Alprax 0.5 mg Tablet

Short-acting benzodiazepine for:

• Short-term relief of severe anxiety (generalised anxiety, anxiety with depression)
• Panic disorder (with or without agoraphobia)

Anxiety (adults): 0.25–0.5 mg three times daily; increase if needed up to 3 mg daily in divided doses.

Panic disorder: 0.5–1 mg at bedtime or 0.5 mg three times daily; increase by up to 1 mg every 3–4 days; usual 5–6 mg daily (maximum 10 mg — specialist).

Elderly / liver impairment: 0.25 mg two to three times daily.

Extended release: once daily in the morning.

• Use for the shortest time (usually 2–4 weeks for anxiety).
• Do not stop suddenly — reduce by no more than 0.5 mg every 3 days (seizure risk with abrupt withdrawal).
• Not for children under 18.

• Myasthenia gravis
• Severe respiratory insufficiency, sleep apnoea
• Severe liver impairment
• Acute narrow-angle glaucoma
• Use with ketoconazole or itraconazole
• Allergy to benzodiazepines

Very common: drowsiness, sedation, tiredness, memory problems, unsteadiness, slurred speech.

Common: dizziness, headache, confusion, low mood, blurred vision, dry mouth, constipation, changes in appetite and weight, sexual problems.

Serious: dependence and severe withdrawal (rebound anxiety, insomnia, seizures — high risk because of short action), paradoxical agitation, falls in elderly, breathing depression with opioids/alcohol.

• Do not drive or operate machinery; avoid alcohol completely.
• High potential for misuse — keep secure.
• History of substance misuse, depression, suicidal thoughts: caution.
• Elderly: lower doses, fall risk.

Avoid in pregnancy, especially the first and last trimesters (floppy infant, withdrawal in the newborn). Avoid while breastfeeding.

• Opioids (profound sedation, breathing depression, death), alcohol, other sedatives, antihistamines, antipsychotics
• Ketoconazole, itraconazole (contraindicated); clarithromycin, erythromycin, fluvoxamine, fluoxetine, ritonavir, grapefruit, oral contraceptives (raise levels)
• Carbamazepine, rifampicin, St John's wort (lower levels)

Drowsiness, confusion, slow reflexes, slurred speech, coma, breathing depression — dangerous with alcohol or opioids. Emergency care; flumazenil in hospital.

Store below 30°C, protected from light.