Alprazolam is occasionally beneficial for patients with major depression or psychosis. It can, however, induce paradoxical effects in these patients and in those with suicidal ideation. The drug should be administered to these patients with careful monitoring. Alprazolam is classified as pregnancy category D because it could harm the fetus when administered to pregnant women. Positive evidence of human fetal risk exists based on investigational, marketing, or human studies, but the potential benefit to the mother may outweigh the potential risks to the fetus.
Many benzodiazepines distribute into breast milk.
Because of the potential for adverse effects in the nursing infant, such as sedation, feeding difficulties, and weight loss, alprazolam generally is not recommended during breast-feeding. Alprazolam should be administered cautiously to patients with severe hepatic disease because the elimination half-life of the drug can be prolonged, possibly resulting in toxicity. Patients with hepatic disease are more likely to experience adverse CNS reactions and should receive reduced initial dosages. Patients with renal impairment should be carefully monitored during prolonged treatment with benzodiazepines to avoid the adverse reactions that may occur from drug accumulation. Delayed elimination can either intensify or prolong the actions of adverse reactions of the drug.