ALPROBEST 0.25 TAB

• Enhances GABA-A receptor activity, producing anxiolysis usually within an hour of a dose.
• The lower strength allows treatment to be started cautiously and titrated, which matters most in the elderly and in the benzodiazepine-naive.
• Effective in panic disorder, where it can reduce both the frequency and severity of attacks during the period before an antidepressant takes effect.
• Useful as short-term cover while a longer-term treatment such as an SSRI or psychological therapy is established.
• Relieves the physical symptoms of anxiety — tension, restlessness, palpitations — as well as the psychological ones.

Not everyone gets these. Most are mild and settle as the course finishes.

• Alprazolam carries a real risk of tolerance, dependence and withdrawal. Prescribe for the shortest period possible — generally two to four weeks including tapering — and review at every visit.
• Never stop abruptly after regular use. Withdrawal can cause rebound anxiety, insomnia, tremor and seizures; taper under supervision.
• Contraindicated in myasthenia gravis, severe respiratory insufficiency, sleep apnoea syndrome, severe hepatic impairment and narrow-angle glaucoma.
• Combining with opioids causes profound sedation and respiratory depression and can be fatal. Avoid; if unavoidable, use the lowest doses with close monitoring.
• Avoid alcohol entirely during treatment.
• Causes drowsiness and impairs reaction time. The patient must not drive or operate machinery until the effect is known.
• Contraindicated in pregnancy and breastfeeding.
• Use with particular caution in the elderly, in a history of substance misuse, and in depression, where benzodiazepines may unmask suicidal ideation.