Alprazolam + Propranolol Pharmacology

Alprazolam + Propranolol

About Alprazolam + Propranolol
Mechanism of Action of Alprazolam + Propranolol
Pharmacokinets of Alprazolam + Propranolol
Onset of Action for Alprazolam + Propranolol
Duration of Action for Alprazolam + Propranolol
Half Life of Alprazolam + Propranolol
Side Effects of Alprazolam + Propranolol
Contra-indications of Alprazolam + Propranolol
Special Precautions while taking Alprazolam + Propranolol
Pregnancy Related Information
Old Age Related Information
Breast Feeding Related Information
Children Related Information
Indications for Alprazolam + Propranolol
Panic attacks
Interactions for Alprazolam + Propranolol
Typical Dosage for Alprazolam + Propranolol
Varies with weight and severity of the disease. Following Alprazolam and Propranolol combinations are available in the market. The dosage has to be decided by the treating specialist.
Alprazolam 0.25 mg + Propranolol 10 mg
Alprazolam 0.25 mg + Propranolol 20 mg
Schedule of Alprazolam + Propranolol
Storage Requirements for Alprazolam + Propranolol
Effects of Missed Dosage of Alprazolam + Propranolol
Effects of Overdose of Alprazolam + Propranolol


About Alprazolam
Benzodiazepine derivative, Anti anxiety.
Mechanism of Action of Alprazolam
Alprazolam mainly acts on Limbic system and ascending reticular formation in the CNS and binds to the BZD receptor. The binding will facilitates GABA mediated chloride channel opening and produce hyperpolarisation. This will produce an increase in the concentration of the inhibitory neurotransmitter GABA and increase in chloride ions and decreases firing rate of neuron. This in turn alters normal functions of the body.
Pharmacokinets of Alprazolam
Absorption: It is well absorbed after oral administration. Distribution: It is distributed widely in the body in protein bound form. Metabolism: It is metabolised to active and inactive metabolite in the liver. Excretion: Drug is excreted in urine.
Onset of Action for Alprazolam
15 - 30 minutes
Duration of Action for Alprazolam
12 - 16 hours
Half Life of Alprazolam
12 -15 hours
Side Effects of Alprazolam
3.Light headedness
4. Slurred speech
6.Constipation or diarrhoea
11.Light headedness
12.Mood changes
13.Muscle rigidity
Contra-indications of Alprazolam
1.Hypersensitivity to Benzodiazepines
2.Acute angle closure glaucoma
Special Precautions while taking Alprazolam
1.Renal impairment
2.Hepatic impairment
3.Pulmonary insufficiency
4.Drug abuse
5.Bipolar disorder
6.Driving vehicles and operating machines and people involving any other dangerous activities
Pregnancy Related Information
Old Age Related Information
Use with caution
Breast Feeding Related Information
Children Related Information
NEONATES- contraindicated
Indications for Alprazolam
1.For the short-term management of anxiety,
2.Treatment of Panic disorder.
Interactions for Alprazolam
Alcohol & other CNS depressants: Enhanced CNS effects.
Aminophylline: Antagonizes the sedative effect.
Cimetidine, Oral contraceptives, Disulfiram, Fluoxetine, Isoniazid, Ketoconazole, Metoprolol, Propoxyphene, Propranolol,
Valproic Acid: Elimination of alprazolam decreased due to inhibition of hepatic metabolism leading to enhanced activity.
Digoxin: Increase in serum concentration of Digoxin.
Imipramine & Desipramine: Enhanced activity of these drugs.
Levodopa: Decrease in antiparkinsonism efficacy.
Rifampicine: Decreases efficacy.
Typical Dosage for Alprazolam
Anxiety: 0.25 - 0.5 mg every 8 hours in a day. Depending on the severity of the disease the dose can be gradually increased every 3 or 4 days.
Maximum dose: 4 mg / day in divided dose.
Anxiety with depression: 0.5 mg every 8 hours in a day
Maintenance dose: 1.5 - 4.5 mg/ day in divided dose
Panic disorder: starting dose: 1.5 mg /day in 3 divided dose. Depending on the severity of the disease the dose can be gradually increased every 3 or 4 days.

Children: Not recommended
Schedule of Alprazolam
Storage Requirements for Alprazolam
The drug should be kept at 15 - 30 degree C in a tightly closed container. Keep out of the reach of children
Effects of Missed Dosage of Alprazolam
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose.
Effects of Overdose of Alprazolam
Give supportive measures and symptomatic treatment. Flumazenil can be given as antagonist. Hypotension can be treated with vasopressors.If the patient is conscious induce emesis followed by charcoal administration


About Propranolol
A synthetic non-selective beta blocker , Antiarrhythmic,antihypertensive,antianxiety,migraine prophylatic.
Mechanism of Action of Propranolol
Propranolol is a non selective beta receptor antagonist. It have negative chronotropic and negative inotropic effects on heart. It decreases oxygen consumption; cardiac work and aortic pressure It decreases nor adrenaline and renin releases. It decreases central sympathetic out flow.
In sympathetic over activity, it prolongs systole by retarding conduction. It increases oxygen supply and exercise tolerance in angina patients. It decrease automaticity and abbreviates refractory period of myocardial fibers and decreases rate of depolarization in SA node, Purkinje fibers, and other ectoptic foci. Prolong effective refractory period of AV node and AV conduction is delayed. At higher doses direct depressant membrane stabilizing action is exerted. The drug decreases BP in hypertensive individuals. Initially total peripheral resistance increases due to blockade of beta mediated vasodilatation and decrease in cardiac output; so little change in BP. But when treatment is continued due to adaptation of resistance vessels to decreased cardiac output total peripheral resistance decreases and systolic and diastolic BP falls.
Antimigraine action: Propranolol is useful in migraine due to its beta blockade action. Through beta blockade action it inhibits vasodilation and relieves migraine.
Pharmacokinets of Propranolol
Absorption: well absorbed orally, bioavailabity is increased by administering along with food.
Distribution: Widely distributed in a plasma protein bound form.
Metabolism: Metabolized in liver.
Excretion: Excreted through urine.

Onset of Action for Propranolol
Duration of Action for Propranolol
Up to 12 hours
Half Life of Propranolol
4 hours
Side Effects of Propranolol
1.Congestive heart failure is precipitated or aggravated
2.Decreases coronary blood flow
5.Decreases exercise capacity
6.Decreases carbohydrate tolerance
7.Decrease insulin release
8.Increases free fatty acid levels and increase LDL to HDL ratio
9.Worsens chronic obstructive lung diseases
10.Gastrointestinal problems
12.Sexual dysfunction
13.Cold extremities
15.Exacerbates prinzmetal`s angina

Contra-indications of Propranolol
1.Hypersensitivity to the drug
2.Second or third degree heart block
3.Congestive heart failure
4.Cardiogenic shock
6.Chronic obstructive pulmonary diseases

Special Precautions while taking Propranolol
1.Peripheral arterial diseases
2.Ischaemic heart disease
3.Congestive heart failure
4.Renal impairment
5.Hepatic impairment
6. Diabetes mellitus
7. The drug should be gradually withdraw with caution
8. Non allergic bronchospastic diseases
9. Thyrotoxicosis
10. Along with other antihypertensive drugs

Pregnancy Related Information
Old Age Related Information
Use with caution
Breast Feeding Related Information
Children Related Information
Use with caution
Indications for Propranolol
1. Hypertension
2. Arrhythmias
3. Anxiety
4. Angina
5. Migraine
6. Prophylaxis of myocardial infarction
7. Tremors
8. Phaeochromocytoma
9. Hypertrophic sub aortic stenosis

Interactions for Propranolol
Quinidine: Orthostatic hypotension.
Rifampicin, Phenobarbital, NSAIDs, Thyroid hormones, Smoking: Decrease antihypertensive action of propranolol.
Corticosteroids: Antagonism of hypotensive effect.
Sympathomimetics: Marked hypertension and bradycardia.
Insulin: Hypoglycemic effects prolonged by propranalol and masking of symptoms of hypoglycemia in diabetes.
Lidocaine: Increased levels of lidocaine may occur resulting in toxicity.
Calcium channel blockers: Severe bradycardia especially in those with impaired LV function.
Phenothiazines: Chlorpromazine increases plasma levels of propranolol.
Reserpine: Additive effect resulting in vertigo, syncope or postural hypotension.
Clonidine: May increase the postural hypotension. Severity of rebound hypertension caused by abrupt withdrawal of clonidine enhanced.
Haloperidol: Severe hypotension.
Prazosin: May increase first dose response (acute postural hypotension) of prazosin.
Theophylline: Propranolol antagonises effect of theophylline.
Alcohol: Enhanced hypotensive effect.
ACE inhibitors: Enhanced hypotensive effect.
Lab tests: May interfere with Glaucoma screening test due to reduction in intraocular pressure.
Typical Dosage for Propranolol
40 to 240mg/day
Hypertension: Starts with 80mg once daily or in 2 divided doses and gradually increases up to 320mg/day based on patient`s response in divided doses 12th hourly or 8th hourly.
Maximum daily dose: 640mg.
Sustained release formulations: 120 to 160mg/day. Once daily.
Children: 1mg/kg/day gradually increases to 4mg/kg/day based on patient`s response in 4 divided doses
Maximum dose: 5mg/kg/day.
Arrhythmias & Anxiety: 30mg to 150mg/day in 3 to 5 divided doses.
Children: 0.5 to 4mg/kg/day in 3 to 4 divided doses.
Angina: 40 to 80mg two times daily to 4 times daily.
Migraine: 80 to 120mg/day in divided doses in 12th hourly to 8th hourly. And gradually increases at 1 week intervals to 160mg/day.
Children: 1mg/kg/day four times daily and gradually increases up to 5mg/kg/day based on patient`s response.
Prophylaxis of myocardial infarction: Initiate the therapy with 20mg dose 5days after myocardial infarction. Then give doses of 40mg thrice daily and gradually increases at weekly intervals up to 80mg based on patients response.

Schedule of Propranolol
Storage Requirements for Propranolol
Store at controlled room temperature between 20 to 25 degree celcious in a well closed container.
Effects of Missed Dosage of Propranolol
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Propranolol
Treatment is supportive and symptomatic. After ingestion empty the stomach by induced emesis or gastric lavage. Administer activated charcoal. Treat Bradycardia with atropine 0.5 to 1mg.If required administer isoproterinol with caution. Treat hypotension with glucagons and vasopressors like epinephrine. Treat cardiac failure with diuretics and cardiac glycosides. Treat bronchospasm with isoproterinol and aminophylline.

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Alprazolam + Propranolol is a generic medicine name and there are several brands available for it. Some of the brands for alprazolam + propranolol might be better known than alprazolam + propranolol itself. If the pharmacy that's willing to deliver medicines to your home doesn't have alprazolam + propranolol in stock, you can ask for one of the branded alternatives for alprazolam + propranolol.