알프라졸람

동물 종별 용량

투여 경로

금기

• Known benzodiazepine hypersensitivity
• Aggressive animals (controversial; anxiety reduction may disinhibit aggressive tendencies)

이상반응

• Sedation
• Increased appetite (polyphagia)
• Transient ataxia
• Behavior changes in cats (irritability, increased affection, depression, aberrant demeanor)
• Paradoxical CNS excitement/agitation (rare in dogs)
• Physical dependence (with chronic use)
• Impeded learning and retarded training

약물 상호작용

• Antacids · May slow the rate, but not the extent of oral absorption of alprazolam; administer 2 hours apart.
• CNS Depressant Agents (barbiturates, narcotics, anesthetics) · Additive CNS depression effects may occur.
• Digoxin · Serum levels of digoxin may be increased; monitor for toxicity.
• Fluoxetine, Fluvoxamine · Increased alprazolam levels.
• Hepatically Metabolized Drugs (Cimetidine, erythromycin, isoniazid, ketoconazole, itraconazole) · Metabolism of alprazolam may be decreased, leading to excessive sedation.
• Rifampin · May induce hepatic microsomal enzymes and decrease the pharmacologic effects of benzodiazepines.
• Tricyclic Antidepressants (Amitriptyline, Clomipramine, Imipramine) · Alprazolam may increase levels of these drugs; concurrent use with clomipramine may improve efficacy for phobias.
• Itraconazole · Inhibits alprazolam metabolism, potentially increasing sedation and toxicity · major
• Ketoconazole · Inhibits alprazolam metabolism · major
• Clomipramine · Used concurrently as an adjunct, but may have additive CNS depressant effects · minor

모니터링

• Clinical efficacy (reduction in anxiety/panic)
• Adverse effects (excessive sedation, paradoxical excitation)
• Hepatic enzymes (particularly when treating cats chronically)

과용량

Overdoses are generally limited to **CNS signs**, primarily dose-dependent CNS depression. - **Clinical Signs**: Ataxia, lethargy, disorientation, and vomiting. Some animals may present with a **paradoxical reaction** (hyperactivity, vocalization, agitation) which may be followed by CNS depression. Severe signs like hypotension, respiratory depression, and cardiac arrest are quite rare in small animals. - **Toxicity**: The reported LD50 in rats is >330 mg/kg, but cardiac arrest has occurred at doses as low as 195 mg/kg. - **Treatment**: Consists of standard protocols for decontamination. The decision to give activated charcoal should be weighed carefully against the risk of aspiration if the patient is sedated. **Flumazenil** can be used to reverse the sedative effects, but is generally reserved for cases with significant CNS and respiratory depression.