Alprazolam

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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

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