In endogenous depression, farmapram (alprazolam) can be used in combination with antidepressants. When using farmapram in patients with depression, cases of hypomanic and manic states have been noted.
Alprazolam should be used with caution in patients with hepatic and/or renal dysfunction.
In patients who have not previously taken CNS-affecting drugs, alprazolam is effective at lower doses compared to patients who have received antidepressants, anxiolytics or suffer from chronic alcoholism.
With prolonged use in high doses, addiction and dependence may develop, especially in patients who are prone to drug abuse.
With rapid dose reduction or abrupt withdrawal of alprazolam, a withdrawal syndrome is observed, with symptoms ranging from mild dysphoria and insomnia to a severe syndrome with abdominal and skeletal muscle cramps, vomiting, increased sweating, tremors and seizures. Withdrawal syndrome is more common in persons who have received alprazolam for a long period (more than 8-12 weeks).
Other tranquilizers should not be used concomitantly with alprazolam.
The safety of using alprazolam in children and adolescents under 18 years of age has not been established. Children, especially younger children, are very sensitive to the CNS depressing effects of benzodiazepines. Alcohol should be avoided during the treatment period.
Effect on the ability to drive motor transport and operate machinery. During the treatment period, it is necessary to refrain from potentially dangerous activities requiring high attention and quick psychomotor reactions (driving motor transport or operating machinery).
During treatment with alprazolam, patients are strictly prohibited from using ethanol. Efficacy and safety of using the drug in patients under 18 years old has not been established.
In case of renal/hepatic insufficiency and prolonged treatment, monitoring of peripheral blood counts and liver enzymes is necessary. Patients who have not previously taken psychoactive drugs “respond” to the drug in lower doses compared to patients who have taken antidepressants, anxiolytics or alcoholics. For endogenous depression, alprazolam can be used in combination with antidepressants. When using alprazolam in patients with depression, there have been cases of hypomanic and manic states.
Withdrawal syndrome (depression, irritability, insomnia, increased sweating, etc.) may be observed when alprazolam is suddenly discontinued, especially with prolonged use (more than 8-12 weeks). If patients have such unusual reactions as increased aggression, acute states of agitation, feelings of fear, suicidal thoughts, hallucinations, increased muscle cramps, difficulty falling asleep, shallow sleep, treatment should be stopped. During pregnancy, it is used only in exceptional cases and only for “vital” indications. It has toxic effect on the fetus and increases the risk of congenital defects if used in the first trimester of pregnancy. Therapeutic doses later in pregnancy may cause CNS depression in the newborn. Continuous use during pregnancy may lead to physical dependence with development of “withdrawal” syndrome in the newborn. Children, especially those of younger age, are very sensitive to the CNS depressing effects of benzodiazepines.