2010/09/17

Alzolam

Composition, structure and packing

Tablets are round, ploskotsilindricheskie, green, with pitch scored on one side and engraved "Alzolam" - on the other.

1 tab. alprazolam 250 mg.

Excipients: lactose, microcrystalline cellulose, starch, magnesium stearate, colloidal silicon dioxide, dyes (quinoline yellow, brilliant blue, scarlet 4R).

Tablets are round, ploskotsilindricheskie, pink, with a pitch scored on one side and engraved "Alzolam" - on the other.

1 tab. alprazolam 500 mcg.

Excipients: lactose, microcrystalline cellulose, starch, magnesium stearate, colloidal silicon dioxide, dyes (quinoline yellow, brilliant blue, scarlet 4R).

Clinico-pharmacological group: tranquilizers (anxiolytic)

Pharmacological action

Anxiolytic drug (tranquilizer) from the group of benzodiazepines average duration of action also has a sedative-hypnotic effect. Enhances the inhibitory action of endogenous GABA (neurotransmitter pre-and postsynaptic inhibition in the CNS). Stimulates benzodiazepine receptors located in the allosteric center of postsynaptic GABA receptors of the ascending activating brain stem reticular formation and lateral horn neurons of the spinal cord, reduces the excitability of the subcortical brain structures (limbic system, thalamus, hypothalamus), inhibits the polysynaptic spinal reflexes. Anxiolytic effect is manifested in the reduction of emotional stress, reducing anxiety, fear, anxiety. Sedative-hypnotic effect is a decrease in symptoms of neurotic origin (anxiety, fear). Pronounced anxiolytic activity combined with moderate soporific effect, shortens the period of sleep, increases the duration of sleep, reduces the number of nighttime awakenings. The mechanism of action of sleeping pills is the oppression of the cells of the reticular formation of the brain. Reduces the impact of emotional, autonomic and motor stimuli that violate the mechanism of sleep.

Statement
anxiety and neuroses with anxiety, stress, anxiety, irritability, worsening of sleep, somatic disorders;
anxiety associated with depression (in the complex therapy;
panic disorder (treatment);
tremor (an old man, essential);
insomnia.

Dosage regimen

Inside, 2-3 times a day regardless of the meal.

Doses are selected depending on the severity of disorder, the sensitivity of the patient and his reaction to the drug. They begin with minimal doses (0.25-0.5 mg / day) with a subsequent increase in the first evening, and then in the afternoon.

Elderly or debilitated patients - 0.25 mg 2-3 times a day.

Further increase in dose (up to 0.5-0.75 mg / d) is carried out with caution, with good tolerability.

With anxiety, restlessness initial daily dose is 0.75-1.5 mg, and may be increased to 3-4.5 mg / day.

In panic disorder - 0.5 mg 3 times a day, daily dose can reach 3-6 mg, the highest daily dose - 10 mg.

The duration of the appointment of alprazolam - from a few days (acute state of fear) to 3 months. Because of the possibility of drug dependence for longer continuous use of the drug is not recommended.

If necessary, discontinuation of therapy the dose is gradually reduced to 0.5 mg every 3 days (abrupt discontinuation of therapy may exacerbate anxiety and fear).

Side effect

Of the nervous system:

at the beginning of treatment (particularly in older patients) - drowsiness, fatigue, dizziness, reduced ability to concentrate, ataxia, disorientation, unsteady gait, mental retardation and motor responses; rare - headache, euphoria, depression, tremors, memory decline, violations of motor coordination, depressed mood, confusion, dysautonomic extrapyramidal reactions (uncontrolled movements, including the eyes), weakness, myasthenia gravis, dysarthria, very rarely - paradoxical reactions (aggressive outbursts, confusion, psychomotor agitation, fear, suicidal , muscle cramps, hallucinations, agitation, irritability, anxiety, insomnia).

From the side of hematopoiesis:

leukopenia, neutropenia, agranulocytosis (chills, pyrexia, sore throat, extreme fatigue or weakness), anemia, and thrombocytopenia.

The part of the digestive system:

dry mouth or salivation, heartburn, nausea, vomiting, decreased appetite, constipation or diarrhea, abnormal liver function, increased activity of "liver" transaminases and alkaline phosphatase, jaundice.

On the part of the genitourinary system:

urinary incontinence, urinary retention, renal failure, reduction or increase in libido, dysmenorrhea. Allergic reactions: skin rash, itching.

Effect on the fetus: teratogenicity (especially the I trimester), CNS depression, respiratory failure and the suppression of sucking reflex in infants whose mothers used the drug.

Other: addiction, drug dependency, lowering blood pressure, rarely - blurred vision (diplopia), weight loss, tachycardia.

With a sharp decrease in dose or cessation of reception - syndrome "cancel" (irritability, nervousness, sleep disturbances, dysphoria, a spasm of smooth muscles of internal organs and skeletal muscles, depersonalization, increased sweating, depression, nausea, vomiting, tremors, disorders of perception, in so h. giperakuziya, paresthesia, photophobia, tachycardia, convulsions, rarely - acute psychosis).

Contraindications
hypersensitivity
coma,
shock
myasthenia gravis,
angle-closure glaucoma (acute onset or predisposition),
acute alcohol poisoning (with the weakening of vital functions),
narcotic analgesics
hypnotics and psychoactive drugs;
severe COPD (the degree of progression of respiratory failure)
acute respiratory failure;
severe depression (suicidal tendencies may occur);
pregnancy (especially the I term)
lactation,
age of 18 years (safety and efficacy have not decided).

C carefully. Hepatic failure, chronic renal failure, cerebral and spinal ataxia, drug dependency history, the propensity to abuse drugs, hyperkinesis, organic brain disease, psychosis (possible paradoxical reactions), hypoproteinemia, sleep apnea (or suspected), advanced age.

Pregnancy and lactation

The drug is contraindicated.

Cautions

In the treatment of alprazolam patients are strictly prohibited etanola.Effektivnost use and safety of the drug in patients younger than 18 years of age ustanovlena.Pri renal / hepatic failure and prolonged treatment is necessary to monitor the pattern of peripheral blood and liver "fermentami.Patsienty not taking psychoactive drugs previously "respond" to the drug at lower doses compared with patients taking antidepressants, anxiolytics, or suffering from alcoholism. In endogenous depression alprazolam can be used in combination with antidepressants. In the application of alprazolam patients with depression also cases of hypomanic and manic states. Like other benzodiazepines, alprazolam has the potential to cause drug dependence during chronic administration in large doses (more than 4 mg / day). In a sudden stop accepting alprazolam may occur syndrome "cancel" (depression, irritability, insomnia, increased sweating, etc.), especially in chronic administration (more than 8-12 weeks). If you have any patients with such unusual reactions, as increased aggressiveness, acute state of excitement, anxiety, suicidal thoughts, hallucinations, increased muscle cramps, difficult to fall asleep, shallow sleep, treatment should be discontinued. During pregnancy, only in exceptional cases and only for "real life" testimony. Toxic effect on the fetus and increases the risk of birth defects when used in the I trimester of pregnancy. Therapeutic dose in later stages of pregnancy can cause depression of the central nervous system of the newborn. The constant use during pregnancy can lead to physical dependence with the development of the syndrome of "cancellation" of the newborn. Children, especially at a young age, are very sensitive to the depressant drug action of benzodiazepines. Using just before birth or during labor may cause newborn respiratory depression, reduced muscle tone, hypotension, hypothermia and a weak act of sucking (syndrome flaccid child "). During the period of treatment must be careful when driving and other lesson potentially dangerous activities which require high concentration and speed of psychomotor reactions.

Overdose

Symptoms (receiving 500-600 mg): drowsiness, confusion, reduced reflexes, nystagmus, tremor, bradycardia, dyspnea or shortness of breath, lower blood pressure, coma.

Treatment: gastric lavage, activated charcoal method. Symptomatic therapy (maintenance of respiration and blood pressure), introduction of flumazenil (in hospital). Hemodialysis is ineffective.

Drug Interactions

There is mutual reinforcement effect when the appointment of antipsychotic (neuroleptic), antiepileptic drugs or sleeping pills, as well as central muscle relaxants, narcotic analgesics, ethanol, and drugs for general anesthesia.

Inhibitors of microsomal oxidation in liver enzymes increase, and inductors reduce the concentration of alprozalama in plasma (may change the effectiveness of alprazolam).

Alprazolam may increase the severity of BP decrease against the background of hypotensive drugs. In case of simultaneous appointment with clozapine may strengthen respiratory depression. Reduces the effectiveness of levodopa in patients with Parkinson's disease. May increase the toxicity of zidovudine.