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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. 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