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Renal Impairment

• Drug should be used with caution Hepatic Impairment

• Should begin with lower starting dose (0.5–0.75 mg/day in 2 or 3 divided doses) Cardiac Impairment

• Benzodiazepines have been used to treat anxiety associated with acute myocardial infarction Elderly

• Should begin with lower starting dose (0.5–0.75 mg/day in 2 or 3 divided doses) and be monitored closely Children and Adolescents

• Safety and efficacy not established but often used, especially short-term and at the lower end of the dosing scale

• Long-term effects of xanax in children/adolescents are unknown

• Should generally receive lower doses and be more closely monitored Pregnancy

• Risk Category D [positive evidence of risk to human fetus; potential benefits may still justify its use during pregnancy]

• Possible increased risk of birth defects when benzodiazepines taken during pregnancy

• Because of the potential risks, xanax is not generally recommended as treatment for anxiety during pregnancy, especially during the first trimester

• Drug should be tapered if discontinued

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• Infants whose mothers received a benzodiazepine late in pregnancy may experience withdrawal effects

• Neonatal flaccidity has been reported in infants whose mothers took a benzodiazepine during pregnancy

• Seizures, even mild seizures, may cause harm to the embryo/fetus Breast Feeding

• Some drug is found in mother’s breast milk ? Recommended either to discontinue drug or bottle feed

• Effects on infant have been observed and include feeding difficulties, sedation, and weight loss

Potential Advantages

• Rapid onset of action

• Less sedation than some other benzodiazepines

• Availability of an XR formulation with longer duration of action Potential Disadvantages

• Euphoria may lead to abuse

• Abuse especially risky in past or present substance abusers Primary Target

• Panic attacks

Anxiety

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Anxiety

Anxiety is an unpleasant emotional state characterized by an often vague apprehension, uneasiness, or dread. Anxiety is often accompanied by physical sensations similar to those of fear such as perspiration, tightness of the chest, difficulty breathing or breathlessness, dry mouth, and headache. Unlike fear, in which the individual is usually aware of its cause, the cause of anxiety is often not clear.

Everyone experiences anxiety; it is a natural and healthy human response many theorists believe has evolved to warn us of impending dangers so that we might better cope with them. If the anxiety, however, seems to be excessive in strength or duration, or happens without sufficient objective reasons, it might be considered an unhealthy, possibly abnormal, response. There are numerous theories as to the causes and functions of anxiety. This entry will cover the four most extensive and influential theories: the existential, psychoanalytic, behavioral and learning , and …

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Separation Anxieties

This fall, returning students might not have to try so hard to fit in–but that’s not necessarily a good thing. According to a new report, more public schools are filled with students of the same racial and economic backgrounds than at any time in the past 20 years. The Civil Rights Project of UCLA has found that schools are resegregating at a faster rate than they have since the early ‘ 90s, when a series of Supreme Court cases started dismantling desegregation policies.

The effects of June’s court decision to limit desegregation efforts based on race won’t be felt until next year, so the future …