alprazolam alprazolam alprazolam, sold under the brand name xanax, among others, is a fast-acting, potent tranquilizer of moderate duration within the triazolobenzodiazepine group of chemicals called benzodiazepines. alprazolam is most commonly used in 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. alprazolamclinical datapronunciation/ælˈpræzəlæm/ or /ælˈpreɪzəlæm/ trade namesxanax, xanor, niravam, othersahfs/drugs.commonographmedlineplusa684001license data us dailymed: alprazolam pregnancycategory au: c dependenceliabilityvery highaddictionliabilitymoderate - highroutes ofadministrationby mouthdrug classbenzodiazepineatc coden05ba12 (who) legal statuslegal status au: s8 (controlled drug) br: class b1 (psychoactive drugs) ca: schedule iv de: anlage iii (special prescription form required) (in doses higher than 1 mg) uk: class c us: schedule iv un: psychotropic schedule iv in general: ℞ (prescription only) pharmacokinetic databioavailability80–90%protein binding80%metabolismliver, via cytochrome p450 3a4metabolitesalpha-hydroxyalprazolam, 4-hydroxyalprazolam, beta-hydroxyalprazolamonset of action20~60 minuteselimination half-lifefull release: 11~13 hoursextended release: 11~16 hoursduration of actionfull release: 6 hoursextended release: 11.3 hoursexcretionkidneyidentifiers iupac name 8-chloro-1-methyl-6-phenyl-4h-triazolo benzodiazepine cas number28981-97-7 ypubchem cid2118iuphar/bps7111drugbankdb00404 ychemspider2034 yuniiyu55mq3izykeggd00225 ychebichebi:2611 ychemblchembl661 ycomptox dashboard (epa)dtxsid4022577 echa infocard100.044.849 chemical and physical dataformulac17h13cln4molar mass308.77 g·mol−13d model (jsmol)interactive image smiles cc1nnc2n1-c1ccc(cl)cc1c(c1ccccc1)=nc2 inchi inchi=1s/c17h13cln4/c1-11-20-21-16-10-19-17(12-5-3-2-4-6-12)14-9-13(18)7-8-15(14)22(11)16/h2-9h,10h2,1h3 ykey:vrefgvbltwbcjp-uhfffaoysa-n y (verify) common side effects include sleepiness, depression or suppressed emotions, mild to severe decreases in motor skills, hiccups, dulling or declining of cognition as well as alertness or general awareness of one’s surroundings or even behavior, dry mouth (mildly), decreased heart rate, suppression (physiological inhibition) of general central nervous system activity (opposite of physiological excitation), impairment of judgment (usually in higher than therapeutic doses), marginal to severe decreases in memory formation, decreased ability to process new information, as well as partial to complete amnesia depending on dosage. some of the sedation and tiredness may improve within a few days. alprazolam withdrawal may occur if use is suddenly decreased; therefore, gradually decreasing the dosage over weeks or months may be required to mitigate the debilitating withdrawal symptoms or possible physical health complications of withdrawal. alprazolam increases all-cause mortality. cold turkey abstinence is therefore almost universally advised against for all benzodiazepines, with even tapering sometimes requiring attentive medical supervision and care. alprazolam, like other benzodiazepines, acts through the gabaa receptor, which is considered to be the main mechanism of action responsible for its primary effects and its physiologically inhibiting components on the body’s central nervous system. alprazolam was invented by jackson hester at the upjohn company and 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. in 2020, it was the 37th most-commonly-prescribed medication in the united states, with more than 16 million prescriptions. medical uses alprazolam pills in boxes, as sold in france. both xanax (original pfizer alprazolam product) and various generic forms of alprazolam are depicted here. alprazolam is mostly used in management of anxiety disorders, panic disorders, and nausea due to chemotherapy. alprazolam is indicated for the treatment of generalized anxiety disorder and panic disorder with or without agoraphobia in adults. the fda label advises that the physician should periodically reassess the usefulness of the drug. panic disorder alprazolam is effective in the relief of moderate to severe anxiety and panic attacks. alprazolam is not recommended in australia for the treatment of panic disorder because of concerns regarding tolerance, dependence, and abuse. most evidence shows that the benefits of alprazolam in treating panic disorder last only four to ten weeks. however, people with panic disorder have been treated on an open basis for up to eight months without apparent loss of benefit. 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 disorders 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. contraindications 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 use disorder 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 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 disinhibition 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 in september 2020, the u.s. food and drug administration (fda) required the boxed warning be updated for all benzodiazepine medicines to describe the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions consistently across all the medicines in the class. paradoxical reactions although unusual, the following paradoxical reactions have been shown to occur: aggression mania, agitation, hyperactivity, and restlessness rage, hostility twitches and tremor food and drug interactions alprazolam is primarily metabolized via cyp3a4. combining cyp3a4 inhibitors such as cimetidine, erythromycin, norfluoxetine, fluvoxamine, itraconazole, ketoconazole, nefazodone, propoxyphene, and ritonavir delay the hepatic clearance of alprazolam, which may result in its accumulation and increased severity of its side effects. imipramine and desipramine have been reported to increase an average of 31% and 20% respectively by the concomitant administration of alprazolam tablets. combined oral contraceptive pills reduce the clearance of alprazolam, which may lead to increased plasma levels of alprazolam and accumulation. alcohol is one of the most common interactions; alcohol and alprazolam taken in combination have a synergistic effect on one another, which can cause severe sedation, behavioral changes, and intoxication. the more alcohol and alprazolam taken, the worse the interaction. combination of alprazolam with the herb kava can result in the development of a semi-comatose state. plants in the genus hypericum (including st. john's wort) conversely can lower the plasma levels of alprazolam and reduce its therapeutic effect. pregnancy and breastfeeding benzodiazepines cross the placenta, enter the fetus, and are also excreted in breast milk. chronic administration of diazepam, another benzodiazepine, to nursing mothers has been reported to cause their infants to become lethargic and to lose weight. the use of alprazolam during pregnancy is associated with congenital abnormalities, and use in the last trimester may cause fetal drug dependence and withdrawal symptoms in the post-natal period as well as neonatal flaccidity and respiratory problems. however, in long-term users of benzodiazepines, abrupt discontinuation due to concerns of teratogenesis has a high risk of causing extreme withdrawal symptoms and a severe rebound effect of the underlying mental health disorder. spontaneous abortions may also result from abrupt withdrawal of psychotropic medications, including benzodiazepines. overdose main article: benzodiazepine overdose xanax 0.25, 0.5 and 1 mg scored tablets the maximum recommended daily dose is 10 milligrams per day. overdoses of alprazolam can be mild to severe depending on the quantity ingested and if other drugs are taken in combination. alprazolam overdoses cause excess central nervous system (cns) depression and may include one or more of the following symptoms: coma and death if alprazolam is combined with other substances. fainting hypotension (low blood pressure) hypoventilation (shallow breathing) impaired motor functions dizziness impaired balance impaired or absent reflexes muscle weakness orthostatic hypotension (fainting while standing up too quickly) somnolence (drowsiness) dependence and withdrawal