📋 Indications & Clinical Dosage
*Short-term use in anxiety:*
Adult: 250-500 mcg 3 times a day, increased if necessary up to 3 mg daily, may be increased every 3-4 days; max: 4 mg/day. For debilitated patients, use elderly dose.
Elderly: 250 mcg 2-3 times a day, increased if necessary up to 3 mg daily.
*Panic Disorder:*
Adult: Initially 0.5-1 mg daily, preferably in the morning, then Increase by 1 mg/day every 3-4 days. Maintenance: 1-10 mg/day. Usual: 3-6 mg/day.
Children: Not recommended.
⛔ Contraindications
Respiratory depression, chronic psychosis, hyperkinesis, obsessional states, phobic states, not recommended for use alone to treat depression (or anxiety associated with depression),
⚠️ Precautions & Warnings
Severe hepatic impairment, muscle weakness, organic brain changes personality disorder, dependence, elderly with dementia, history of seizures, tardive dyskinesia; reduce dose or discontinue, signs of neuroleptic malignant syndrome; discontinue, diabetes; monitor patients for signs of hyperglycaemia.
🔄 Drug Interactions
Potent inhibitors of CYP3A4 or 206. Potent inducers of CYP3A4. Alpha blockers, alcohol, CNS drugs
⚠️ Adverse Reactions / Side Effects
Ataxia, amnesia, confusion, dependence, drowsiness, lightheadedness, muscle weakness, paradoxical increase in aggression, dizziness, dysarthria, GI disturbances, gynaecomastia, headache, hypotension, incontinence, salivation changes, slurred speech, tremor, urinary retention, vertigo, visual disturbances. Rare: Apnoea, blood disorders, jaundice, respiratory depression, skin reactions
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Contraindicated
Lactation / Breastfeeding:
Contraindicated
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.