcohol and other drugs that produce CNS depression: Additive CNS depressant effects Antacids and anti- cholinergics: Slowing of disintegration and dissolution of alprazolam, leading to decreased absorption.(2)3

Renal and hepatic insufficiency: Dose reduction mandatory. Avoid long term use.(2)

Anxiety Disorder: Initial: 0.25 mg to 0.5 mg given three times daily. Maximum: 4 mg per day given in divided doses. Panic Disorder: Initial: 0.5 mg given three times daily. Maximum: Doses up to 10 mg per day may be required.(1,2,3)

1. Mihic SJ, Harris RA. Hypnotics and sedatives. In: Brunton L, Chabner B, Knollmann B eds. Goodman & Gilman’s The Pharmacological basis of Therapeutics. 12th ed. USA: McGraw Hill; 2011: 457-82. 2. Alprazolam. Highlights of prescribing information. [Online] [Cited 2013 Sept 10]. Available from: URL: 3. National Formulary of India. 4th ed. Government of India, Ministry of Health and Family Welfare. India: Indian Pharmacopoeia Commission; 2011.