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Detoxification Strategies
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Jennifer Kljajic, Ahmed Zaafran
What is very important to note is that blood serum levels need to be stable throughout the day so that the individual tapering can maintain some manageable level of activities of daily living in between dose reduction. Practitioners in methadone clinics have known this for years, and benzodiazepines need the same amount of careful discernment in keeping individuals stable as they taper. Due to the half-life of the medication, it is important to factor that into the taper. If someone is taking alprazolam, they need to dose four times daily due to the approximate 6-hour half-life. Lorazepam in general is dosed three times daily due to the 8-hour half-life, and clonazepam is dosed twice daily due to the 12-hour half-life. Diazepam is dosed once daily due to 30-hour half-life. The half-life of all of these drugs is approximate due to inter-individual variability in metabolism and excretion rates. When tapering, a person would need to make even cuts across the doses. For example, if someone is taking 1 mg of Ativan a day (individual doses of 0.33 mg three times daily), a 5% dose decrease would be 0.316 mg three times daily for a total of 0.95 mg, and then the next step would be 0.3 mg three times daily for a total of 0.9 mg with a duration hold at each level anywhere from 7 to 14 days or holding until the withdrawal symptoms stabilize. The only accurate way of performing these dose tapers is to have the dose compounded at a compounding pharmacy or prescribing the liquid form of these medications for accurate measurement.
Rational Medical Therapy of Functional GI Disorders
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Richard M. Sperling, Kenneth R. McQuaid
Psychological Abnormalities Approximately 80% of CPUE patients have been found on structured interview to have a psychiatric diagnosis (41). Overall, CPUE patients display a higher degree of neuroticism, poor coping strategies, somatic anxiety, clinical pain reporting, and GI symptom susceptibility on various psychological questionaires (15,16,61). Up to 35% of CPUE patients fulfill diagnostic criteria for a diagnosis of panic disorder (61,62). Patients with panic disorder may come first to the attention of internists, family physicians, or emergency physicians complaining of somatic symptoms such as chest pain. Compared with other patients with CPUE, these patients tend to have higher levels of anxiety and psychological distress and more functional impairment from their chest pain. It is helpful to identify these patients early in the evaluation of chest pain to avoid a costly and unnecessary evaluation. Panic disorder may be effectively treated with pharmacological therapies, including alprazolam (63). The psychometric assessment and treatment of psychological disorders in functional disease is discussed elsewhere.
Drugs Affecting the Central Nervous System
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: The use of Alprazolam during the in 1st and 3rd Trimesters should be avoided because the pregnancy experience in humans, and the reproduction studies in animals have shown an increased risk of congenital abnormalities, neonatal flaccidity and withdrawal symptoms.
Mortality in an Opioid Treatment Program
Published in Journal of Psychoactive Drugs, 2022
Elenore P. Bhatraju, Caitlin Fuller, Paul Grekin, Shay Rockman, K. Michelle Peavy
The majority of deaths occurred in patients who were in treatment for six months or longer. Six deaths occurred in the first 30 days of treatment, of which only one was due to drug poisoning. This finding is in contrast to past work showing a higher risk of mortality during the first four weeks of treatment (Evans et al. 2015). The current OTP adheres to a careful approach to dosage increases early in treatment, which may account for a low number in deaths at the outset of treatment. Consistent with prior studies, patients taking alprazolam, a benzodiazepine, were at higher risk of death from drug poisoning (McCance-Katz, Sullivan, and Nallani 2010). Interestingly, and in contrast to Pearce et al. (2020), women were overrepresented among our sample’s total deaths. Women generally makeup about 40% of the clinic population but accounted for 50% of the overall deaths, and were significantly more likely to die from drug poisoning than men. This finding supports the need for more research that focuses on women and examines comorbidities and psychosocial factors among these patients. Other research highlights gender differences in drug-taking behavior (Becker, McClellan, and Reed 2013; Greenfield et al. 2007), also supporting the need for research focused on women.
Brain circuits and neurochemical systems in essential tremor: insights into current and future pharmacotherapeutic approaches
Published in Expert Review of Neurotherapeutics, 2018
Sara M Schaefer, Ana Vives Rodriguez, Elan D Louis
There is level B evidence for the use of alprazolam, and level C evidence for the use of clonazepam in ET; studies have shown some efficacy but recommendation for their use is limited by side effects and abuse potential [44]. Alprazolam demonstrated marginal benefit in ET in one class I and one class II study, averaging about 30% improvement in tremor based on clinical rating scales, whereas clonazepam has had mixed results in class II and class III studies [44,51,52]. Side effects in these studies were a significant barrier to completion. Benzodiazepines are GABAA receptor agonists that require both an α and a γ subunit [20,53]. GABAA receptors with γ subunits make up the majority of GABAA receptors, and are abundant in many areas of the brain (i.e. throughout the layers of the cerebellum, in the motor cortex, thalamus, and other regions) [17]. Benzodiazepines have particular affinity for receptors that contain α1–3 and α5 subunits, which explains their broad clinical effects. α1-Containing GABAA receptors are the primary receptors found in the cerebellum, thalamus, and cerebral cortex, and thus their activation could have broad effects, while α2-containing GABAA receptors are found in limbic pathways and are anxiolytic, and α5 subunits are found in the hippocampus and their activation induces amnesia (Table 1) [17,20]. The localization of α3 subunits in the dentate nucleus may be particularly relevant, as it is conceivable that inhibitory effects in this region could serve to reduce abnormal cerebellar output.
Formulation and characterization of alprazolam-loaded nanoliposomes: screening of process variables and optimizing characteristics using RSM
Published in Drug Development and Industrial Pharmacy, 2018
Seyed Hesamoddin Hashemi, Majid Montazer, Nasser Naghdi, Tayebeh Toliyat
Moreover, alprazolam is assumed to be the most toxic drug in the benzodiazepines family [5], and it is associated with various side effects such as drowsiness, muscle weakness, and ataxia [6]. Furthermore, tolerance and dependency, which are the worst side effects associated with benzodiazepines, are more critical in alprazolam [7]. In order to avoid the worst side effects of treatment with oral alprazolam, limited researches were carried out to obtain transdermal delivery of alprazolam through the development of transdermal dosage forms, such as patches. Obtaining more consistent serum levels through stationary permeation of alprazolam across the skin is the most important purpose of alprazolam transdermal delivery; this leads to avoiding the variations associated with oral therapy and reducing the worst side effects of benzodiazepines, such as tolerance and dependency. In comparison to oral dosage forms, transdermal delivery of alprazolam as a noninvasive route without risk offers other significant advantages, such as avoidance of hepatic first-pass metabolism and better patient compliance through a single administration for a few days [8,9].