Immediate-release: Decrease initial dose to 0.25 mg PO q8-12hr; may gradually increase if necessary and as tolerated; may increase every 3-4 days by ≤1 mg/day to 5-6 mg/day average dose Extended-release: Start at 0.5 mg PO q Day; may gradually increase if necessary and as tolerated; may increase q3-4Days by ≤1 mg/day to 3-6 mg/day Use smallest effective dose to avoid ataxia and oversedation Elderly especially sensitive to benzodiazepine effects; higher plasma levels exhibited because of reduced clearance Mean half-life: 16.3 hours in healthy elderly individuals (range: 9-26.9 hr), compared with 11 hours in healthy adults (range: 6.3-15.8 hr) Drowsiness (77%) Impaired coordination (40-50%) Increased appetite (30-35%) Fatigue (30-35%) Memory impairment (30-35%) Irritability (30-35%) Decreased salivation (30-35%) Cognitive disorders (20-30%) Insomnia (20-30%) Dcreased appetite (20-30%) Headache (20-30%) Lightheadedness (20-30%) Dysarthria (20-30%) Diarrhea, constipation, and nausea/vomiting (20-30%) Weight change (20-30%) Nasal congestion (15-20%) Decreased or increased libido (10-15%) Menstrual disorder (10-15%) Difficult micturition (10-15%) Tachycardia (5-10%) Confusion (5-10%) Insomnia (5-10%) Nausea/vomiting (5-10%) Blurred vision (5-10%) Nasal congestion (5-10%) Hypotension (1-5%) Syncope (1-5%) Akathisia (1-5%) Dizziness (1-5%) Increased salivation (1-5%) Nervousness (1-5%) Tremor (1-5%) Weight change (1-5%) Gastrointestinal: Liver enzyme elevations, hepatitis, hepatic failure CNS: Hypomania, mania Immunologic: Stevens-Johnson syndrome, angioedema, peripheral edema Endocrine: Hyperprolactinemia, gynecomastia, galactorrhea Concomitant use of benzodiazepines and opioids may result in profound respiratory depression, coma, and death; administer concomitantly when there are no alternative options; limit dosages and durations to minimum required; monitor for signs and symptoms of respiratory depression and sedation 10 days) Do not stop treatment abruptly; slowly taper to discontinuation (0.5 mg q3Days) Use caution in elderly patients Use caution in debilitated patients Use caution in severe respiratory depression Use caution in patients who recently received other respiratory depressants Use caution in patients who are at risk of falls May have prolonged effects in obese patients when discontinued; use caution Not for us in acute alcohol intoxication Use with caution in patients with hepatic or renal impairment Myasthenia gravis (allowable in limited circumstances) Use caution in cases of respiratory disease (COPD), sleep apnea, renal/hepatic disease, open-angle glaucoma (questionable), depression, suicide ideation, drug abuse CNS depressant; may impair ability to perform hazardous tasks Paradoxical reactions, including hyperactive or aggressive behavior reported Cigarette smoking may decrease alprazolam concentration up to 50% Mania and hypomania episodes reported in depressed patients Pregnancy category: D Lactation: Enters breast milk/not recommended Minor tranquilizers should be avoided in first trimester of pregnancy due to increased risk of congenital malformations Maternal use shortly before delivery is associated with floppy infant syndrome (good and consistent evidence) Prenatal benzodiazepine exposure slightly increases oral cleft risk (limited or inconsistent evidence) Binds receptors at several sites within the CNS, including the limbic system and reticular formation; effects may be mediated through GABA receptor system; increase in neuronal membrane permeability to chloride ions enhances the inhibitory effects of GABA; the shift in chloride ions causes hyperpolarization (less excitability) and stabilization of the neuronal membrane The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. If you’ve ever taken Xanax or someone you know takes the prescription drug, you may wonder where is Xanax metabolized? Before going into the specifics of where Xanax is metabolized, the following is a brief overview of the drug. Xanax is part of a class of medicines called benzodiazepines. These drugs are intended for the treatment of anxiety primarily, as well as panic disorders, and in some cases insomnia, and treatment for withdrawal from alcohol. A doctor must prescribe benzos including Xanax, but the number of prescriptions being written continues to increase exponentially, making these drugs relatively easy for people to get. When someone takes Xanax, there is a change in their brain function is a result, because these substances cross the blood-brain barrier and impact GABA, which is a neurotransmitter that controls communication between neurons in the central nervous system. If you experience anxiety or panic, there is likely a lot of activity firing between neurons, and Xanax calms this and creates a sedative impact while reducing symptoms of clinically-defined anxiety. We know the struggle, which is why we're uniquely qualified to help. Can i buy zovirax at walmart When viagra fails to work Patients with chronic kidney disease experience fatigue, anxious mood. Hydroxyzine, Alprazolam, and Tramadol to treat their chronic kidney disease. Did you know that there are certain medications out there that can cause forms of kidney damage? Don't get me wrong. These medications can. How Does Xanax Alprazolam Treat Panic Disorder. Sleep apnea; Liver disease; Drug or alcohol addiction; Kidney disease; Depression. In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. For this medicine, the following should be considered: Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully. Appropriate studies have not been performed on the relationship of age to the effects of alprazolam in the pediatric population. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of alprazolam in the elderly. However, elderly patients are more likely to have unwanted effects (eg, severe drowsiness, dizziness, confusion, clumsiness, or unsteadiness) and kidney, liver, or lung problems, which may require caution and an adjustment in the dose for patients receiving this medicine. Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using this medicine. Xanax (alprazolam) and Omeprazole do not pose any problems for patients with kidney disease. Omeprazole should be monitored in patients with chronic kidney disease (CKD) because of the possibility of low blood levels of magnesium. Long term use of omeprazole can cause low blood levels of magnesium. Hence, you may need to review the long term use of Omeprazole with your primary care physician (PCP). 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