Alprazolam is generally safe to use in companion animals; however, behavioral and medical side effects and adverse events can occur.
SIDE EFFECTS & ADVERSE EVENTS
- Common side effects associated with alprazolam administration include1
- Increased appetite
- Paradoxical excitement
- In animals, physiologic tolerance can occur and possibly lead to rebound and/or withdrawal signs when alprazolam is discontinued.2,3
- Rebound effects may include recurrence of original signs for which the medication was chosen (eg, anxiety, phobia).
- In humans, signs of withdrawal include seizures, irritability, anxiety, panic attacks, and tension.
Patients presented for aggression should be closely monitored for irritability and worsening of aggressive signs.1
- Use caution in patients receiving medications that impair or induce oxidative metabolism by the cytochrome P450 3A4 enzyme,4 including
- Antifungals (eg, ketoconazole, itraconazole)4
- Certain antibiotics (eg, doxycycline)4
- Certain anticonvulsants (eg, phenobarbital)4
- Gradual decrease of alprazolam over 2 weeks is recommended for animals that have been treated daily for >14 days.2
- Alprazolam treatment for aggression is controversial because of potential risk for disinhibition.
- Certain nutraceuticals and natural substances (eg, St. John’s wort, valerian root) may decrease serum alprazolam levels by induction of CYP3A4 and increase CNS depression.
- Administer these substances with caution in patients receiving alprazolam.4
- Doses may need to be decreased in older patients or those with impaired hepatic or renal function.