Tricalm
Generic Name
Alprazolam
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| tricalm 5 mg tablet | ৳ 10.00 | ৳ 100.00 |
Description
Overview of the medicine
Tricalm 5 mg Tablet contains Alprazolam, a benzodiazepine primarily used for the short-term management of anxiety disorders and panic disorder. It works by affecting brain chemicals that may be unbalanced in people with anxiety.
Uses & Indications
Dosage
Adults
The usual starting dose for anxiety is 0.25-0.5 mg, three times daily. For panic disorder, the initial dose is 0.5 mg three times daily. Doses are gradually titrated based on response. A 5 mg tablet is a very high dose for Alprazolam, typically not used as an initial dose and usually reserved for severe, refractory cases of panic disorder or severe anxiety in patients with established tolerance, or as a single daily dose in extended-release formulations where total daily dose for panic disorder can rarely go up to 10 mg.
Elderly
Elderly or debilitated patients should start with a lower dose, e.g., 0.25 mg two to three times daily, to minimize the risk of oversedation and ataxia. A 5 mg dose is generally considered inappropriate for elderly patients.
Renal_impairment
Use with caution. Dosage adjustment may be required in patients with renal impairment, starting with the lowest effective dose.
How to Take
Take Tricalm 5 mg Tablet orally, with or without food, as directed by your doctor. Swallow the tablet whole with a glass of water.
Mechanism of Action
Alprazolam binds to specific benzodiazepine receptors on the GABA-A receptor complex, enhancing the inhibitory effects of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter in the central nervous system. This leads to reduced neuronal excitability.
Pharmacokinetics
Onset
Approximately 15-30 minutes.
Excretion
Metabolites are excreted primarily in the urine.
Half life
The elimination half-life is approximately 11-15 hours in healthy adults, but can vary.
Absorption
Rapidly absorbed following oral administration. Peak plasma concentrations are typically achieved within 1 to 2 hours.
Metabolism
Primarily metabolized in the liver by cytochrome P450 3A (CYP3A4) to two main active metabolites, α-hydroxyalprazolam and 4-hydroxyalprazolam, and an inactive benzophenone derivative.
Side Effects
Contraindications
- Acute narrow-angle glaucoma
- Concomitant use with strong cytochrome P450 3A (CYP3A) inhibitors (e.g., ketoconazole, itraconazole)
- Patients with severe respiratory insufficiency
- Patients with myasthenia gravis
- Patients with sleep apnea syndrome
- Patients with severe hepatic insufficiency
- Hypersensitivity to alprazolam or other benzodiazepines
Drug Interactions
Opioids
Increased risk of respiratory depression, profound sedation, coma, and death. Concomitant use should be avoided or limited to cases where alternatives are inadequate.
Fluoxetine, Fluvoxamine, Nefazodone
May increase alprazolam concentrations, requiring dose adjustment.
Strong CYP3A inhibitors (e.g., ketoconazole, itraconazole, clarithromycin)
Significantly increase alprazolam plasma concentrations, potentially leading to increased and prolonged sedative effects. Concomitant use is contraindicated.
CNS depressants (e.g., alcohol, other anxiolytics, antihistamines, antidepressants)
Additive CNS depressant effects, increasing the risk of sedation and impaired psychomotor function.
Storage
Store below 30°C in a cool, dry place, away from direct sunlight and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include somnolence, confusion, impaired coordination, diminished reflexes, and coma. Management involves supportive care, gastric lavage, administration of activated charcoal, and close monitoring of vital signs. Flumazenil, a benzodiazepine receptor antagonist, may be used as an antidote but should be administered with caution due to the risk of inducing seizures in dependent patients.
Pregnancy & Lactation
Pregnancy: Alprazolam is classified as Pregnancy Category D. It should not be used during pregnancy, especially during the first trimester, due to potential risks of congenital malformations and neonatal withdrawal symptoms. Lactation: Alprazolam is excreted into breast milk. It is not recommended for use during breastfeeding due to the potential for sedation and withdrawal symptoms in the infant.
Side Effects
Contraindications
- Acute narrow-angle glaucoma
- Concomitant use with strong cytochrome P450 3A (CYP3A) inhibitors (e.g., ketoconazole, itraconazole)
- Patients with severe respiratory insufficiency
- Patients with myasthenia gravis
- Patients with sleep apnea syndrome
- Patients with severe hepatic insufficiency
- Hypersensitivity to alprazolam or other benzodiazepines
Drug Interactions
Opioids
Increased risk of respiratory depression, profound sedation, coma, and death. Concomitant use should be avoided or limited to cases where alternatives are inadequate.
Fluoxetine, Fluvoxamine, Nefazodone
May increase alprazolam concentrations, requiring dose adjustment.
Strong CYP3A inhibitors (e.g., ketoconazole, itraconazole, clarithromycin)
Significantly increase alprazolam plasma concentrations, potentially leading to increased and prolonged sedative effects. Concomitant use is contraindicated.
CNS depressants (e.g., alcohol, other anxiolytics, antihistamines, antidepressants)
Additive CNS depressant effects, increasing the risk of sedation and impaired psychomotor function.
Storage
Store below 30°C in a cool, dry place, away from direct sunlight and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include somnolence, confusion, impaired coordination, diminished reflexes, and coma. Management involves supportive care, gastric lavage, administration of activated charcoal, and close monitoring of vital signs. Flumazenil, a benzodiazepine receptor antagonist, may be used as an antidote but should be administered with caution due to the risk of inducing seizures in dependent patients.
Pregnancy & Lactation
Pregnancy: Alprazolam is classified as Pregnancy Category D. It should not be used during pregnancy, especially during the first trimester, due to potential risks of congenital malformations and neonatal withdrawal symptoms. Lactation: Alprazolam is excreted into breast milk. It is not recommended for use during breastfeeding due to the potential for sedation and withdrawal symptoms in the infant.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24 to 36 months from the date of manufacture, refer to the product packaging for specific dates.
Availability
Available in pharmacies
Approval Status
Approved (DGDA)
Patent Status
Expired
Clinical Trials
Alprazolam has undergone extensive clinical trials demonstrating its efficacy in the treatment of anxiety and panic disorders. Ongoing research continues to explore its long-term effects and optimal usage.
Lab Monitoring
- Liver function tests (periodically during prolonged therapy)
- Kidney function tests (if renal impairment is suspected or present)
Doctor Notes
- Emphasize the importance of short-term use and gradual dose tapering to minimize withdrawal risks. A 5 mg single tablet dose of alprazolam is exceptionally high and requires careful patient selection, titration, and close monitoring for adverse effects and dependence.
- Counsel patients on the dangers of concomitant use with opioids and alcohol due to severe CNS depression.
- Assess for a history of substance abuse prior to initiation, as these patients are at higher risk for dependence.
- Regularly evaluate the need for continued treatment and consider non-pharmacological interventions.
Patient Guidelines
- Do not stop taking Tricalm abruptly, as it can lead to severe withdrawal symptoms. Gradually reduce the dose under medical supervision.
- Avoid alcohol and other central nervous system depressants while on this medication, as they can enhance sedative effects.
- Do not exceed the prescribed dose, as it increases the risk of dependence and side effects.
- Be aware of the potential for physical and psychological dependence, especially with long-term use.
- Report any unusual changes in mood, behavior, or severe side effects to your doctor immediately.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Alprazolam can cause drowsiness, dizziness, and impaired coordination, which may impair your ability to drive or operate machinery safely. Patients should be warned of these potential effects.
Lifestyle Advice
- Avoid driving or operating heavy machinery until you know how this medicine affects you, as it can cause drowsiness and impaired coordination.
- Practice stress management techniques such as meditation or deep breathing exercises.
- Maintain a regular sleep schedule.
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