A Nurse’s Guide to Alprazolam

• Understand the actions and uses of Alprazolam to promote safety with its usage. 
• Specific situations should be avoided with the use of Alprazolam. 
• Nursing considerations must be considered when administering Alprazolam – patient/family teaching, administration, dosage, and side effects. 

Nurses often administer benzodiazepines in their daily practice. These medications are primarily used to relieve acute anxiety and panic attacks.  

However, doctors may also prescribe benzodiazepines to induce sleep in patients who have difficulty sleeping for prolonged periods.  

Here in this blog, we are going to discuss a drug that belongs to benzodiazepines, known as alprazolam.  

Actions and Usage of Alprazolam 

As a nurse, you should not confuse ALPRAZOLam with LORazepam or Xanax with Tenex or Zantac. Alprazolam is a benzodiazepine schedule IV drug, which means they have a risk for dependence, hence drug abuse.  

Therefore, you need to monitor that the patient does not become dependent on it. Moreover, when you withdraw the drug, tapering off is a good option as it may cause withdrawal symptoms, especially when given at high doses for long periods.  

The half-life of alprazolam is 6–27 hours. Therefore, its abrupt or too-rapid withdrawal may result in:  

• Restlessness 
• Irritability 
• Insomnia 
• Hand tremors 
• Abdominal and muscle cramps 
• Diaphoresis 
• Vomiting 
• Seizures 

Actions of Alprazolam  

Alprazolam acts by increasing the effects of the inhibitory neurotransmitter GABA (gamma amino butyric acid) in the brain. Hence, due to its CNS depressant effects, it produces anxiolytic effects. It is well absorbed from the gastrointestinal tract, has a protein binding of 80%, is metabolized in the liver, and is primarily excreted in the urine.  

Uses of Alprazolam 

Alprazolam is given for the following: 

• Management of generalized anxiety disorders (GAD) 
• Short-term relief of symptoms of anxiety and panic disorder, with or without agoraphobia 
• Anxiety associated with depression 

Moreover, it is also used as off-label therapy to treat anxiety in children and perioperative anxiety when the patient is too anxious undergoing surgery.  

Avoiding Alprazolam Usage 

When Alprazolam is prescribed, consider the risk versus benefit ratio. However, its use should be avoided in conditions such as: 

• Hypersensitivity to alprazolam 
• Acute narrow angle-closure glaucoma 
• Concurrent use with ketoconazole, itraconazole, or other potent CYP3A4 inhibitors 

In the following scenarios, alprazolam should be given with caution: 

• Patients with renal or hepatic impairment or predisposed to urate nephropathy  
• Obese patients 
• Patients taking CYP3A4 inhibitors/inducers and major CYP3A4 substrates concurrently 
• Debilitated patients  
• Patients with acute respiratory disease 
• Patients with depression, especially those with suicidal risk 
• Elderly because of the increased risk of severe toxicity 
• Those having a history of substance abuse 

Nursing Considerations of Alprazolam Usage 

Before starting alprazolam therapy, assess the patient for the degree of anxiety, drowsiness, dizziness, light-headedness, and motor and autonomic responses, and initiate fall precautions. Check if the patient has agitation, trembling, cold, and clammy hands with diaphoresis. 

In patients receiving long-term alprazolam therapy, hepatic and renal function tests should be monitored. Order their complete blood count test periodically. Assess the patient for paradoxical reactions, particularly during early treatment.  

Moreover, evaluate for therapeutic responses such as calm facial expression, decreased restlessness, and insomnia. Also, the patient’s respiratory and cardiovascular status must be monitored. 

Patient/Family Teaching With Alprazolam Usage 

With alprazolam therapy, teach the patient and his family members about the following things: 

• Benzodiazepines relieve anxiety symptoms for a short time. However, they do not cure it. Therefore, you must seek counseling therapy or psychotherapy that can help lower nervousness and anxiety and assist with sleep, preventing insomnia. 
• With drug therapy, also use other methods to calm and relax your mind, such as physical exercise, stress-management techniques, and relaxation techniques. 
• Identify triggers for anxiety, such as caffeine, cold medications, and appetite suppressant consumption. Avoiding their intake might help prevent stress, nervousness, and insomnia.  
• Tell other healthcare providers that you take benzodiazepines so that they prescribe accordingly and no drug interaction occurs.  
• Avoid doing hazardous activities that require alertness and psychomotor coordination until you know about the central nervous system effects of alprazolam.  
• Smoking reduces drug effectiveness. Therefore, avoid smoking with alprazolam therapy.  
• Avoid alcohol intake with benzodiazepines because they both can depress your central nervous system, leading to life-threatening consequences.  
• Do not take other drugs, over-the-counter products, or herbal remedies without first consulting the prescriber or a pharmacist with alprazolam therapy.  
• Take the drug as your physician has prescribed. Do not stop taking it abruptly, which could lead to life-threatening withdrawal symptoms. You can stop taking it with the approval of your prescriber.  
• If you take the drug for a long time, dependence might occur.  
• Take the drug at night or later in the day to prevent drowsiness in the daytime.  
• If dizziness occurs, change positions slowly from recumbent to sitting position before standing.  
• Alprazolam may cause dry mouth that can be relieved by sour hard candy, gum, and sips of water. 

Administration/Handling of Alprazolam 

Nurses play an essential role in the administration of drugs. Therefore, they should know how to administer the drug.  

For oral administration of immediate-release preparations of alprazolam, give without regard to food. Crush the tablets and give them sublingually if oral intake is not possible. 

For oral administration of extended-release preparations of alprazolam, administer once daily and do not break, crush, dissolve, or divide them. Instead, make the patient swallow whole. 

For oral administration of orally disintegrating preparations of alprazolam, place the tablet on the tongue and allow it to dissolve. Ask the patient to swallow with saliva. Administration with water is not necessary.  If using half the tablet, discard the remaining half.   

Typical Dosage Of Alprazolam 

The usual dose of alprazolam when immediately released or orally disintegrating tablets (ODT) are used is 0.25 to 0.5 mg orally administered three times a day, and its maximum dose is 4 mg/day. 

The usual adult dose of alprazolam for panic disorder, when immediately released tablets or ODTs are given, is 0.5 mg orally administered three times a day, and its maximum dose given is 10 mg/day. 

Extended-release tablets of alprazolam can be given initially as 0.5 to 1 mg orally once a day and maintained at 3 to 6 mg orally per day, preferably in the morning, and its maximum dose per day is 10 mg/day. 

Side Effects of Alprazolam 

Alprazolam is generally well tolerated. In some patients, it can cause lightheadedness, dizziness, and drowsiness. Ask the patient to report to the doctor soon if they experience any adverse drug reactions, such as: 

• Weak or shallow breathing 
• Hallucinations  
• Seizures  
• Increased energy and a decreased need for sleep  
• Being agitated, talkative with racing thoughts 
• Double vision  
• Jaundice- yellowing of eyes and skin  

Alprazolam overdose results in drowsiness, confusion, diminished reflexes, coma, and blood dyscrasias. To treat that, flumazenil is used as an antidote.  

The Bottom Line

Alprazolam belongs to the group of classes known as benzodiazepines, commonly used to treat panic attacks and anxiety. Compel your patients to take the alprazolam tablet as prescribed and report if they have any adverse drug reactions.

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