JADE R.

DINOLAN

BSN-III

Antianxiety Agents

1. Hydroxyzine

Definition:

Mechanism of action:

 Exerts central nervous system (CNS) depressant activity at the

subcortical level of the CNS
 Has anticholinergic, antihistaminic, and antiemetic properties
 Blocks histamine 1 receptors

Common dosage given:

INTRAMUSCULAR

 Anxiety
 Adults: 50 to 100 mg 4 times/day
 Pruritus
 Adults: 25 mg 3 or 4 times/day
 Pre- and post-operative sedative
 Adults: 50 to 100 mg
 Children: 0.6 mg/kg
 Antiemetic/adjunctive therapy to analgesia
 Adults: 25 to 100 mg q 4 to 6 hr as needed
 Children: 0.5 to 1 mg/kg q 4 to 6 hr as needed

ORAL

 Anxiety
 Adults: 50 to 100 mg 4 times/day
 Children ( ≥6 yr): 50 to 100 mg/day in divided doses
 Children (< 6 yr): 50 mg/day in divided doses
 Pruritus
 Adults: 25 mg 3 or 4 times/day
 Children ( ≥6 yr): 50 to 100 mg/day in divided doses
 Children (< 6 yr): 50 mg/day in divided doses
 Pre- and post-operative sedative
 Adults: 50 to 100 mg
 Children: 0.6 mg/kg

Contraindication:
  Hypersensitivity
 Pregnancy
 Lactation

Indication:

 Anxiety disorders
 Temporary relief of anxiety symptoms
 Allergic reactions producing pruritic conditions
 Antiemetic
 Reduction of narcotic requirement, alleviation of anxiety, and
 Control of emesis in preoperative/postoperative clients (parenteral only)

2. ALPRAZOLAM (XANAX)

Definition:

Mechanism of action:

 Benzodiazepines are thought to potentiate the effects of gamma-aminobutyric acid (GABA), a

powerful inhibitory neurotransmitter, thereby producing a calmative effect. The activity may
involve the spinal cord, brain stem, cerebellum, limbic system, and cortical areas.

Common dosage given:

ALPRAZOLAM (XANAX)

 Anxiety disorders and anxiety symptoms: PO (Adults): 0.25 to 0.5 mg 3 times/day. Maximum
daily dose 4 mg in divided doses. In elderly or debilitated patients: PO: 0.25 mg 2 or 3
times/day. Gradually increase if needed and tolerated. Total daily dosages of greater than 2
mg should not be used.
 Panic disorder: PO (Adults): Initial dose: 0.5 mg 3 times/day. Increase dose at intervals of 3
to 4 days in increments of no more than 1 mg/day.
 Extended-release tablets: PO (Adults): 0.5 to 1 mg once daily. May increase the dose at
intervals of 3 to 4 days in increments of no more than 1 mg/day until desired effect has been
achieved. Total daily dose range: 3 to 6 mg

Contraindication:

 Hypersensitivity
 Psychoses
 Acute narrow angle glaucoma
 Pre-existing CNS depression
 Pregnancy and lactation
 Shock
 Coma
Indication:

 Anxiety disorders
 Anxiety symptoms
 Anxiety associated with depression
 Panic disorder
 UNLABELED USES:
 Premenstrual dysphoric disorder
 Irritable bowel
 syndrome and other somatic symptoms associated with anxiety

3. Meprobamate

Definition:

Mechanism of action:

 Depresses multiple sites in the CNS, including the thalamus and limbic system.
 May act by blocking the reuptake of adenosine.

Common dosage given:

 Anxiety disorders/anxiety symptoms: PO (Adults and children

 >12 yr): 1200 to 1600 mg/day in 3 or 4 divided doses.
 Children (6 to 12 yr): PO: 100 to 200 mg 2 or 3 times/day.

Contraindication:

 Hypersensitivity to the drug

 Combination with other CNS depressants
 Children under age 6
 Pregnancy and lactation
 Acute intermittent porphyria

Indication:

 Anxiety disorders
 Temporary relief of anxiety symptoms

4. Buspirone HCl

Definition:

Mechanism of action:
  Unknown
 May produce desired effects through interactions with serotonin, dopamine, and other
neurotransmitter receptors
 Delayed onset (a lag time of 7 to 10 days between onset of therapy and subsiding of anxiety
symptoms)

 Cannot be used on a prn basis

Common dosage given:

 PO: (Adults): Initial dosage 7.5 mg 2 times/day. Increase by 5 mg/day every 2 to 3 days as
needed. Maximum daily dosage: 60 mg

Contraindication:

 Hypersensitivity to the drug

 Severe hepatic or renal impairment
 Concurrent use with MAO Inhibitors

Indication:

 Anxiety disorders
 Anxiety symptoms
 Unlabeled uses:
 Symptomatic management of premenstrual syndrome

5.

ANTI-DEPRESSANTS

2. PROTRIPTYLINE (VIVACTIL)

Definition:

Mechanism of action:

 Inhibit reuptake of norepinephrine or serotonin at the presypnaptic neuron

Common dose given

PROTRIPTYLINE (VIVACTIL)

 Depression: PO (Adults): 15 to 40 mg/day divided into 3 or 4 doses.

Maximum daily dose: 60 mg. Adolescent and elderly patients: 5 mg 3 times/day.

Contraindication:

 Hypersensitivity to any tricyclic or related drug

 Concomitant use with monoamine oxidase inhibitors (MAOIs)
 Acute recovery period following myocardial infarction
  Narrow angle glaucoma • Pregnancy and lactation (safety not established)
 Known or suspected seizure disorder (maprotiline)

Indication:

 Depression
 Unlabeled uses:
 Migraine prevention

2. VORTIOXETINE (BRINTELLIX)

Major depressive disorder: PO (Adults): Initial dosage: 10 mg once

daily. Dosage may be titrated to 20 mg/day, and may be administered without regard to meals.