Alprazolam
Benzodiazepine Sedative/Tranquilizer (Systemic Drug)
Prescriber Highlights
Used for adjunctive behavioral treatment in dogs and cats, especially for prophylaxis of anxiety triggered by storms, fireworks, and similar events
C-IV controlled substance
Uses, Indications
Useful for adjunctive therapy in anxious, aggressive dogs, or animals demonstrating panic reactions
Most effective when used before a triggering event
May be useful in treating anxiety disorders in cats
Unlike oral diazepam, alprazolam has not been implicated in causing liver failure in cats
Contraindications, Precautions, Warnings
Contraindications
Some veterinarians believe alprazolam is contraindicated in aggressive patients, as anxiety may restrain animals from aggressive tendencies. This remains controversial.
Precautions
Patients with impaired hepatic or renal function or narrow angle glaucoma; debilitated or geriatric patients
Warnings
May impair working animal performance; has potential for human abuse and drug diversion
Side Effects
Sedation, transient ataxia, and increased appetite
In cats, irritability, depression, increased affection, and aberrant demeanor are also possible
Rarely, dogs may exhibit a contradictory response (eg, CNS excitement including increased aggression, anxiety, agitation)
Drug Interactions*
May increase serum levels of tricyclic antidepressants (eg, amitriptyline, clomipramine) and digoxin
Alprazolam metabolism may decrease when used with hepatically metabolized drugs (eg, cimetidine, erythromycin, ketoconazole, itraconazole)
Additive effects may occur when used with other CNS depressant agents (eg, barbiturates, narcotics, anesthetics)
Fluoxetine and fluvoxamine may increase serum alprazolam levels
*Not a complete list
Monitoring
Clinical efficacy and side effects
Consider monitoring hepatic enzymes in cats when used long term
Client Information
Administer alprazolam 30 minutes to 1 hour prior to triggering events
Most common side effect is drowsiness, but excitement and behavioral changes (eg, increased appetite), although rare, may occur, especially in cats
Immediately report yellowing of the gums, skin, or whites of the eyes
Dosage Forms
The following are human-labeled products available for veterinary off-label use:
Alprazolam oral tablets: 0.25 mg, 0.5 mg, 1 mg, and 2 mg
Alprazolam extended-release oral tablets: 0.5 mg, 1 mg, 2 mg, and 3 mg
Alprazolam orally disintegrating tablets: 0.25 mg, 0.5 mg, 1 mg, and 2 mg
Alprazolam oral solution: 1 mg/mL in 30 mL
—Compiled and summarized from Plumb’s® Veterinary Drugs by Shannon Palermo, VMD
Information about this drug was adapted from Plumb’s® Veterinary Drugs. Further details and more therapeutics can be found with a subscription at plumbsveterinarydrugs.com