Alprazolam (Xanax): What You Need To Know

By: The Drug Classroom

Alprazolam is a common benzodiazepine that has been one of the top psychoactive prescriptions for years. It is primarily used for anxiety and panic disorders, but it has been prescribed for other purposes. The substance is also taken recreationally. Among the positive effects are anxiety reduction, sedation, insomnia reduction, muscle relaxation, and disinhibition. The negative effects can include memory impairment, drowsiness, headache, dry mouth, depression, and confusion. When taken in medical settings, the most common negative effects are drowsiness and sedation. Those decline after the first couple weeks, though they don't always go away entirely.

Other problems can include fatigue, slurred speech, and memory impairment. It's primarily used as an anxiolytic, but it's been widely prescribed for panic disorder and, to a lesser extent, for depression. In recreational settings, some people find it's very enjoyable while others feel alternative benzodiazepines are better. At common doses it offers anxiety reduction, relaxation, disinhition, and sedation. Euphoria may also exist to varying degrees. Memory loss is one of the biggest problems with the drug. Using it with other depressants or at strong doses puts you at risk of developing gaps in your memory.

In more severe cases, you may have little to no recollection of what you did under the influence. Returning to medical use, the drug has been investigated for many conditions and is used for a few. Alprazolam has shown efficacy in acute and chronic anxiety, panic disorder, and depression. Most studies have only looked at its efficacy for a few months, yet we know people are prescribed it for years. At least in the short-term there is some benefit, but alternative medications or non-drug treatments are often preferred. For example, cognitive behavioral therapy can be as useful for anxiety and is also longer-lasting. And in panic disorder, SSRIs are the first-line treatment, not benzodiazepines. Because of the limitations of the current studies and the legitimate problems with physical dependence, the usual recommendation is to limit Alprazolam use to 2 to 4 weeks or have it be used intermittently.

In practice, however, people may be using it daily for years. As long as they're aware of the safety concerns, that kind of treatment might be fine for some people. When used orally, the drug lasts for 4 to 7 hours and begins working in 20 to 40 minutes.

Alprazolam (Xanax): What You Need To Know

The instant release form offers medical benefits for 3 to 6 hours, whereas the controlled release form can last over 12 hours. Unlike some other common benzodiazepines, like Diazepam, Alprazolam is a triazolobenzodiazepine. That means it contains a triazole ring. The drug functions as a GABAa positive allosteric modulator. It binds to the benzodiazepine site on GABAa receptor complexes, enabling an increase in GABA's activity. This produces more inhibition in multiple parts of the brain.

Alprazolam has also been connected to a rise in dopamine activity in the striatum. The dose for anxiety ranges from .75 mg to 4 mg daily, and with panic disorder, the dose can reach over 5 mg per day in some patients. This all depends on the individual patient and what kind of dose escalation they require. In other settings, a light dose is .25 to .5 mg, a common dose is .5 to 1.5 mg, and a strong dose is 1.5 to 2 mg. Upjohn filed a patent covering Alprazolam in 1969. It would be over a decade before the drug entered the market, meanwhile other benzodiazepines grew in popularity. The substance was studied in animals in the 1970s.

It was found to have anxiolytic effects and a greater potency than diazepam. Human trials produced similar findings and it entered the market in 1981 under the name Xanax. No other triazolobenzodiazepine had been approved for anxiety at this point. Research and case reports from the 1980s suggested it could be used for more than anxiety, such as with panic disorder and phobias. From 1985 to 1988, emergency room admissions involving the drug increased by 50% and prescriptions also grew significantly. By 1988, it was the stop selling benzodiazepine in the US and one of the top prescriptions overall.

The drug was approved in the US for panic disorder in 1991. Prescriptions for panic disorder increased over the years even though other first-line treatments were recommended. Prescriptions overall increased by 71% between 1997 and 2007 in the US. They grew 99% in Australia during the same time. Alprazolam is currently the most prescribed and misused benzodiazpine in the US. The substance is Schedule 4 in the US.

It is normally controlled elsewhere, while also being available in medical settings. Most of the deaths or near fatal cases involve Alprazolam being used with other depressants. When it's used on its own, recreational doses are primarily concerning because of mental impairment and amnesia. One of the greatest issues with benzodiazepines is that it can be very dangerous in withdrawal.

If you use the drug for weeks and especially months, a state of physical dependence will develop. Abruptly stopping the drug can then lead to seizures, agitation, anxiety, delirium, and insomnia. Even tapering can still result in severe physical problems, but the primary concerns are rebound anxiety and insomnia. It's risky to use the drug with other depressants like alcohol, opioids, and other benzodiazepines.

If you have any questions, feel free to leave them in the comments section. In order for The Drug Classroom to provide more education, support is necessary. And the best way to support is through Patreon, at patreon.com/thedrugclassroom. You can also contribute through PayPal or Bitcoin. You can connect with me on Twitter @SethAFitzgerald and via email at seth@thedrugclassroom.com. More information and links to references can be found on the TDC website using the link below.

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