Alprazolam, known by its brand name Xanax, is a prescription drug that belongs to the benzodiazepine class of drugs. It is used in adults to treat severe anxiety disorders and panic disorders. This medicine is usually only prescribed for short periods of time, as long-term use can reduce effectiveness and the risk of dependence.

What is Alprazolam prescribed for?

Alprazolam is 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 can cause a variety of adverse effects. The most common side effects are:[4]

  • Drowsiness
  • Headache
  • Depression
  • Sedation
  • Impairmed coordination
  • Dry mouth
  • Dizziness
  • Memory impairment
  • Fatigue
  • Difficulty articulating words
  • Irritability

Less commonly, alprazolam may have other adverse effects such as:

  • Disorientation
  • Amnesia
  • Attention disorders
  • Change in body weight
  • Insomnia
  • Nervousness
  • Dermatitis
  • Nausea
  • Tremors
  • Confusion states
  • Decreased appetite
  • Blurred vision
  • Complete loss of coordination
  • increased or reduced sex drive

It is also important to be aware of possible allergic reactions, in which case treatment should be discontinued. Some of the symptoms linked to a severe allergic reaction are:

  • Chest pain
  • Clenched throat
  • Swollen tongue, mouth, or face
  • Hives
  • Continuous coughing
  • Difficulty breathing

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

During treatment with alprazolam, the consumption of alcohol and other drugs that inhibit the excitation of the central nervous system should be avoided, since they potentiate its adverse effects.

The patient should inform the doctor about all the medications he/she is using since the drug can interact with many other medications.

Medications that alprazolam can have a dangerous interaction with include:

  • Antifungal medicines such as itraconazole and ketoconazole
  • Sodium oxybate (used to treat narcolepsy, but also used as an illegal street drug GHB)
  • Tipranavir (an HIV medication)

Medications that alprazolam can have a moderate interaction with include:

  • Carbamazepine
  • Cimetidine
  • Clarithromycin
  • Erythromycin base
  • Erythromycin ethylsuccinate
  • Erythromycin lactobionate
  • Erythromycin stearate
  • Idelalisib
  • Ivacaftor
  • Nefazodone
  • Rifabutin
  • Rifampin
  • Saquinavir
  • St. John's wort
  • Valerian

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]

Resources:

  1. Ait-Daoud N, Hamby AS, Sharma S, Blevins D. A Review of Alprazolam Use, Misuse, and Withdrawal. J Addict Med. 2018 Jan/Feb;12(1):4-10https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846112/
  2. BALDWIN, D. S.; et al. Evidence-based pharmacotherapy of generalized anxiety disorder. Int J Neuropsychopharmacol. 8. 293–302, 2005https://academic.oup.com/ijnp/article/14/5/697/722046?login=false
  3. Product Information. Xanax XR (alprazolam). Pfizer U.S. Pharmaceuticals Group (2005).https://labeling.pfizer.com/ShowLabeling.aspx?id=543
  4. Guina J, Merrill B. Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives. J Clin Med. 2018 Jan 30;7(2):17.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852433/
  5. Yamamoto T, Dargan PI, Dines A, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Sedefov R, Wood DM; Euro-DEN Research Group. Concurrent Use of Benzodiazepine by Heroin Users-What Are the Prevalence and the Risks Associated with This Pattern of Use? J Med Toxicol. 2019 Jan;15(1):4-11https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314928/
  6. Isbister GK, O'Regan L, Sibbritt D, Whyte IM. Alprazolam is relatively more toxic than other benzodiazepines in overdose. Br J Clin Pharmacol. 2004 Jul;58(1):88-95.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884537/
  7. Elmesallamy GE, Abass MA, Ahmed Refat NA, Atta AH. Differential effects of alprazolam and clonazepam on the immune system and blood vessels of non-stressed and stressed adult male albino rats. Interdiscip Toxicol. 2011 Sep;4(3):132-43.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3203915/
  8. Rosenbaum JF. The development of clonazepam as a psychotropic: the massachusetts general hospital experience. J Clin Psychiatry. 2004;65 Suppl 5:3-6.https://www.psychiatrist.com/read-pdf/4343/ bn