Alprazolam (Xanax)

What is Alprazolam prescribed for?

Alprazolam is an anti-anxiety medication prescribed to treat different symptoms of anxiety disorders, including anxiety associated with depression.^[1] It is also used to treat patients with panic disorders with or without agoraphobia, and for anxiety associated with alcohol withdrawal.

Benzodiazepines, in general, have five main effects: anxiolytic, muscle relaxant, tranquilizer, somniferous and antiepileptic. Alprazolam is characterized by its mainly anxiolytic effect.^[2]

Alprazolam brand names

Alprazolam is sold under the brand name Xanax, Xanax XR, Niravam and Trankimazin.

How does Alprazolam work?

Alprazolam acts by decreasing brain functions, which causes a tranquilizing effect by stimulating GABA (γ-aminobutyric acid) receptors.

The neurotransmitter GABA is the main inhibitory neurotransmitter in the central nervous system. Alprazolam increases its inhibitory effect on neuronal cells, blocking the cortical and limbic excitation that produces the calming effect.

How is Alprazolam usually taken?

Alprazolam is taken orally. Its presentation can be variable, in tablets or in concentrated liquid. The doctor will determine the appropriate dose depending on the severity of the symptoms and the specific effects observed in the patient.

If the patient needs a higher dose, it should be given gradually in order to avoid adverse effects.

Depending on the disorder and the patient's profile, the amount taken will differ.

For example:

• Adult patients with anxiety will often be advised to take an initial dose of 0.25 to 0.50 mg, 3 times a day. This dose of alprazolam can then be increased, depending on the needs of the patient, up to 4 mg per day in divided doses.

• Patients with previous diseases or geriatric patients will often be advised to take an initial dose of 0.25 mg 2 to 3 times daily. Doses can be gradually increased as needed, and often under observation.

• Patients with panic disorder will often be advised to take an initial single dose of 0.50 to 1.00 mg before bedtime. The dose will be adjusted according to the patient's response but should never exceed 1 mg every 3 to 4 days.^[3] They may also be prescribed extended-release tablets that administer the drug over a longer period of time.

How long does Alprazolam stay in your system?

Alprazolam is rapidly absorbed; peak plasma concentrations are observed 1 to 2 hours after administration.

Alprazolam is metabolized mainly by the liver, and 80% is excreted in the urine. The drug has a half-life of 12 to 15 hours, but it will depend on whether the patient suffers from any type of renal or hepatic insufficiency.

Alprazolam side effects

Alprazolam precautions

Alprazolam can cause breathing issues, particularly when used alongside alcohol or opioid medications. If a patients breathing becomes slow, shallow or their lips become blue, emergency medical attention is required immediately.

Caution should be taken with patients with a history of drug abuse since this drug may cause psychological and/or physical dependence. This drug should only be taken only under medical advice with a prescription, at the doses indicated by the doctor, only for the period of time indicated.

People whose profession requires the manipulation of machinery or driving should be cautious as alprazolam can cause drowsiness or dizziness.

Due to the potentially addictive nature of the drug, it is important that the doctor gradually reduces the dosage to avoid withdrawal symptoms, such as:

• Cramps
• Tremors
• Vomiting
• Sweating
• Convulsions

Abrupt discontinuation of treatment should be avoided.

In patients with hepatic or renal insufficiency, it is important to control the doses to avoid any accumulation of the drug in the body and, therefore, adverse effects.

Furthermore, it should be administered with caution in patients with respiratory diseases since it may aggravate their respiratory insufficiency.

The use of alprazolam may enhance cognitive impairment in patients with late Parkinson's disease, those with acute weakness of voluntary contraction muscles (myasthenia gravis) or those with acute porphyria.

Caution should be exercised when prescribing alprazolam in geriatric patients, as it may alter their motor functions and balance, as well as their cognitive functions. Therefore, it is recommended to start treatment with very low doses.

Its use should be avoided during pregnancy since its consumption is associated with a high risk of congenital malformations during the first trimester of pregnancy. It is important to inform the doctor of a possible pregnancy if you are taking alprazolam. In addition, since there is a possibility that the drug may be excreted through breast milk, and so breastfeeding should not be initiated until the use of this drug is discontinued.

Alprazolam drug interactions

Alprazolam storage

Alprazolam should be kept out of the reach of children. It should not be exposed to heat, light or humidity, and should be stored in its original container at room temperature, provided it does not exceed 30°C (86 F).

Talk to the pharmacist for proper disposal of leftover or expired medication.

What to do if you overdose on alprazolam

If you take more than the prescribed dose and you begin to feel any of the following symptoms, you should immediately go to the nearest hospital:

• Fainting
• Convulsions
• Extreme agitation
• Yellowing of the skin and eyes
• Weak breathing
• Hallucinations

It is important to take your medicine with its original packaging with you so the doctors have as much information as possible and can treat you accordingly.^[6]

Frequently asked questions about alprazolam

What does alprazolam look like?

The drug is usually presented in orange or bluish-colored tablets, cylindrical, biconvex, and slotted on one side to facilitate taking the appropriate doses.

Alprazolam vs Clonazepam: Which is stronger?

Both drugs are benzodiazepines that help calm the body. While alprazolam is prescribed to treat acute symptoms related to anxiety, panic disorders, and anxiety caused by depression, clonazepam is used to treat seizures, epilepsy, insomnia, and panic attacks.

The half-life of alprazolam is 12 to 15 hours, but that of clonazepam is 18 to 50 hours, so the effect of alprazolam is faster, but that of clonazepam is longer lasting in time. Thus, it is considered that the use of clonazepam avoids the rebound effect observed with alprazolam when a dose is forgotten, with the consequent anxiety between doses.^[8][9]