home All hormones Xanax: instructions for use. What happens if you overdose on Xanax? Usual Older Adult Dose for Depression

Xanax: instructions for use. What happens if you overdose on Xanax? Usual Older Adult Dose for Depression

in a blister pack 10 pcs.; in a cardboard pack 3 packs.

10 pcs in blister; There are 3 blisters in a cardboard pack.

pharmachologic effect

Pharmacological effects - muscle relaxant, anxiolytic, anticonvulsant.

Excites benzodiazepine receptors, promotes the liberation of GABA and its participation in synaptic transmission.

Indications for Xanax®

Anxiety states and neuroses with feelings of anxiety, tension, restlessness, irritability, deterioration of sleep, somatic disorders, mixed anxious-depressive and neurotic reactive-depressive states, accompanied by decreased mood, loss of interest in the environment, psychomotor agitation, sleep disturbances, decreased appetite, changes body weight, somatic complaints, disorders cognitive activity, suicidal thoughts (feelings of guilt, low value), decreased energy, etc., incl. for somatic disorders, alcohol withdrawal syndrome, functional and organic diseases (cardiovascular, dermatological, gastrointestinal tract), panic states(with or without phobic symptoms), panic attacks and phobias with agoraphobia.

Contraindications

Hypersensitivity, psychotic depression (not useful), pregnancy (especially the first trimester), children's adolescence and adolescence (up to 18 years); diseases thyroid gland(table 0.5 mg).

Side effects

Headache, dizziness, drowsiness, sleep disturbances, fatigue, memory impairment, depression, dysarthria, muscle weakness, tremor, coordination disorders, ataxia, weight changes, dyspepsia, anorexia, dystonia, jaundice, liver dysfunction, decreased libido, dysmenorrhea, urinary incontinence or retention, visual disturbances; rarely - agitation, irritability, hallucinations, hostility and aggressive behavior (more often with alcohol, drug abuse, or taking other psychotropic drugs); with long-term use - addiction (especially with alcoholism, toxic or drug addiction), drug dependence, withdrawal symptoms (with abrupt withdrawal of the drug).

Directions for use and doses

Orally, the optimal dose is determined individually depending on the severity of symptoms and the severity of the clinical effect. It is better to increase the dosage by taking more medicine in evening time(before bedtime). In general, patients who have never been treated with psychotropic medications before require lower dosages. Elderly and debilitated patients are advised to take smaller dosages of alprazolam, since an overdose may cause the development of excessive sedation or ataxia. It is proposed to periodically re-evaluate the patient's condition with subsequent clarification of the dosage of alprazolam. Initial dosage* Dose rangeAnxiety 0.25-0.5 mg 3 times a day 0.5-4 mg per day in several dosesDepression 0.5 mg 3 times a day 1.5-4.5 mg per day in divided dosesPanic disorders 0.5-1 mg at bedtime or 0.5 mg 3 times a day. The dosage should be selected individually depending on the effect, probably increasing the dosage by no more than 1 mg every 3-4 days. In clinical studies average dosage was 5.7 ± 2.27 mg/day, for some patients the highest dosage was 10 mg per dayElderly or debilitated patients 0.25 mg 2 or 3 times a day 0.5-0.75 mg per day in divided doses with gradual increases if necessaryAnxiety 1 mg per day in 1 or 2 divided doses 0.5-4 mg per day in 1 or 2 divided dosesDepression 1 mg per day in 1 or 2 divided doses 0.5-4.5 mg daily in 1 or 2 divided dosesPanic disorders 0.5-1 mg at bedtime or 0.5 mg 2 times a day The dosage should be selected individually depending on the effect, an increase is likely daily dosage no more than 1 mg every 3-4 days. In clinical studies, the average maintenance dosage was 5-6 mg per day, in 1 or 2 divided doses. Some patients required doses of up to 10 mg per dayElderly patients 0.5-1 mg per day in 1 or 2 doses 0.5-1 mg per day; dosage can be gradually increased if necessary

Xanax
Xanax retard

* If side effects develop, the dosage of the medicine should be reduced. In general, the usual dosage is sufficient for most patients. If the patient requires more high dosage, increasing the dosage should be done with caution to avoid the development of side effects. Duration of therapy: up to 6 months - for anxiety and depressive disorders; up to 8 months - in the treatment of panic disorders. The dosage of the medication should be reduced gradually. It is suggested to reduce the daily dose by no more than 0.5 mg every 3 days. In some cases, a slower dosage reduction is required. No studies have been conducted on the effectiveness and safety of Xanax in people under 18 years of age.

Precautionary measures

Use with extreme caution in cases of impaired liver and kidney function, severe depression, suicidal tendencies, panic disorders. To avoid withdrawal syndrome (withdrawal symptoms), treatment is stopped gradually, reducing the dose by no more than 0.5 mg every 3 days. During treatment, it is not suggested to drive a car or other potentially dangerous mechanisms. During the period of use, lactating women should stop breastfeeding.

Storage conditions for the drug Xanax®

At a temperature of 20-25 °C.

Keep out of the reach of children.

Shelf life of Xanax®

Do not use after the expiration date stated on the packaging.

Common name: alprazolam

Trade marks: Niravam, Xanax, Xanax XR

What kind of drug is Xanax?

Xanax (alprazolam) is a benzodiazepine. Alprazolam affects chemical substances in the brain, which may be imbalanced in people who regularly feel anxious, worried, fearful, anxious, fearful.

Xanax is used as a sedative to treat anxiety disorders, panic disorders, and worries caused by depression. Xanax may also be used for purposes not listed in this article.

Important information

You should not use Xanax if you have angle-closure (narrow-angle) glaucoma, if you are also taking Itraconazole or Ketoconazole, or if you are allergic to Xanax or similar drugs (Valium, Ativan, Tranxin, and others).

You should not use Xanax if you are pregnant. This medicine may cause birth defects or withdrawal symptoms in the newborn, which may be life-threatening.

Alprazolam may be addictive. Abuse can lead to addiction, overdose, or death.

Xanax with alcohol

Do not drink alcohol while taking Xanax. This drug may increase the effects of alcohol. Alprazolam may be habit-forming and should only be used by the person for whom it was prescribed. Keep the medicine in a safe place where others cannot get to it.

Before taking this medicine

It is dangerous to buy Xanax online or from sellers outside the United States. Medicines distributed over the Internet may contain dangerous ingredients. Sales of Xanax outside the US are not subject to FDA regulation. food products and Drug Administration (FDA) regarding the safety of this drug.

You should not take Xanax if you have:

narrow-angle (closed-angle) glaucoma;
if you are taking Itraconazole or Ketoconazole;
if you are allergic to Alprazolam or other benzodiazepines such as Chlordiazepoxide (Librium), Clorazepate (Tranxin), Diazepam (Valium), Lorazepam (Ativan), or Oxazepam (Serax).

To make sure Xanax is safe for you, tell your doctor if you have any of the following conditions:

Xanax and pregnancy

You should not use Xanax if you are pregnant. This medicine may cause birth defects. Your child may become addicted to drugs.

This can result in a baby being born with life-threatening withdrawal symptoms.

Babies born while taking Xanax may need additional treatment within a few weeks. Tell your doctor that you are pregnant or planning to become pregnant. Use effective contraception to prevent pregnancy while on Xanax.

Alprazolam can be transmitted through breast milk, which, in turn, can harm infant. You should not breastfeed your baby while taking Xanax.

The calming effect of the medicine may last longer in older people. Accidental falls to the floor are common in older patients taking benzodiazepines. Use caution to avoid falling or accidental injury while taking Xanax.

Xanax instructions for use

Take Xanax tablets as prescribed by your doctor. Follow all directions prescribed by your healthcare provider.

Never use alprazolam in larger quantities or for longer than prescribed. Tell your doctor if the medicine no longer helps you or if your symptoms go away.

Alprazolam may be addictive. Never share Xanax medication with another person, especially people with a history of drug use. Keep the medicine in a place where your relatives, especially children, cannot reach it.

Abuse of the drug can lead to addiction, overdose, or death. Selling this medication without a prescription is against the law.

Do not bite, chew, or swallow Xanax tablets. Simply swallow and wash down the tablets with water. Do not stop taking Xanax suddenly, as you may experience unpleasant symptoms of addiction. Ask your doctor about how to safely stop using this medication.

If you plan to use this medicine for long term Frequent medical examinations may be required.

Store Xanax at room temperature away from moisture and heat. Keep track of the amount of medicine in each new package.

Xanax is a drug and you should be aware if anyone is using your medication without a prescription.

What to do if you forgot to take Xanax?

Take the missed dose as soon as you remember. Or skip your dose if it is time for your next scheduled dose. Under no circumstances take 2-3 tablets at once to make up for missed doses.

What happens if you overdose on Xanax?

Contact your doctor or call an ambulance immediately.

An overdose of alprazolam can be fatal. Symptoms of overdose may include excessive drowsiness, confusion, muscle weakness, loss of balance or coordination, dizziness, and fainting.

What should I avoid while taking Xanax?

Xanax may slow your thinking or reaction times. Be careful if you are driving a car or doing anything that requires increased attention.

Avoid drinking alcohol while taking it as it may cause dangerous side effects.

Grapefruit and grapefruit juice may interact with alprazolam and lead to unwanted side effects. Discuss grapefruit consumption with your healthcare provider.

Is not full list side effects, others may occur. Ask your doctor about side effects.

Xanax dosage

Usual Adult Dose for Restlessness and Anxiety:

Initial dose: 0.25 to 0.5 mg orally 3 times daily. This dose can be gradually increased every 3 to 4 days if necessary and if the body tolerates the medicine well.

Maintenance dose: May increase to maximum daily dose of 4 mg in divided doses

Usual Adult Dose of Xanax for Panic Disorder:

Initial dose: 0.5 mg orally 3 times daily. This dose can be gradually increased every 3 to 4 days if necessary and if the body tolerates this medicine well.

Maintenance dose: 1 to 10 mg per day in equally divided doses.

Average dose: 5 to 6 mg per day in equally divided doses.

Usual Adult Dose of Xanans for Depression:

Initial dose: 0.5 mg orally 3 times daily
The daily dose can be gradually increased, but not more often than 1 mg every 3 to 4 days
Average dose: Studies using alprazolam for the treatment of depression showed a mean effective dose of 3 mg orally daily in equally divided doses

Maximum dose: Studies on the use of alprazolam for the treatment of depression have shown that the maximum dose is the use of 4.5 mg orally daily in divided doses.

Usual Older Adult Dose for Restlessness and Anxiety:

Due to increased sensitivity to benzodiazepines in elderly patients, it is not recommended to use alprazolam in daily doses greater than 2 mg.

Smaller doses may also be effective and safer. Total daily doses should not exceed the suggested maximum values, or if exceeded, but very rarely.

Usual Elderly Dose for Depression:

Initial dose: 0.25 mg orally 2-3 times daily for elderly or debilitated patients. This dose can be gradually increased if necessary and the body tolerates this medicine normally.

Usual Elderly Dose for Panic Disorder:

Initial dose: 0.25 mg orally 2-3 times daily for elderly or debilitated patients. This dose can be gradually increased if necessary and the body tolerates this medicine normally.

What other drugs will affect how Xanax works?

Using this medicine with others medicines that cause drowsiness or slow breathing may cause dangerous side effects or death. Ask your healthcare provider before taking a sleeping pill, pain reliever, cough medicine, muscle relaxer, anti-anxiety medication, or anxiety medication. anxiety state, depression or seizures.

Tell your doctor about all the medications you are taking, have completed, or are about to take, especially:

This list is not complete. Other drugs may also interact with Alprazolam, including prescription and over-the-counter drugs. In addition, interaction with vitamins and foods is possible plant origin. Not all possible drug interactions are listed in this article.

Side effects of Xanax

Call emergency medical services if you have signs of an allergic reaction to Xanax:

hives;
labored breathing;
swelling of the face, lips, tongue, or throat.

Call your doctor right away if you have:

depressed mood, thoughts of suicide or self-harm;
accelerated thinking (jumping thoughts), an unusual surge of energy, risky behavior;
confusion, agitation, hostility, hallucinations;
uncontrolled muscle movements, tremors, convulsions;
increased or rapid heartbeat

Common medication side effects may include:

Common side effects of Xanax include: ataxia, cognitive dysfunction, constipation, difficulty urinating, drowsiness, dysarthria, increased fatigue, memory loss, skin rashes, weight gain, weight loss, anxiety, blurred vision, diarrhea, insomnia, decreased libido, increased appetite and decreased appetite.

Other side effects include: hypotension, sexual disorders, muscle twitching and increased libido. See below for a complete list of side effects.

The most common side effects of Xanax.

If you have any of the following side effects while taking alprazolam, tell your doctor right away:

Common side effects:

Less common:

Abdominal or stomach pain
blurred vision
body aches or pain
burning, itching, numbness, tingling, crawling all over the body
change in behavior
chills
clay-colored chair
confusion about one's identity and about place and time
cough

dark urine color
decreased frequency of urination
decrease in urine volume
diarrhea
difficulty or labored breathing
difficulty moving
difficulty urinating (dribbling)
difficulty concentrating
dizziness and malaise when you suddenly get up from a lying or sitting position
dry mouth
ear plugs
the environment seems unreal
fainting

fear or nervousness
feeling of unreality
feeling of warmth
fever
general feeling of discomfort or illness
headache
hyperventilation
inability to move eyes
inability to sit up straight
increased blinking or eyelid spasms
irregular heartbeat
joint pain
lack or loss of self-control

runny nose
see, hear, or feel things that do not exist
seizures
feeling of detachment from self or body
shake
trembling
shortness of breath
sneezing
a sore throat
numbness of the tongue
sweating
swollen joints
talkativeness
chest tightness

trouble breathing, speaking, or swallowing
body balance problem
twitching, twisting, or uncontrollable repetitive movements of the tongue, lips, face, arms, or legs
uncontrolled movements and twisting of the neck, torso, arms or legs
unpleasant odor when exhaling
unusual sleepiness, dullness, tiredness, weakness, or feeling sluggish
unusual facial expressions
unusually deep sleep
unusual long duration sleep
vomiting blood
dyspnea
yellow eyes and skin

Rare

Frequency unknown:

general fatigue and weakness
light colored chair
prolonged stomach pain;
upper right abdominal pain;

Minor Side Effects

Some side effects of alprazolam do not require medical attention. As your body gets used to the drug, these side effects may go away.

Your healthcare provider can help you prevent or reduce these side effects, but be sure to see your doctor if any of the following side effects persist for a long time or if they bother you:

Frequent:

Less common:

Rare:

Frequency of side effects unknown:

Blistering of the skin, peeling of the skin, or falling off of parts of the skin
sores, sores, or white spots in the mouth or lips
breast swelling or breast tenderness in women and men
unexpected or excessive milk production from the mammary glands

International and chemical names: alprasolam; 8-chloro-1-methyl-6-phenyl-4H-S-triazolo benzodiazepine;

Basic physical and chemical properties

tablets of 0.25 mg - white ellipsoidal tablets with a break line; tablets 0.5 mg - pink pills ellipsoidal in shape with a fault line;

Compound

1 tablet 0.25 mg contains alprazolam - 0.25 mg;

excipients: lactose, microcrystalline cellulose, sodium docusate, sodium benzoate, colloidal silicon dioxide, corn starch, magnesium stearate;

1 tablet 0.5 mg contains alprazolam - 0.5 mg;

excipients: lactose, microcrystalline cellulose, sodium docusate, sodium benzoate, colloidal silicon dioxide, corn starch, sodium aluminum lakerythrosine, magnesium stearate.

Release form

Pills.

Pharmacotherapeutic group

Anxiolytics. Benzodiazepine derivatives. ATS code N05BA 12.

Pharmacological properties

Pharmacodynamics. The drug has all the properties of benzodiazepines: anxiolytic, hypnosedative, muscle relaxant and anticonvulsant effects are noted. At the same time, all representatives of the group of benzodiazepines differ from each other in the weight of the listed components in the spectrum of psychotropic effect.

The generally accepted point of view is that the pharmacological diabenzodiazepine is the result of increased neuronal inhibition in receptors in which the mediator is gamma-aminobutyric acid(GABA).

Pharmacokinetics. After oral administration of Xanax, the maximum concentration of alprazolam in plasma is observed after 1-2 hours. The average modern half-life of alprazolam is 12-15 hours.

Alprazolam is preferentially subject to oxidation. The main metabolites of the drug include alpha-hydroxyalprazolam and benzophenone poquidnealprazolam. The plasma levels of these compounds remain at very low levels.

The biological activity of alpha-hydroxyalprazolam corresponds to approximately half the activity of alprazolam. Its half-life value is of the same order of magnitude as that of alprazolam. The benzophenone metabolite is a practically inactive compound. Alprazolam and its metabolites are excreted from the body in the urine.

In vitro, alprazolam binds (80%) to whey protein.

Indications for use

Anxiety disorders (anxiety neuroses) accompanied by feelings of anxiety, tension, agitation, insomnia, a sense of danger, irritability and somatic symptoms.

Mixed anxiety-depressive disorders.

Neurotic reactive-depressive disorders, accompanied by depressive affect, increasing loss of interest in the world around us, feelings of anxiety, psychomotor agitation and insomnia, impaired appetite, changes in body weight, somatic disorders, feelings of inferiority or guilt, and suicidal ideation.

Anxiety states, mixed anxiety-depressive states, neurotic reactive-depressive disorders develop against the background of somatic diseases.

Panic disorders, in combination with or without phobic symptoms.

Directions for use and doses

The optimal dose of alprazolam is determined individually in each specific case, depending on the severity of symptoms and the severity of the clinical effect. The average daily dose meets the needs of most patients. In some cases, increasing the dose level is allowed, but the increase should be carried out with caution, avoiding the development of side effects. It is more efficient to increase the dosage by taking large quantity the drug in the evening (before bedtime). In general, patients who have not previously been treated with psychotropic drugs require lower doses than patients who have experience taking tranquilizers, antidepressants and sleeping pills. Elderly and debilitated patients are advised to take small doses of alprazolam, since an overdose can cause the development of excessive sedation or ataxia. It is recommended to periodically evaluate the patient's condition with subsequent adjustment of dosialprazolam.

	Starting dose*	Dose range
	0.25 - 0.5 mg three times a day	0.5 - 4.0 mg/day in divided doses
Depression	0.5 mg three times daily	1.5 - 4.5 mg/day in divided doses
Elderly and frail patients	0.25 mg two or three times daily	0.5 - 0.75 mg/day in several doses, gradually increasing the dose if necessary
Panic disorders	0.5-1.0 mg at bedtime or 0.5 mg three times a day	The dose should be selected individually depending on the effect, it is possible to increase the dose by no more than 1 mg every 3-4 days. The average dose is 5.7 ± 2.27 mg/day. Maximum - 10 mg/day.

If side effects develop, the dose of the drug should be reduced.

DISCONTINUATION OF THERAPY. The dose of the drug should be reduced gradually. It is recommended to reduce the daily dose by no more than 0.5 mg every 3 days. In some cases, you need to reduce the dose more slowly.

Side effect

Side effects, if they occur, are observed at the very beginning of Xanax therapy and gradually disappear with further use of the drug or with a reduced dose.

Patients with anxiety, anxiety-depressive syndrome and neurotic depression most often experience drowsiness and dizziness. Less commonly observed effects are headache, depression, blurred vision, insomnia, nervousness/anxiety, tremor, weight changes, memory impairment, coordination disorders, possible gastrointestinal disorders and autonomic manifestations.

Along with this, adverse events such as dystonia, irritability, anorexia, fatigue, blurred speech, jaundice, ulcerative weakness, changes in libido, menstrual dysfunction, urinary incontinence (or, conversely, urinary retention) and liver dysfunction may occur. Very rarely There is an increase in intraocular pressure.

In patients with panic disorders, side effects more often include sedation, drowsiness, fatigue, ataxia, incoordination, and slurred speech. Less commonly observed are mood changes, gastrointestinal symptoms, dermatitis, memory impairment, sexual dysfunction, intellectual impairment and confusion.

Side effects such as difficulty concentrating, confusion, agitation, hallucinations, and reactions such as irritability, agitation, temper tantrums, and aggressive or hostile behavior are rarely reported with Xanax, as with other benzodiazepines. In many of these cases, patients were also receiving other psychotropic medications and/or had other psychiatric conditions.

A small number of reports suggest that patients with a history of aggressive behavior, patients with alcohol or drug abuse, have a higher risk of developing such reactions. Episodes of irritability, hostility, and intrusive thoughts have been reported in patients with post-traumatic reactive disorder when alprazolam therapy is discontinued.

Contraindications

Xanax is contraindicated in patients with hypersensitivity to benzodiazepines.

Overdose

An overdose of alprazolam causes drowsiness, confusion, loss of coordination, decreased reflexes and, at the final stage, a comatose state.

As in all cases of overdose, close monitoring of breathing, pulse rate, and blood pressure should be carried out. It should be taken for a medical purpose and first of all rinse the stomach. All drugs to maintain vital functions should be administered intravenously. If necessary, you should carry out artificial ventilation lungs. For hypotension, the use of vasopressors is advisable.

Forced diuresis or hemodialysis are ineffective in treating overdose.

Features of application

It should be borne in mind that the effectiveness of Xanax in long-term use more than 6 months for the treatment of anxiety, as well as anxiety associated with depression and neurotic (reactive) depression, has not been proven. However, patients with panic disorders were effectively treated with Xanax for 8 months. The doctor should periodically evaluate the effectiveness of the drug in each specific case.

Xanax 0.5 mg tablets should not be prescribed to patients with thyroid pathology.

The effectiveness of the drug has not been confirmed when used for the treatment of so-called psychotic depressions, that is, with bipolar and unipolar variants of endogenous depression.

When taking benzodiazepines, including alprazolam, addiction and psychophysical dependence can develop. Should be adhered to special measures safety when prescribing the drug to alcoholics or drug addicts and substance abusers, since they have a tendency to addiction and dependence. With a rapid dose reduction or abrupt discontinuation of benzodiazepines, including yalprazolam, withdrawal syndrome occurs. Its manifestations can vary from mild dysphoria and insomnia to severe syndromes with a picture of muscle and abdominal spasms, vomiting, sweating, tremor, and convulsions. Heavy withdrawal symptoms occur in patients who took the drug in high doses ah and for a long time. However, withdrawal symptoms may also occur after sudden cessation taking benzodiazepines prescribed for therapeutic doses. Sudden discontinuation of alprazolam should be avoided. When stopping alprazolam, patients with panic attacks may experience panic symptoms that closely resemble withdrawal symptoms.

The use of the drug in patients with severe depression and suicidal behavior should be carried out with extreme caution. Panic disorders are associated with primary or secondary depression and an increased incidence of suicide among untreated patients. Similar safety precautions should be observed when prescribing high doses of Xanax in the treatment of panic disorders, as well as when prescribing other psychotropic compounds and in patients with a high, but admitted, suicidal readiness.

Special safety measures should be observed when treating patients with impaired liver and kidney function.

It should be remembered that no studies have been conducted regarding the effectiveness and safety of Xanax in children (under 18 years of age).

Pregnancy and lactation

Based on data from the use of other benzodiazepines, it can be assumed that Xanax has a teratogenic effect if taken in the first trimester of pregnancy. If Xanax is used during pregnancy, or a pregnant woman is treated with alprazolam, she should be informed of the possible risk of intrauterine fetal malformations. Since Xanax is used for urgent indications, its use in the first trimester of pregnancy should be avoided. Due to the fact that benzodiazepines are excreted in breast milk, breastfeeding should also be avoided during Xanax therapy.

Effect on ability to drive a car

As with the use of other benzodiazepine tranquilizers, patients taking Xanax are not recommended to drive or drive heavy mechanical devices until it has been established that they do not experience drowsiness or dizziness in response to the drug.

Interaction with other drugs

All benzodiazepines, including yalprazolam, potentiate the effect of other psychotropic compounds, anticonvulsants and antihistamines, alcohol and other drugs that exhibit a bleaching effect on the central nervous system. The pharmacokinetic interaction of benzodiazepines with other drugs is well known. For example, the clearance of alprazolam and some other benzodiazepines may be delayed by simultaneous administration cimetidine or macrolide antibiotics.

It is recommended to be cautious and consider reducing the dose of Xanaxup when taking it concomitantly with cimetidine and macrolides such as erythromycin, as well as nefazodone, fluvoxamine, fluoxetine, propoxyphene, sertraline, diltiazem and oral contraceptives.

Conditions and shelf life

Store out of the reach of children at room temperature 15 - 25°C.

Sooner or later, people are faced with the need to strengthen their body through one or another pharmacological product. Let's find out to whom and for what, as well as in what dosages a drug such as Xanax is prescribed. Let's find out what this is below.

Topical medications in the modern world

The current life of people is a kind of permanent stress. Some people are more sensitive to it, while others are less sensitive to it.

But it makes no sense to deny the fact that at absolutely every turn a person faces new problems that can throw him off balance, we are talking about:

About emotional difficulties that most often arise as a result of a conflict of interest.
The more an individual becomes fixated on a situation, the worse the consequences for his mental health.
Against the background of various nervous disorders it is likely that all sorts of problems with the kidneys, skin or liver will develop.
Basic psychological suggestion or heart-to-heart talk is often not enough, which is why medication may be required.

What's in the West?

In the West, this issue is treated much more calmly, since there visiting a psychotherapist is absolutely not considered something shameful, nor is using medications prescribed by a specialist. Every fifth citizen visits such a doctor from time to time, and in some countries the percentage of people seeking help from a psychotherapist is even higher. There are a lot of reviews about the drug "Xanax".

There is no shame in admitting that you have a mental health problem. You could say that this is less scary than ignoring the problem and doing nothing about it, leaving you in an unhealthy state for the rest of your life.

When do doctors prescribe Xanax to patients?

What is Xanax? Today, this drug allows many people to get rid of mental problems. But the product is not cheap. For one pack, which contains thirty tablets of two milligrams each, you will have to pay about two thousand rubles.

Xanax has a number of effects on the human body:

The sedative function, against the background of which the level of irritability decreases, causes drowsiness along with emotional dullness.
The muscle relaxant effect is expressed in the elimination of muscle tension and cramps.
Nootropic effects help improve short-term memory.

The use of Xanax, according to reviews, seems advisable only when:

Long-term depression occurs.
Regular nervous conditions appear.
Panic attacks occur frequently.
The body is in a state of alcohol withdrawal.
A person has suicidal thoughts.

It is important to emphasize that deciding whether to consume it medicine or not, is taken exclusively by the attending physician. These tablets are available in pharmacies with a prescription. As a rule, a psychotherapist comes to conclusions about the need to prescribe medication to a patient after several meetings with the patient, as well as from collecting detailed information about the medical history.

How should you take Xanax?

It is advisable to take Xanax tablets only when medicinal purposes, and not for entertainment. Any attempts to “play around” with such a potent medicine can cost your health. Actually, the list of side effects includes the following violations:

The appearance of yellowness of the skin.
Unmotivated attacks of aggression.
The appearance of hallucinations.
Fainting states.
Long-term depression.
Formation of allergic reactions.

The use of Xanax must be justified.

In case of addiction

With an existing addiction to this drug, things can get even worse. So, the following may occur:

Excessive sensitivity to light and sound.
Frequent vomiting.
The appearance of seizures.
Seizures panic attacks.
Formation of tachycardia.
Sleep disturbances and, as a result, insomnia.

In the case where the patient is taking this drug solely for the treatment of an existing disorder, the doctor writes required dosage in accordance with mental state of this or that person, which, as a rule, depends on:

age of the patient;
patient's health status;
the presence of a specific pathology;
the duration of the required course of treatment.

Release form

There are two types of Xanax tablets, namely those weighing 0.25 and 0.5 milligrams. Most often, the patient is prescribed one piece three times a day, during meals. This is done to avoid complications from the gastrointestinal system.

Thus, against the background various pathologies a person takes from 0.75 to 1.5 milligrams per day, and in more serious situations upper value dosage is doubled. Basically, treatment is carried out in two stages, namely during the loading and maintenance periods. The duration is sometimes up to eight months.

What effect does Xanax have on the human body?

So, what Xanax is is now known. It belongs to the group of benzodiazepines. This drug can cause addiction. If it is discontinued, the symptoms may be worse than those that bothered the patient initially. For this reason, this drug should be discontinued gradually, slowly reducing the dose of the medication by a third every week. Within the framework of uncontrolled use, such a practice may become impossible.

When used correctly, this drug can actually help and has the following positive effects:

It relieves a person of all kinds of anxiety due to its sedative effect.
Affects an adequate perception of reality, which becomes possible due to the influence of its active ingredients for short-term memory.
Helps you look at problems from a different angle, which is ensured by reducing emotional lability.
Relaxes a person due to a muscle relaxant effect. This is confirmed by the instructions for use for the drug "Xanax".

But people should not forget that it is possible to get rid of various problems, as well as excessive tension and nervousness, using completely different means that do not have a huge list of side effects. Thus, everyone is free to choose their own personal outlet in the form of books, music, hiking, meditation, travel or relaxation by the sea.

In addition, you can change your consciousness using ordinary coffee, which can influence the normal functioning of the nervous system, while being an absolutely legal remedy that is practically harmless. In any case, it cannot be compared with any tranquilizers in terms of side effects. What else does the instructions for use say about Xanax?

Xanax as an effective tranquilizer

The medication is a tranquilizer, which is sold in tablets of 0.25 and 0.5 milligrams and is available strictly according to a doctor’s prescription. Due to its relative availability, this medicine became popular among the so-called creative intelligentsia, and with the passage of time it completely “ran away” to the masses.

Thus, it is prescribed by psychotherapists if they are able mental health patients are diagnosed with the following ailments:

the main problem

The main problem is that Xanax can be highly addictive. To get rid of it, a person will have to demonstrate the miracles of his willpower. For those who started taking this drug in an uncontrolled manner, it is with addiction that excessive difficulties arise. Thus, absolutely everyone who, for one reason or another, has led to addiction will have to feel the full range of side effects in the form of intensification of existing problems.

According to the instructions for Xanax, its effectiveness has been proven as a result clinical trials. In the West, psychiatrists like to prescribe this remedy in cases of anxiety and depressive states to reduce the overall suicide rate among eligible patients. And as statistics show, treatment is mostly effective.

Special instructions for taking Xanax

Compared with those patients who suffer from a chronic type of alcoholism or who have previously received antidepressants or anxiolytics, as well as for patients who have not previously taken drugs that affect the central nervous system, this remedy effective at lower dosing options.

Treatment of endogenous forms of depression can be carried out by combining Xanax with various antidepressants. In patients with severe depression, this drug can cause manic and hypomanic states. On the background long-term treatment large doses the development of strong addiction and, in addition, significant drug dependence is likely. This effect from Xanax is observed mainly among patients who are prone to abuse of certain medications.

In case of abrupt cessation or rapid reduction of the dose of medication, a so-called withdrawal syndrome is often observed, when symptoms of various degrees of severity appear, for example, from ordinary insomnia and a slight degree of dysphoria to a difficult syndrome with tremor. In this case, sweating may also increase, vomiting may occur, and in addition, the person may begin to suffer from cramps in the abdomen and skeletal muscles along with cramps.

Doctors often note withdrawal syndrome among patients who have taken Xanax for a long time, namely more than twelve weeks. During the treatment period it is very important to refrain from using alcoholic drinks, it is prohibited to drive a car or engage in potentially dangerous activities that require high speed response and significant attention. Xanax should not be used simultaneously with other types of tranquilizers.

Analogues of Xanax

What can replace the drug in question? Alzolam, Helex, Alprox, Kassadan, Xanax Retard, Alprazolam, Neurol, Zolomax, and Frontin have a similar effect.

Compound

One tablet contains: alprazolam 0.25 mg.

Excipients: microcrystalline cellulose (E460), lactose, starch, sodium docusate + sodium benzoate (E211), colloidal silicon dioxide (E551), magnesium stearate

Description

White, biconvex, elliptical tablets with “Upjohn 29” printed on one side and scored on the other side.

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pharmachologic effect

CNS-active drugs of the 1,4-benzodiazepine class are thought to exert their effects by binding to stereospecific receptors in the central nervous system. Their exact mechanism of action is unknown. From a clinical point of view, all benzodiazepines have a dose-dependent depressant effect on the central nervous system, ranging from mild impairment of test performance to hypnosis.

Pharmacokinetics

Suction

Alprazolam is completely absorbed after oral administration. The maximum concentration in blood plasma is achieved within 1-2 hours after taking the drug. Concentrations of the drug in blood plasma are proportional to the dose taken. In the dose range from 0.5 to 3.0 mg, the maximum concentrations of the drug in blood plasma ranged from 8.0 to 37 ng/ml. Using a specific quantitative assay, the mean plasma half-life of alprazolam in healthy adults was found to be approximately 11.2 hours (range: 6.3 - 26.9 hours).

Distribution

Alprazolam binds to plasma proteins in vitro (80%). In most cases, serum albumin is involved in drug binding.

Metabolism/Elimination

Alprazolam is actively metabolized in the human body (mainly by cytochrome P450 3A4 (CYP3A4)) with the formation of two main metabolites in the blood plasma: 4-hydroxyalprazolam and α-hydroxyalprazolam. In addition, benzophenone formed from alprazolam has been detected in humans. Their half-life is similar to that of alprazolam. Plasma concentrations of 4-hydroxyalprazolam and α-hydroxyalprazolam relative to the concentration of unchanged alprazolam were always less than 4%. The reported relative potencies of 4-hydroxyalprazolam and α-hydroxyalprazolam in benzodiazepine receptor binding experiments and animal seizure inhibition models are 0.20 and 0.66, respectively. These low concentrations and even lower potencies of 4-hydroxyalprazolam and α-hydroxyalprazolam indicate that they are unlikely to contribute significantly to the pharmacological effects of alprazolam. Benzophenone is an inactive metabolite.

Alprazolam and its metabolites are excreted primarily in the urine.

Changes in the absorption, distribution, metabolism and excretion of benzodiazepines have been observed with various diseases, including alcoholism, impaired liver and kidney function. In addition, changes were also observed in elderly patients. The mean elimination half-life of alprazolam in healthy older participants was 16.3 hours (range: 9.0 - 26.9 hours, n = 16) compared with 11.0 hours (range: 6.3 - 15.8 h., n = 16), observed in healthy adult participants. In patients with alcoholic illness liver, the half-life of alprazolam ranged from 5.8 to 65.3 hours (mean 19.7 hours, n = 17) compared with 6.3 to 26.9 hours (mean 11.4 hours, n = 17) in healthy participants. In the obese group, the half-life of alprazolam ranged from 9.9 to 40.4 hours (mean 21.8 hours, n = 12) compared with 6.3 to 15.8 hours (in average 10.6 hours, n = 12) in healthy participants.

Vv And Due to its similarity to other benzodiazepines, alprazolam is believed to cross the placental barrier and be excreted into breast milk in humans.

Race - In Mongoloid individuals, the maximum concentration and half-life of alprazolam are approximately 15% and 25% higher compared to Caucasians.

Pediatric age - The pharmacokinetics of alprazolam have not been studied in children.

Gender - The patient's gender does not affect the pharmacokinetics of alprazolam.

Smoking - Alprazolam concentrations may be reduced by up to 50% in smokers compared to non-smokers.

Drug interactions

Alprazolam is primarily eliminated via cytochrome P450 3A (CYP3A)-mediated metabolism. Majority drug interactions registered when taking alprazolam are interactions with drugs that have an inhibitory or stimulating effect on the CYP3A4 isoenzyme.

Compounds that are potent CYP3A inhibitors can be expected to increase plasma concentrations of alprazolam. Studies of the following drugs, as well as their effect on the AUC of alprazolam, were conducted in vivo: ketoconazole increased the AUC of alprazolam by 3.98 times, itraconazole - by 2.70 times; nefazodone - 1.98 times, fluvoxamine - 1.96 times and erythromycin - 1.61 times

Indications for use

Anxiety disorders

XANAX (alprazolam) tablets are indicated for the treatment anxiety disorder(the condition that most closely matches generalized anxiety disorder according to the AFA Diagnostic and Statistical Manual) or short-term relief of anxiety symptoms. State of anxiety or tension associated with stress Everyday life, as a rule, does not require treatment with anxiolytics.

Generalized anxiety disorder is characterized by unrealistic or excessive feelings of worry and worry (anxiety) over two or more life events nny m circumstances for 6 months or longer, during which time the patient should be concerned about these problems on most days. These patients often have at least, 6 of the following 18 symptoms: motor tension (shaking, twitching or unsteadiness; muscle tension, pain or soreness; motor restlessness; fatigue); autonomic hyperactivity (shortness of breath or feeling of suffocation; increased or rapid heartbeat; sweating or cold clammy hands; dry mouth; dizziness or weakness, nausea, diarrhea, or other gastrointestinal disturbances; feeling hot or cold; frequent urination; difficulty swallowing or feeling of a “lump in the throat”); alertness and feelings of being monitored (feeling on edge or on edge; exaggerated start-up response; difficulty concentrating or feeling “brainless” due to anxiety; difficulty falling or staying asleep; irritability). These symptoms should not be due to the presence of other mental disorders or organic pathology.

XANAX is effective in treating symptoms of anxiety associated with depression.

Contraindications

XANAX tablets are contraindicated in patients with a known sensitivity to this drug or other benzodiazepines. XANAX can be used in patients with open-angle glaucoma who are receiving proper treatment, but taking this drug Contraindicated in patients with narrow-angle glaucoma.

The simultaneous use of XANAX tablets with ketoconazole and itraconazole is contraindicated, since these drugs significantly disrupt oxidative metabolism mediated by cytochrome P450 3A (CYP3A) (see section Interactions with other drugs).

Pregnancy and lactation

Benzodiazepines may have harmful effects on the fetus when used by pregnant women. If XANAX is used during pregnancy, or if the patient becomes pregnant while taking this drug, she should be advised of the potential hazard to the fetus. Based on experience with other members of the benzodiazepine class, XANAX is believed to increase the risk of birth defects development when prescribed to pregnant women during the first trimester. Since these drugs are rarely used to provide emergency care, then their use in the first trimester of pregnancy should almost always be avoided. When prescribing the drug, it is necessary to consider the possibility that a woman of childbearing age may become pregnant. Patients should be advised to consult with their doctor about the advisability of stopping use of the drug if they become pregnant during therapy or plan to become pregnant. Despite the fact that in mother's milk is revealed low level benzodiazepines, including alprazolam, during therapy with XANAX breast-feeding should be stopped.

Directions for use and doses

To obtain the maximum clinical effect, the dose of alprazolam in each specific case should be set individually. Although the usual daily doses given below will meet the needs of most patients, there may be patients who require dosages in excess of 4 mg/day. In such cases, in order to avoid the development of side effects, the dose of the drug must be increased gradually.

Anxiety disorders and transient symptoms anxiety

Treatment of patients with anxiety should begin with a dose of 0.25 - 0.5 mg three times a day. To achieve maximum therapeutic effect the dose of the drug can be increased at intervals of 3-4 days to a maximum daily dose of 4 mg, divided into several doses. The lowest possible effective dose should be used and the need for continued treatment should be reassessed frequently. The risk of developing dependence may increase with increasing dose and duration of treatment.

In all patients, the dose of the drug should be reduced gradually when treatment is stopped or the daily dose is reduced. Although there is no systematically collected data to support a specific drug discontinuation regimen, it is recommended to reduce daily dose of the drug by no more than 0.5 mg every 3 days. Some patients may require an even slower dosage reduction.

Panic disorder

Successful treatment of a large number of patients with panic disorder required the use of the drug XANAX in doses exceeding 4 mg per day. Controlled studies conducted to determine the effectiveness of XANAX in the treatment of panic disorder used doses ranging from 1 to 10 mg per day. The average dose used was approximately 5 - 6 mg per day. Among approximately 1,700 patients enrolled in the panic disorder treatment development program, approximately 300 patients received XANAX at doses greater than 7 mg/day, including approximately 100 patients receiving maximum doses greater than 9 mg/day. A small number of patients required a dose of 10 mg per day to achieve a successful result.

Dose titration

Treatment can be started with a dose of 0.5 mg three times a day. Depending on the clinical effect, the dose can be increased in increments of no more than 1 mg per day at intervals of 3 to 4 days. Slower titration of doses exceeding 4 mg/day is recommended to fully realize the pharmacodynamic effect of XANAX. To reduce the possibility of developing interdose symptoms, the time of taking the drug during the waking period should be spaced as evenly as possible, i.e. for three or four doses per day.

As a rule, treatment should be started with a low dose to minimize the risk of adverse reactions in patients with hypersensitivity to the drug. The dose of the drug should be increased until an acceptable therapeutic response is achieved (i.e., a significant reduction or complete relief of panic attacks), the development of intolerance, or the maximum recommended dose is reached.

Maintaining the dose at a constant level

In patients receiving the drug in doses exceeding 4 mg/day, it is recommended to periodically re-evaluate and consider reducing the drug dosage. In a controlled post-marketing dose-response study, patients receiving months of XANAX were able to reduce their total maintenance dose by 50% without any apparent loss of clinical efficacy. Due to the risk of developing withdrawal symptoms, it is recommended to avoid abrupt discontinuation of the drug (see section Special instructions and precautions for use).

The required duration of treatment for patients with panic disorder responding to XANAX is unknown. Once the seizure-free period has been extended, an attempt can be made to discontinue the drug by gradually reducing the dose, but there is evidence that this may often be difficult without relapse and/or withdrawal symptoms.

Dose reduction

Due to the risk of developing withdrawal symptoms, abrupt discontinuation of the drug should be avoided (see section Special instructions and precautions for use). In all patients, the dose of the drug should be reduced gradually when treatment is stopped or the daily dose is reduced. Although there is no systematically collected data to support a specific discontinuation regimen, it is recommended that the daily dose of the drug be reduced by no more than 0.5 mg every 3 days. Some patients may require an even slower dosage reduction.

In any case, dose reduction should be carried out under strict control and should be gradual. If severe withdrawal symptoms develop, you should resume taking the drug according to the previous regimen, and only after the condition has stabilized can you attempt to stop taking the drug using a regimen with a slower dose reduction. In a controlled post-marketing discontinuation study in patients with panic disorder, comparing this recommended dose reduction regimen with a slower dose reduction regimen, there were no differences in the proportion of patients tapering to zero dose between groups. However, a slower tapering schedule was associated with a reduced incidence of withdrawal symptoms. It is recommended that the dose be reduced by no more than 0.5 mg every 3 days, taking into account the fact that even slower discontinuation of the drug may be appropriate for some patients. Some patients may be refractory to all drug discontinuation regimens.

Dosing in special categories of patients

In elderly patients with serious illness liver or in weakened patients, as a rule, the initial dose is 0.25 mg 2-3 times a day. If necessary and well tolerated, this dose can be gradually increased. Elderly people may have increased sensitivity to benzodiazepines. If side effects develop when taking the drug at the recommended initial dose, the dose of the drug may be reduced.

Use in children

The safety and effectiveness of the drug XANAX in patients under 18 years of age has not been established.

Side effect

Side effects, if they occur, usually appear at the beginning of therapy, and usually disappear with continued therapy or with dose reduction.

Most spontaneous case reports of behavioral adverse reactions involve patients being concomitantly treated with other CNS-acting drugs and/or underlying psychiatric conditions. Patients who are diagnosed with borderline personality disorders have a history of violent or aggressive behavior, as well as alcoholism or drug addiction, are at risk for such side effects.

Episodes of irritability, hostility, and intrusive thoughts have been reported in patients with post-traumatic reactive disorder when alprazolam therapy is discontinued.

Overdose

Clinical experience

Symptoms of an alprazolam overdose include: drowsiness, confusion, loss of coordination, decreased reflexes, and coma. Messages about fatal outcome have been reported in cases of overdose of alprazolam and other benzodiazepines. In addition, cases of death due to an overdose of benzodiazepines, incl. alprazolam in the presence of alcohol, with blood alcohol levels in some of these patients below levels typically observed in alcohol-related deaths.

General treatment of overdose

There is limited information on overdose with XANAX tablets. As with an overdose of any drug, it is necessary to monitor breathing, heart rate and blood pressure. General supportive measures are indicated, as well as immediate gastric lavage. Intravenous fluids should be started and patency maintained. respiratory tract. In case of development arterial hypotension Vasopressor drugs can be used. Dialysis is ineffective. As with an intentional overdose of any drug, it should be kept in mind that the patient may have taken several medicines. To completely or partially eliminate the sedative effect of benzodiazepines, the use of flumazenil (a specific benzodiazepine receptor antagonist) is indicated, which can be used in situations with confirmed or suspected benzodiazepine overdose.

Interaction with other drugs

Interaction of alprazoles with drugs that inhibit cytochrome P4503A-mediated metabolism

The first step in the metabolism of alprazolam is hydroxylation, which is catalyzed by a metabolic pathway that may have a profound effect on the clearance of alprazolam. Therefore, alprazolam should be avoided in patients receiving very potent CYP3A inhibitors. Only with great caution should alprazolam be used in combination with drugs that inhibit the CYP3A isoenzyme to a lesser, but still significant extent, and an appropriate reduction in dosage should be considered. Interactions with alprazolam for some medicinal products have been quantitatively analyzed based on clinical data; for other medicinal products, interactions are predicted from in vitro data and/or experience with similar drugs of the same pharmacological class.

The following is information for medicinal products known to inhibit the metabolism of alprazoles and/or other benzodiazepines, presumably through inhibition of CYP3A.

Potent CYP3A inhibitors

Azole antifungals Ketoconazole and itraconazole are potent inhibitors of the CYP3A isoenzyme, demonstrating an increase in plasma alprazolam concentrations in vivo by 3.98 and 2.70 times, respectively. Concomitant use of alprazolam with these drugs is not recommended. Other antifungal agents from the azole group should also be considered as potent inhibitors of the CYP3A isoenzyme and their joint use not recommended with alprazolam (see Contraindications section).

Medicines that have been shown to be CYP3A inhibitors in clinical studies involving alprazolam (use caution and consider an appropriate dose reduction of alprazolam when co-administered with the following medicines)

Nefazodone - concomitant use of nefazodone resulted in a two-fold increase in alprazolam concentrations.

Fluvoxamine - Concomitant use of fluvoxamine nearly doubled the maximum plasma concentration of alprazolam, decreased the clearance of alprazolam by 49%, prolonged the half-life by 71%, and decreased psychomotor performance. Cimetidine - simultaneous use of cimetidine led to an increase in maximum concentration alprazolam in blood plasma by 86%, a decrease in clearance by 42% and an extension of the half-life by 16%.

Medicines that have been shown to be likely clinically significant CYP3A inhibitors in clinical studies involving alprazolam (caution should be exercised when used concomitantly with alprozalam)

Fluoxetine - simultaneous use of fluoxetine with alprazolam led to an increase in the maximum concentration of alprazolam in blood plasma by 46%, a decrease in clearance by 21%, an extension of the half-life by 17%, and a decrease in psychomotor performance.

Propoxyphene - concomitant use of propoxyphene resulted in a 6% decrease in the maximum plasma concentration of alprazolam, a 38% decrease in clearance, and a 58% prolongation of the elimination half-life.

Oral contraceptives - simultaneous use oral contraceptives led to an increase in the maximum concentration of alprazolam in blood plasma by 18%, a decrease in clearance by 22% and an extension of the half-life by 29%.

Features of application

General instructions

Addiction and withdrawal reactions, including seizures

Some adverse clinical events, some of which are life-threatening, are a direct consequence of physical dependence on the drug XANAX. These phenomena include various symptoms withdrawal symptoms, the most important of which are seizures (see Drug Abuse and Drug Dependence). Even with a relatively short period of use of the drug in doses recommended for the treatment of transient anxiety and anxiety disorder (i.e., in doses from 0.75 to 4.0 mg per day), there is a certain risk of developing dependence. Data from the spontaneous reporting system indicate that the risk of developing dependence and its severity is higher in patients receiving the drug in doses exceeding 4 mg/day and for a long period of time (more than 12 weeks). However, in a controlled post-marketing discontinuation study in patients with panic disorder, treatment duration (3 months vs. 6 months) had no effect on patients' ability to taper to zero dosage. In contrast, patients receiving XANAX at doses greater than 4 mg/day had more difficulty reducing the drug dose to zero compared to patients receiving XANAX at doses below 4 mg/day.

Importance of XANAX dose and associated risks in the treatment of panic disorder: Due to the fact that the relief of panic disorder often requires the use of XANAX in daily doses exceeding 4 mg, the risk of developing dependence in patients with panic disorder may be higher than in patients receiving treatment for less severe anxiety. Experience with the drug in randomized, placebo-controlled discontinuation studies in patients with panic disorder demonstrated a high incidence of rebound and withdrawal symptoms in patients receiving XANAX compared to patients receiving placebo.

In a controlled clinical trial designed specifically to identify withdrawal symptoms, in which 63 patients were randomized to receive XANAX, the following withdrawal symptoms were identified: increased sensory perception, impaired concentration, dysosmia, brain fog, paresthesia, muscle spasms, muscle cramps, diarrhea, blurred vision, decreased appetite and weight loss. Other symptoms, such as anxiety and insomnia, were also commonly observed when the drug was stopped, but it was not possible to differentiate whether they were due to relapse, rebound syndrome, or withdrawal syndrome. The development of seizures after stopping XANAX or reducing its dose was observed in 8 of 1980 patients with panic disorder or in patients participating in clinical studies in which XANAX doses exceeding 4 mg/day for 3 months were allowed. The development of five of these cases was clearly observed during a sharp reduction in the dose of the drug or discontinuation of the drug in doses of 2 to 10 mg per day. The development of three cases was observed in situations in which there was no clear relationship with a sharp dose reduction or discontinuation of the drug. In one case, the development of seizures was observed upon discontinuation of the drug after a single dose of 1 mg against the background of a previous reduction in the dose of the drug from 6 mg per day at a rate of 1 mg every 3 days. In two other cases, no relationship with drug dose reduction was established; in these two cases, patients received the drug at a dose of 3 mg per day before the development of seizures. The duration of drug use in the 8 cases described above varied from 4 to 22 weeks. Rare reports have been received, submitted on a voluntary basis, of patients who developed seizures while gradually reducing the dose of XANAX. The risk of developing seizures is greatest within 24 to 72 hours after stopping the drug (for information about the recommended dosage reduction and discontinuation schedule, see Dosage and Administration).

Status Epilepticus and its treatment

The Voluntary Event Reporting System demonstrates that withdrawal-induced seizures have been reported when XANAX is discontinued. In most cases, a single episode of seizures was reported. However, reports of a series of seizures have been received, as well as status epilepticus. Interdose symptoms

Anxiety symptoms have been reported in patients with panic disorder taking XANAX at prescribed maintenance dosages. morning time, as well as between doses of the drug XANAX. These symptoms may reflect the development of tolerance or the presence of a time interval between doses longer than the duration of the clinical effect of the dose taken. In any case, this means that the prescribed dose is not sufficient to maintain plasma concentrations of the drug above the levels necessary to prevent the development of relapse, rebound symptoms, or withdrawal symptoms throughout the entire dosage interval. In such situations, it is recommended to use the same daily dose of the drug, but divide it into large quantity receptions (see section Doses and method of administration).

Risk when reducing the dose of the drug

Discontinuation reactions may occur when the drug dosage is reduced, regardless of the reason for the dose reduction, including both targeted and accidental dose reductions (for example, if the patient forgets to take the drug, while the patient is hospitalized). Therefore, you should gradually reduce your dose or stop taking XANAX.

CNS depression and performance impairment

Due to its depressant effect on the central nervous system, patients receiving XANAX should be advised to refrain from performing hazardous work or participation in dangerous species activities that require complete mental concentration, such as operating machinery or driving vehicles. For the same reason, patients should be advised to refrain from drinking alcohol and other drugs that depress the central nervous system while taking XANAX.

Precautionary measures

General information Suicide

As with the use of other psychotropic drugs, it is necessary to adhere to the usual precautions regarding the prescription and amount of the drug prescribed in patients with severe depression or people who may be expected to have latent suicidal ideation or suicidal plans. Panic disorder was associated with primary and secondary major depressive disorders and increased rates of suicide reports in untreated patients.

Mania

Episodes of hypomania and mania have been reported in patients with depression while taking XANAX.

Uricosuric action

Alprazolam has a weak uricosuric effect. Despite the fact that other drugs with weak uricosuric effects have caused the development of acute renal failure, no cases of acute renal failure have been reported while taking XANAX.

Use in patients with concomitant diseases

To avoid the development of ataxia or excessive sedation, which may present special problem in elderly or debilitated patients, it is recommended to limit the use of the drug to a minimum effective dose(see section Doses and route of administration). When treating patients with renal, hepatic or pulmonary insufficiency Normal precautions must be observed. There have been rare reports of death in patients with severe lung disease shortly after starting treatment with XANAX. In both patients with alcoholic liver disease and obese patients receiving XANAX, a decrease in the rate of systemic elimination of alprazolam (e.g., prolongation of the drug's plasma half-life) was observed (see Pharmacokinetics).

Laboratory research

Carrying out laboratory research at healthy patients, as a rule, are not required. However, if treatment is delayed, periodic general analysis blood, urine and biochemical research blood in accordance with good medical practice.

Drug abuse and drug dependence Physical and mental dependence

Following discontinuation of benzodiazepines, including XANAX, withdrawal symptoms similar in nature to those observed with sedative/hypnotics and alcohol have been observed. Symptoms may range from mild dysphoria and insomnia to severe withdrawal symptoms, which may include cramping in the abdominal cavity and muscles, vomiting, sweating, tremors and convulsions. In patients who have had their dosage reduced, it is often difficult to distinguish between signs and symptoms resulting from drug withdrawal and symptoms of disease relapse. The long-term treatment strategy for these phenomena will differ in development and therapeutic goal. If necessary, emergency treatment of withdrawal symptoms includes re-prescribing XANAX in doses sufficient to suppress symptoms. There have been reports of other benzodiazepines being ineffective in completely reversing withdrawal symptoms. These adverse outcomes were due to incomplete cross-tolerance but may also reflect the use of an inappropriate dosing regimen of the replacement benzodiazepine or the influence of concomitant medications.

Although the severity and frequency of withdrawal symptoms are related to the dose and duration of treatment, withdrawal symptoms, including seizures, have been reported after short-term therapy with XANAX at doses within the recommended range for the treatment of anxiety (eg, 0.75 up to 4 mg/day). Withdrawal signs and symptoms are often more severe after rapid decline dose or sudden discontinuation of the drug. The risk of developing seizures after discontinuation of the drug may increase when taking doses exceeding 4 mg/day (see Precautions). Patients, especially those with a history of seizures or epilepsy, should not abruptly stop taking any CNS depressant drug, including XANAX. For all patients taking XANAX who require a dosage reduction, it is recommended that the dose be reduced gradually under close supervision (see Precautions and Dosage and Administration section).

Development risk psychological dependence common with all benzodiazepines, including XANAX. The risk of developing psychological dependence may also increase when using the drug in doses exceeding 4 mg/day and with longer use. This risk is further increased in patients with a history of alcohol or drug abuse. Some patients have found it difficult to reduce their dose and stop taking XANAX, especially when taking higher doses over a longer period of time. Persons predisposed to developing dependence should be closely monitored when using XANAX. As with all anxiolytics, reuse of the drug should be limited to individuals under medical supervision.

according to a doctor's prescription.