Xanax While Pregnant

Xanax While Pregnant


Contents:


Instruction for Use of the Medicinal Preparation

Xanax is anxiolytic drug (tranquilizer) derived from triazole-benzoldiazepine. It has anxiolytic, sedative, somnolent, anticonvulsive and central myoreleasing effects. The mechanism of action is determined by amplification of inhibitory impact of endogenous GABA on central nervous system due to increase of sensitivity of GABA receptors to a mediator as a result of stimulation the benzoldiazepine receptors located in the allosteric center of postsynaptic GABA receptors of the ascending activating reticular formation of brain stem and inserted neurons of the intermediolateral column of the spinal cord; reduces excitability of subcrustal structures of a brain (limbic system, thalamus, hypothalamus), slow down polysynaptic spinal reflexes.

The expressed anxiolytic activity (reduction of an emotional pressure, weakening of anxious, fear, concern feelings) is combined with moderately expressed somnolent action; shortens a falling asleep period, increases a period of sleep, reduces the number of night awakenings. The mechanism of somnolent action consists in debilitation of cells of the brain stem reticular formation. It reduces influence of the emotional, vegetative and motor irritants breaking the falling asleep mechanism.

The Indications for the Use

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Anxiety conditions, neurosises which are followed by anxious, danger, concern, tension feelings, sleep disturbance, irritability, and also somatic disorders; the mixed disturbing depressions; the neurotic reactive depressions which are followed by decrease in mood, loss of interest to surroundings, sleep loss, reduced appetite, somatic disorders; the anxiety conditions and neurotic depressions which have developed against somatic diseases; panic frustration in a combination or without phobia symptoms.

Pharmacodynamics

Anxiolytic remedy (tranquilizer) derived from triazole-benzoldiazepine. It has anxiolytic, sedative, somnolent, anticonvulsive and central myoreleasing effects. The mechanism of action is determined by amplification of inhibitory impact of endogenous GABA on central nervous system due to increase of sensitivity of GABA receptors to a mediator as a result of stimulation the benzoldiazepine receptors located in the allosteric center of postsynaptic GABA receptors of the ascending activating reticular formation of brain stem and inserted neurons of the intermediolateral column of the spinal cord; reduces excitability of subcrustal structures of a brain (limbic system, thalamus, hypothalamus), slow down polysynaptic spinal reflexes.

The expressed anxiolytic activity (reduction of an emotional pressure, weakening of anxious, fear, concern feelings) is combined with moderately expressed somnolent action; shortens a falling asleep period, increases a period of sleep, reduces the number of night awakenings. The mechanism of somnolent action consists in debilitation of cells of the brain stem reticular formation. It reduces influence of the emotional, vegetative and motor irritants breaking the falling asleep mechanism.

Application During Pregnancy

Alprazolam has toxic effect on the embryo and increases the risk of the development of congenital defects in application during the 1st trimester of pregnancy period. Continuous application at pregnancy may result in physical dependency of the newborn with the development of withdrawal syndrome. Taking in therapeutical dosages at later terms of pregnancy can lead to debilitation of central nervous system of the infant. Application just before childbirth or at the time of delivery can lead to respiratory depression of the newborn child, weakness of muscular tonus, hypotension, hypothermia and the weak act of sucking (a syndrome of sluggish sucking of the newborn).

Additionally, a release of benzoldiazepines substances with breast milk may seem to occur. It would lead to drowsiness of the newborn and may complicate feeding. And it is shown by experimental researches that alprazolam and its metabolites are released with breast milk.

Contraindications to Application

Coma, shock, myasthenia, closed-angle glaucoma (sharp stab or predisposition), sharp alcoholic poisonings (with weakening of the vital functions of the organism), opiate analgetics, sedative and psychotropic drugs, chronic obstructive respiratory diseases with initial manifestations of respiratory insufficiency, sharp respiratory insufficiency, a heavy depression (suicide bents), pregnancy (especially during the 1st trimester), the lactation period, children and teenagers under 18 years of age, hypersensibility to benzoldiazepines.

The Potential Adverse Effects

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  • In relation to central nervous system: at the time of starting the treatment (especially in patients of advanced age) there are drowsiness, feeling of fatigue, dizziness or vertigo, decline in the ability to concentration of attention, an ataxy, disorientation and loss of coordination while walking, delay of mental and motive reactions; seldom may be a headache, euphoria, a depression, a tremor, reduced memory, reduced movement coordination disorders, undifferentiated sad in mood, confusion of consciousness, dystonic extrapyramidal reactions (the uncontrolled movements, including eye movements), weakness, myasthenia, articulation disturbances; in some cases - paradoxical reactions (gusts of aggression, confusion of consciousness, psychomotor excitement, fear, suicide bent, muscular spasms, hallucinations, excitation, irritability, uneasiness, sleeplessness).
  • In relation to the gastrointestinal tract: there may be dry mouth or a salivation, heartburn, nausea, vomiting, loss of appetite, constipation or diarrhea, hepatic dysfunction, increase of hepatic transaminase and alkaline phosphatase activity, jaundice.
  • In relation to the hematopoietic system: there may be leucopenia, neutropenia, agranulocytosis (a shivering, a hyperthermia, a sore throat, excessive fatigue or weakness), anemia, thrombocytopenia.
  • In relation to the urinary tract: there may be urine incontience, urine delay, dysfunction of kidneys, decrease or increase of a libido, dysmenorrhea.
  • In relation to the endocrine system: there may be change of body weight, violation of libido, violation of menstrual cycle.
  • In relation to the cardiovascular system: there may be decrease in arterial blood pressure, tachycardia.
  • Possible allergic reactions: skin eruption, itch.

Method of Application and Doses

Individual consumption. It is recommended to use the minimum effective doses. The dose has been resolved during treatment depending on the reached effect and tolerability. In need of increase of a dose it should be increased gradually, starting at evening and then all day receiving.

The initial dose makes 250-500 mcg three times a day. If necessary it is possible to increase up to 4.5 mg gradually.
For the elderly or weakened patients the initial dose makes 250 mcg 2-3 three times a day, supporting doses - 500-750 mcg. If necessary the dose can be increased taking into account individual tolerability.

Cancellation or decrease in a dose of alprazolam should be carried out gradually, lowering a daily dose no more than by 500 mcg each 3 days; sometimes there should be more slow cancellation required.

Interaction With Other Preparations

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During simultaneous application of psychotropic, anticonvulsive drugs with ethanol, there has been increasing inhibitory effect of alprazolam on central nervous system.

At simultaneous application, H2-histamine receptor blockers reduce clearance of alprazolam and amplify inhibitory effect of alprazolam on central nervous system; antibiotics from the group of macrolides reduce clearance of an alprazolam, too.

At simultaneous application, hormonal contraceptives for oral administration increase terminal half-life of alprazolam.

During simultaneous application of alprazolam with dextropropoxyphene there has been more expressed inhibitory effect of alprazolam on central nervous system, than in a combination with other benzoldiazepines, since increase of concentration of alprazolam in blood plasma is possible in this case.

Simultaneous administration of digoxin increases the risk of the development of intoxication by digitalis glycosides.

Alprazolam increases concentration of imipramin in blood plasma.

Simultaneous administration of itraconazole and ketoconazole amplifies effects of alprazolam.

During simultaneous application of paroksetin, there has been increasing effect of alprazolam caused by suppression of its metabolism.

Fluvoksamin increases concentration of an alprazolam in blood plasma and the risk of the development of its adverse effects.

During simultaneous use of fluoxetine there has been increasing concentration of alprazolam in blood plasma due to reduction of its metabolism and clearance under the influence of fluoxetine, that is followed by psychomotor disorders.

It is impossible to eliminate a possibility to enhance the activity of alprazolam by simultaneous application with erythromycin.

Precautionary Measures During Application

Take extra care in administration in cases of hepatic and kidneys dysfunction, heavy depressions, suicide mood, panic frustration. In order to avoid a withdrawal syndrome (the abstinent phenomena) treatment should be discontinued gradually, reducing a dose no more, than by 0,5 mg each 3 days. During the treatment driving or handling potentially dangerous mechanisms isn't recommended. Lactating women have to refrain from breastfeeding at the time of intaking the preparation.

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