Restyl (Alprazolam)
Also sold as: Restyl, Alprax, Anxit, Trika
Pregnancy
Cat D
Lactation
Avoid
Schedule
H1
Forms
Tablet 0.25/0.5/1mg +1
Indications
- Generalized anxiety disorder (short-term)
- Panic disorder
- Anxiety with depression (adjunct)
- NOT first-line — long-term use risks dependence
Adult Dosing
GAD
0.25-0.5 mg PO TDS PRN; max 4 mg/day
Panic disorder
0.5 mg TDS, titrate up; max 10 mg/day (specialist)
Elderly
Start 0.125-0.25 mg BD
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| No adjustment needed | No CrCl-based dose adjustment required |
Hepatic Adjustment
Reduce dose by 50% in severe hepatic impairment
Pregnancy & Lactation
Pregnancy: Category D
AVOID — neonatal withdrawal, floppy baby syndrome, cleft palate (1st trimester)
Lactation: Avoid
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| CNS depressants (alcohol, opioids, barbiturates) | Severe sedation, respiratory depression, death | Major |
| Opioids (FDA black box) | Fatal respiratory depression | Major |
| CYP3A4 inhibitors (clarithromycin, ketoconazole, ritonavir) | Increased alprazolam levels | Major |
| Carbamazepine, rifampicin | Reduced alprazolam levels | Moderate |
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Side Effects
Common
- Sedation
- Drowsiness
- Dizziness
- Confusion (elderly)
- Memory impairment
- Tolerance, dependence
Serious / Discontinue If
- Respiratory depression (especially with opioids/alcohol)
- Severe withdrawal (seizures) on abrupt stop
- Paradoxical agitation (elderly, children)
- Falls in elderly
- Dependence within 4 weeks of regular use
Contraindications
- Acute narrow-angle glaucoma
- Severe respiratory insufficiency
- Sleep apnea
- Severe hepatic impairment
- Concomitant strong CYP3A4 inhibitors
- Substance use disorder history (relative)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Restyl 0.5 | Sun Pharma | 15 tab ₹35 |
| Alprax 0.5 | Torrent | 15 tab ₹38 |
| Anxit 0.5 | Cadila | 15 tab ₹32 |
Monitoring Required
- Cognitive function, dependence/tolerance, falls in elderly
Patient Counseling Points
- Use ONLY for short courses (max 2-4 weeks ideally)
- NEVER mix with alcohol or opioids
- Do not drive/operate machinery
- Do not stop abruptly — must taper
- Higher fall risk in elderly
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References
- BNF
- Lexicomp Drug Information
- Indian National Formulary
- Specialty society guidelines (RSSDI/CSI/IAP)