Alprazolam, sold under the trade name Xanax, among others, is a short-acting benzodiazepine. It is most commonly used in short term management of anxiety disorders, specifically panic disorder or generalized anxiety disorder (GAD). Other uses include the treatment of chemotherapy-induced nausea, together with other treatments. GAD improvement occurs generally within a week. Alprazolam is generally taken by mouth.
Common side effects include sleepiness, depression, headaches, feeling tired, dry mouth, and memory problems. Some of the sedation and tiredness may improve within a few days. Due to concerns about misuse, some do not recommend alprazolam as an initial treatment for panic disorder. Withdrawal or rebound symptoms may occur if use is suddenly decreased. Other rare risks include suicide, possibly due to loss of inhibition. Gradually decreasing the dose over weeks or months may be required. Alprazolam, like other benzodiazepines, acts through the GABAA receptor.
Alprazolam was patented in 1971 and approved for medical use in the United States in 1981. Alprazolam is a Schedule IV controlled substance and is a common drug of abuse. It is available as a generic medication. The wholesale cost in the United States is less than US$0.03 per dose as of 2018. In 2016, it was the 19th most prescribed medication in the United States, with more than 27 million prescriptions.
Alprazolam 0.5mg pills
Alprazolam is mostly used in short term management of anxiety disorders, panic disorders, and nausea due to chemotherapy. Alprazolam may also be indicated for the treatment of generalized anxiety disorder, as well as for the treatment of anxiety conditions with co-morbid depression. The FDA label advises that the physician should periodically reassess the usefulness of the drug.
Alprazolam is effective in the relief of moderate to severe anxiety and panic attacks. However, it is not a first-line treatment since the development of selective serotonin reuptake inhibitors. Alprazolam is no longer recommended in Australia for the treatment of panic disorder due to concerns regarding tolerance, dependence, and abuse. Most evidence shows that the benefits of alprazolam in treating panic disorder last only 4 to 10 weeks. However, people with panic disorder have been treated on an open basis for up to 8 months without apparent loss of benefit.
In the United States, alprazolam is FDA-approved for the treatment of panic disorder with or without agoraphobia. Alprazolam is recommended by the World Federation of Societies of Biological Psychiatry (WFSBP) for treatment-resistant cases of panic disorder where there is no history of tolerance or dependence.
Anxiety associated with depression is responsive to alprazolam. Clinical studies have shown that the effectiveness is limited to 4 months for anxiety disorders. However, the research into antidepressant properties of alprazolam is poor and has only assessed its short-term effects against depression. In one study, some long term, high-dosage users of alprazolam developed reversible depression. In the US, alprazolam is FDA-approved for the management of anxiety disorders (a condition corresponding most closely to the APA Diagnostic and Statistical Manual DSM-IV-TR diagnosis of generalized anxiety disorder) or the short-term relief of symptoms of anxiety. In the UK, alprazolam is recommended for the short-term treatment (2–4 weeks) of severe acute anxiety.
Nausea due to chemotherapy
Alprazolam may be used in combination with other medications for chemotherapy-induced nausea and vomiting.
Benzodiazepines require special precaution if used in children and in alcohol- or drug-dependent individuals. Particular care should be taken in pregnant or elderly people, people with substance abuse history (particularly alcohol dependence), and people with comorbid psychiatric disorders. The use of alprazolam should be avoided or carefully monitored by medical professionals in individuals with: myasthenia gravis, acute narrow-angle glaucoma, severe liver deficiencies (e.g., cirrhosis), severe sleep apnea, pre-existing respiratory depression, marked neuromuscular respiratory, acute pulmonary insufficiency, chronic psychosis, hypersensitivity or allergy to alprazolam or other benzodiazepines, and borderline personality disorder (where it may induce suicidality and dyscontrol).
Like all central nervous system depressants, alprazolam in larger-than-normal doses can cause significant deterioration in alertness and increase drowsiness, especially in those unaccustomed to the drug’s effects.
Elderly individuals should be cautious in the use of alprazolam due to the possibility of increased susceptibility to side-effects, especially loss of coordination and drowsiness.
Side effects from alprazolam
Sedative drugs, including alprazolam, have been associated with an increased risk of death.
Possible side effects include:
- Anterograde amnesia and concentration problems
- Ataxia, slurred speech
- Drowsiness, dizziness, lightheadedness, fatigue, unsteadiness, and impaired coordination, vertigo
- Dry mouth (infrequent)
- Hallucinations (rare)
- Jaundice (very rare)
- Seizures (less common)
- Skin rash, respiratory depression, constipation
- Suicidal ideation or suicide
- Urinary retention (infrequent)
- Muscle weakness
- Paradoxical reactions
- Although unusual, the following paradoxical reactions have been shown to occur:
- Mania, agitation, hyperactivity, and restlessness
- Rage, hostility
- Twitches and tremor