The benzodiazepines, including alprazolam, produce additive CNS depressant effects when co-administered with other psychotropic medications, anticonvulsants, antihistaminics, ethanol and other drugs which themselves produce CNS depression. Consult your doctor before use, or if you are planning to fall pregnant. Withdrawal symptoms were identified as those which were generally not characteristic of panic disorder and which occurred for the first time more frequently during discontinuation than at baseline. Now, he sits on my lap and chills in a very calm state. The duration of treatment can vary, depending on the condition being treated, your dog's response to the medication, and the side effects he might experience. Dog medication dosage for Amoxicillin is between 5mg and 10 mg per lb. What are side effects for overdose of sleeping pills & how to manage it? - Dr. Sanjay Gupta
Demonstrations of the effectiveness of XANAX by systematic clinical study are limited to 4 months duration for anxiety disorder and 4 to 10 weeks duration for panic disorder; however, patients with panic disorder have been treated on an open basis for up to 8 months without apparent loss of benefit. The physician should periodically reassess the usefulness of the drug for the individual patient. Dosage should be individualized for maximum beneficial effect. In such cases, dosage should be increased cautiously to avoid adverse effects.
Treatment for patients with anxiety should be initiated with a dose of 0. The dose may be increased to achieve a maximum therapeutic effect, at intervals of 3 to 4 days, to a maximum daily dose of 4 mg, given in divided doses. The lowest possible effective dose should be employed and the need for continued treatment reassessed frequently. The risk of dependence may increase with dose and duration of treatment. In all patients, dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage.
Although there are no systematically collected data to support a specific discontinuation schedule, it is suggested that the daily dosage be decreased by no more than 0. Some patients may require an even slower dosage reduction. The successful treatment of many panic disorder patients has required the use of XANAX at doses greater than 4 mg daily.
In controlled trials conducted to establish the efficacy of XANAX in panic disorder, doses in the range of 1 to 10 mg daily were used. The mean dosage employed was approximately 5 to 6 mg daily. Occasional patients required as much as 10 mg a day to achieve a successful response. Treatment may be initiated with a dose of 0. Depending on the response, the dose may be increased at intervals of 3 to 4 days in increments of no more than 1 mg per day. To lessen the possibility of interdose symptoms, the times of administration should be distributed as evenly as possible throughout the waking hours, that is, on a three or four times per day schedule.
Generally, therapy should be initiated at a low dose to minimize the risk of adverse responses in patients especially sensitive to the drug. Dose should be advanced until an acceptable therapeutic response ie, a substantial reduction in or total elimination of panic attacks is achieved, intolerance occurs, or the maximum recommended dose is attained.
Because of the danger of withdrawal, abrupt discontinuation of treatment should be avoided. In any case, reduction of dose must be undertaken under close supervision and must be gradual. If significant withdrawal symptoms develop, the previous dosing schedule should be reinstituted and, only after stabilization, should a less rapid schedule of discontinuation be attempted.
In a controlled postmarketing discontinuation study of panic disorder patients which compared this recommended taper schedule with a slower taper schedule, no difference was observed between the groups in the proportion of patients who tapered to zero dose; however, the slower schedule was associated with a reduction in symptoms associated with a withdrawal syndrome. It is suggested that the dose be reduced by no more than 0. Some patients may prove resistant to all discontinuation regimens.
In elderly patients, in patients with advanced liver disease or in patients with debilitating disease, the usual starting dose is 0. This may be gradually increased if needed and tolerated. The elderly may be especially sensitive to the effects of benzodiazepines. If side effects occur at the recommended starting dose, the dose may be lowered. NDC Unit dose NDC Bottles of Side effects to XANAX Tablets, if they occur, are generally observed at the beginning of therapy and usually disappear upon continued medication.
In the usual patient, the most frequent side effects are likely to be an extension of the pharmacological activity of alprazolam , eg, drowsiness or lightheadedness. The data cited in the two tables below are estimates of untoward clinical event incidence among patients who participated under the following clinical conditions: These data cannot be used to predict precisely the incidence of untoward events in the course of usual medical practice where patient characteristics, and other factors often differ from those in clinical trials.
These figures cannot be compared with those obtained from other clinical studies involving related drug products and placebo as each group of drug trials are conducted under a different set of conditions. Comparison of the cited figures, however, can provide the prescriber with some basis for estimating the relative contributions of drug and non-drug factors to the untoward event incidence in the population studied. Even this use must be approached cautiously, as a drug may relieve a symptom in one patient but induce it in others.
For example, an anxiolytic drug may relieve dry mouth [a symptom of anxiety] in some subjects but induce it [an untoward event] in others. Additionally, for anxiety disorders the cited figures can provide the prescriber with an indication as to the frequency with which physician intervention eg, increased surveillance, decreased dosage or discontinuation of drug therapy may be necessary because of the untoward clinical event. From the studies cited, it has not been determined whether these symptoms are clearly related to the dose and duration of therapy with XANAX in patients with panic disorder.
To discontinue treatment in patients taking XANAX, the dosage should be reduced slowly in keeping with good medical practice. Some patients may benefit from an even slower dosage reduction. As with all benzodiazepines, paradoxical reactions such as stimulation, increased muscle spasticity , sleep disturbances, hallucinations and other adverse behavioral effects such as agitation, rage, irritability, and aggressive or hostile behavior have been reported rarely.
Should any of the above events occur, alprazolam should be discontinued. Isolated published reports involving small numbers of patients have suggested that patients who have borderline personality disorder , a prior history of violent or aggressive behavior, or alcohol or substance abuse may be at risk for such events. Instances of irritability, hostility, and intrusive thoughts have been reported during discontinuation of alprazolam in patients with posttraumatic stress disorder.
Various adverse drug reactions have been reported in association with the use of XANAX since market introduction. The majority of these reactions were reported through the medical event voluntary reporting system. Because of the spontaneous nature of the reporting of medical events and the lack of controls, a causal relationship to the use of XANAX cannot be readily determined.
If XANAX Tablets are to be combined with other psychotropic agents or anticonvulsant drugs, careful consideration should be given to the pharmacology of the agents to be employed, particularly with compounds which might potentiate the action of benzodiazepines. The benzodiazepines, including alprazolam, produce additive CNS depressant effects when co-administered with other psychotropic medications, anticonvulsants, antihistaminics, ethanol and other drugs which themselves produce CNS depression.
Patients who receive alprazolam and digoxin should therefore be monitored for signs and symptoms related to digoxin toxicity. The clinical significance of these changes is unknown. Drugs demonstrated to be CYP3A inhibitors of possible clinical significance on the basis of clinical studies involving alprazolam caution is recommended during coadministration with alprazolam. Drugs and other substances demonstrated to be CYP 3A inhibitors on the basis of clinical studies involving benzodiazepines metabolized similarly to alprazolam or on the basis of in vitro studies with alprazolam or other benzodiazepines caution is recommended during coadministration with alprazolam.
Available data from clinical studies of benzodiazepines other than alprazolam suggest a possible drug interaction with alprazolam for the following: Data from in vitro studies of alprazolam suggest a possible drug interaction with alprazolam for the following: Data from in vitro studies of benzodiazepines other than alprazolam suggest a possible drug interaction for the following: Carbamazepine can increase alprazolam metabolism and therefore can decrease plasma levels of alprazolam.
The symptoms can range from mild dysphoria and insomnia to a major syndrome that may include abdominal and muscle cramps, vomiting, sweating, tremors and convulsions. Distinguishing between withdrawal emergent signs and symptoms and the recurrence of illness is often difficult in patients undergoing dose reduction.
The long term strategy for treatment of these phenomena will vary with their cause and the therapeutic goal. When necessary, immediate management of withdrawal symptoms requires re-institution of treatment at doses of XANAX sufficient to suppress symptoms. There have been reports of failure of other benzodiazepines to fully suppress these withdrawal symptoms. These failures have been attributed to incomplete cross-tolerance but may also reflect the use of an inadequate dosing regimen of the substituted benzodiazepine or the effects of concomitant medications.
While it is difficult to distinguish withdrawal and recurrence for certain patients, the time course and the nature of the symptoms may be helpful. A withdrawal syndrome typically includes the occurrence of new symptoms, tends to appear toward the end of taper or shortly after discontinuation, and will decrease with time.
In recurring panic disorder, symptoms similar to those observed before treatment may recur either early or late, and they will persist. While the severity and incidence of withdrawal phenomena appear to be related to dose and duration of treatment, withdrawal symptoms, including seizures, have been reported after only brief therapy with XANAX at doses within the recommended range for the treatment of anxiety eg, 0.
Signs and symptoms of withdrawal are often more prominent after rapid decrease of dosage or abrupt discontinuance. Patients, especially individuals with a history of seizures or epilepsy , should not be abruptly discontinued from any CNS depressant agent, including XANAX. Some patients have experienced considerable difficulty in tapering and discontinuing from XANAX, especially those receiving higher doses for extended periods.
As with all anxiolytics, repeat prescriptions should be limited to those who are under medical supervision. Certain adverse clinical events, some life-threatening, are a direct consequence of physical dependence to XANAX. These include a spectrum of withdrawal symptoms ; the most important is seizure see Drug Abuse And Dependence. Even after relatively shortterm use at the doses recommended for the treatment of transient anxiety and anxiety disorder ie, 0.
However, in a controlled postmarketing discontinuation study of panic disorder patients, the duration of treatment 3 months compared to 6 months had no effect on the ability of patients to taper to zero dose. Because the management of panic disorder often requires the use of average daily doses of XANAX above 4 mg, the risk of dependence among panic disorder patients may be higher than that among those treated for less severe anxiety.
Experience in randomized placebo-controlled discontinuation studies of patients with panic disorder showed a high rate of rebound and withdrawal symptoms in patients treated with XANAX compared to placebo-treated patients. Relapse or return of illness was defined as a return of symptoms characteristic of panic disorder primarily panic attacks to levels approximately equal to those seen at baseline before active treatment was initiated.
Rebound refers to a return of symptoms of panic disorder to a level substantially greater in frequency, or more severe in intensity than seen at baseline. Withdrawal symptoms were identified as those which were generally not characteristic of panic disorder and which occurred for the first time more frequently during discontinuation than at baseline. In a controlled clinical trial in which 63 patients were randomized to XANAX and where withdrawal symptoms were specifically sought, the following were identified as symptoms of withdrawal: Other symptoms, such as anxiety and insomnia, were frequently seen during discontinuation, but it could not be determined if they were due to return of illness, rebound, or withdrawal.
In a controlled postmarketing discontinuation study of panic disorder patients, the duration of treatment 3 months compared to 6 months had no effect on the ability of patients to taper to zero dose. Five of these cases clearly occurred during abrupt dose reduction, or discontinuation from daily doses of 2 to 10 mg. Three cases occurred in situations where there was not a clear relationship to abrupt dose reduction or discontinuation.
In one instance, seizure occurred after discontinuation from a single dose of 1 mg after tapering at a rate of 1 mg every 3 days from 6 mg daily. In two other instances, the relationship to taper is indeterminate; in both of these cases the patients had been receiving doses of 3 mg daily prior to seizure. The duration of use in the above 8 cases ranged from 4 to 22 weeks. There have been occasional voluntary reports of patients developing seizures while apparently tapering gradually from XANAX.
The medical event voluntary reporting system shows that withdrawal seizures have been reported in association with the discontinuation of XANAX. In most cases, only a single seizure was reported; however, multiple seizures and status epilepticus were reported as well. These symptoms may reflect the development of tolerance or a time interval between doses which is longer than the duration of clinical action of the administered dose.
In either case, it is presumed that the prescribed dose is not sufficient to maintain plasma levels above those needed to prevent relapse, rebound or withdrawal symptoms over the entire course of the interdosing interval. Withdrawal reactions may occur when dosage reduction occurs for any reason. This includes purposeful tapering, but also inadvertent reduction of dose eg, the patient forgets, the patient is admitted to a hospital.
Because of its CNS depressant effects, patients receiving XANAX should be cautioned against engaging in hazardous occupations or activities requiring complete mental alertness such as operating machinery or driving a motor vehicle. For the same reason, patients should be cautioned about the simultaneous ingestion of alcohol and other CNS depressant drugs during treatment with XANAX. Benzodiazepines can potentially cause fetal harm when administered to pregnant women.
If XANAX is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. Because of experience with other members of the benzodiazepine class, XANAX is assumed to be capable of causing an increased risk of congenital abnormalities when administered to a pregnant woman during the first trimester.
Because use of these drugs is rarely a matter of urgency, their use during the first trimester should almost always be avoided. Alprazolam is not considered safe for use during pregnancy. Administering benzodiazepines to a pregnant dog could lead to abnormalities and deformities in offspring. Because Xanax is a prescription medication you will always need to seek a prescription from your vet before use.
During the consult your vet will likely ask questions to determine whether or not your dog is suitable for treatment. Be sure to discuss: When you want to stop treatment with the drug after a period of prolonged use, you will be required to gradually decrease the dosage daily before stopping completely. Withdrawing the drug immediately could lead to issues. The vet will be able to help you with this. There are several uses of alprazolam for treating dogs. It is most often used to treat: It is sometimes used to treat aggression but this is controversial and often advised against as it can reduce inhibition.
If you were hoping to use the medicine to calm a hyperactive dog, you could try out some brain games for dogs instead. The following side effects are possible during treatment with Xanax: If you notice that they become tinted yellow at any point call the vet immediately, as this is a signal of liver damage. An overdose of Xanax will greatly depress the central nervous system which can manifest in the following ways: In some cases hyperactivity occurs following an overdose in contrast to sedation.
If you have accidentally administered an overdose or if you suspect your dog has eaten a number of pills you should call the vet immediately or call the ASPCA Animal Poison Control hotline on Flumazenil may be administered in cases of severe CNS depression and standard methods of binding the drug in the stomach will be employed.