Alprazolam

Alprazolam: Uses, Dosage and Side Effects

Overview

Alprazolam increases the CNS’s GABA activity, which has a variety of cognitive effects, including the suppression of memory and a reduction in anxiety.

Uses of Alprazolam

• Treatment of anxiety and fear-related disorders in dogs and cats, especially where there are signs of panic.
• It can also be used to treat urine spraying in cats, although a high rate of relapse following withdrawal should be anticipated.
• As an adjuvant to clomipramine or specific serotonin reuptake inhibitors for the management of phobic behaviours in dogs and cats, particularly when there are signs of panic

Dose of Alprazolam in Dogs and Cats

Dogs:

• An initial dose between 0.01-0.1 mg/kg p.o. as needed up to 4 times per day is advised for anxiolysis; the dose can be adjusted up or down to the minimum effective dose, which may be lower than this level.

Cats:

• An initial dose of 0.125-0.25 mg/kg p.o. as needed up to twice a day is recommended for anxiolysis, however doses as low as 0.25 mg/cat p.o q8-12h and as high as 0.6 mg/kg p.o. have been documented. The dosage should be titrated down to the lowest effective dose after the initial dose.

Side Effects of Alprazolam in Dogs and Cats

• Drowsiness and mild transient incoordination may develop.
• Idiosyncratic hepatotoxicity associated with benzodiazepines (largely diazepam, but not alprazolam) has been reported in the cat.

Contraindications of Alprazolam in Dogs and Cats

• Hypersensitivity to benzodiazepines.
• Glaucoma.
• Significant liver or kidney disease, although appears to be less hepatotoxic than diazepam or clorazepate.
• Not recommended in pregnant or lactating animals.
• There is concern over its use with anxiously aggressive animals due to the potential for disinhibition.

Some Notes:

It is recommended to avoid administering Alprazolam with these drugs due to the occurrence of interactions between each other:

• Antihypertensive agents (amlodipine, enalapril, telmisartan): Increase risk for hypotension and orthostasis
• Antifungals (fluconazole, itraconazole, ketoconazole):Metabolism of alprazolam may be decreased, and excessive sedation may occur
• Carbonic anhydrase inhibitors ( acetazolamide, methazolamide): may interfere with the beneficial effects of CAIs by inhibiting respiratory responses to hypoxia.
• Cns depressant agents: increase the risk for CNS and/or respiratory depression.
• Fluoxetine and fluvoxamine: May cause excessive sedation
• Hepatic enzyme inhibitors (cimetidine, diltiazem, grapefruit juice, isoniazid): Metabolism of alprazolam May be decreased and cause excessive sedation
• Ifosfamide: increase the risk for ifosfamide-induced neurotoxic effects
• Macrolide antibiotics ( clarithromycin, erythromycin): Metabolism of alprazolam may be decreased and excessive sedation may occur
• Macrocyclic lactones (ivermectin, milbemycin oxime): Benzodiazepine effects May be potentiated by concurrent macrocyclic lactone use
• Opioids: May increase the risk for cardiorespiratory and CNS depression
• Phenobarbital: May increase the risk for respiratory depression
• Propofol: May increase the risk for cardiorespiratory depression.
• Theophylline/Aminophylline: May decrease the levels and effectiveness of benzodiazepines. Withdrawing theophylline from a stable patient may increase the risk of benzodiazepine toxicity