- Classification: Benzodiazepine
- CSA Schedule: Schedule IV
- Trade or Other Names: Xanax, Alprax, Alprocontin, Kalma, Niravam, Tranax, Trika, Xanor, Zolam, Zopax
- Medical Uses: Acute anxiety, sleeping aide (hypnotic), light anesthesia
- Physical Dependence: High for nonmedical use
- Psychological Dependence: High
- Tolerance: Yes
- Duration (hours): 1–11
- Usual Method: Oral
- Possible Effects: Drowsiness, respiratory depression
- Effects of Overdose: Slow and shallow breathing, anterograde amnesia, anticonvulsive effects, sedation
- Withdrawal Syndrome: Seizures, tremors, tachycardia, anxiety, insomnia, agitation, dizziness
About Xanax (Alprazolam)
Alprazolam (Xanax) is an extremely useful drug in medicine, with myriad uses and a good side-effect profile. Unfortunately, alprazolam is one of the most commonly reported drugs of abuse, because of its high potency, rapid onset and relatively short duration. The addictive characteristic is caused by the high rate of physical dependence and serious withdrawal symptoms. Most patients that are prescribed alprazolam do not abuse their medication for recreational uses, but it is such a commonly prescribed drug that it is unavoidable that some do. About half of patients on long-term therapy develop physical dependence and require that the drug is slowly tapered. Doctors should always prescribe alprazolam at the lowest effective dose, for the shortest duration required. Patients should keep their medication away from children, teenagers and anyone with a known history of drug abuse.
Alprazolam is known by the brand names: Xanax, Alprax, Alprocontin, Kalma, Niravam, Tranax, Trika, Xanor, Zolam, Zopax. Alprazolam is a potent short-acting drug, part of the benzodiazepine pharmacological family. Benzodiazepines constitute a large group of drugs. They share the common chemical structure of a benzene ring (benzo) attached to diazepine ring. The first benzodiazepine was synthesized in 1955, but only reached the medical world in 1960 under the brand name Librium. In 1963 Valium was released and both were very immensely successful. This led to a decrease in the prescription of the more dangerous barbiturates as doctors shifted to the newer, safer drug. Alprazolam was first released in 1981 and soon became a commercial success, also known as a ‘blockbuster drug ‘ – generating more than $1 billion of revenue.
Origins of Xanax use
Alprazolam is primarily indicated for the treatment of acute anxiety states and as a sleeping aide (hypnotic). Benzodiazepines should not be prescribed for the anxieties of everyday life, but rather kept in reserve for acute pathological conditions that are not responding to non-pharmacological methods.
Alprazolam is also used as a pre-medication to induce a light anesthesia before surgery or during outpatient procedures.
Benzodiazepines are also sometimes used to manage alcohol withdrawal. They diminish the acute withdrawal symptoms.
For long-term management of anxiety disorders, antidepressants and/or psychotherapy are favored. This is because benzodiazepines – especially alprazolam – have a high risk for abuse.
Alprazolam should not be consumed by patients with known sensitivity to benzodiazepines or who are currently taking ketoconazole.
Benzodiazepines and barbiturates exert their effects on consciousness and sleep by facilitating the activity of γ-aminobutyric acid (GABA) at various sites in the brain. GABA, the most abundant inhibitory neurotransmitter in the central nervous system, regulates the excitability of neurons in almost every neuronal tract. The GABAA receptor has binding sites for benzodiazepines and barbiturates, as well as for alcohol and some inhalation anesthetics.
Benzodiazepines bind to a GABA receptor channel and increase the receptors affinity for GABA. This increases the action of GABA, which counteracts the effects of excitatory neurotransmitters causing central nervous system depression.
Barbiturates work on a similar principle but are independent of the presence of GABA. This is why they are capable of causing greater central nervous system depression and toxicity than benzodiazepines. They are more dangerous and can cause respiratory depression, coma or death. When taken with another central nervous system depressant (e.g. alcohol and opiates) the risk increases as they cause a synergistic effect on one another causing severe sedation and intoxication.
How xanax is consumed
Benzodiazepines are typically taken orally, but some (diazepam, lorazepam) are used intravenously.
Lower doses have a sedative and anxiolytic effect and high doses produce sleep and anesthesia. Alprazolam can relieve anxiety at doses that cause relatively little sedation.
Alprazolam is usually given in pills ranging in strength – 0.25mg, 0.5mg, 1mg & 2mg preparations.
The adult dose for an acute anxiety state is 0.25mg-0.5mg, 3 times daily or 1mg in a single, slow release tablet. The elderly usually only take 0.25mg 3 times daily or 0.5mg in a single, slow release tablet.
Alprazolam has a fast onset of action (1-2hr) and a medium duration of action (7-12hrs) because of its high lipid solubility. This means it is quickly absorbed from the gut and distributed to the brain. As the concentration of alprazolam in the blood declines, the drug is redistributed from the brain back to the blood, which contributes to the termination of the effects on the brain. Almost all benzodiazepines are metabolized by the liver and most are converted to active metabolites.
Effects of xanax use
Short Term Use Effects:
- Sedation, anxiolytic
- Dissociation (detachment from immediate surroundings). Daydreaming is a very mild, nonpathological form of dissociation.
- Anterograde amnesia (person won’t remember what happens from the time the drug is taken until the effects wear off). This is especially useful when patients undergo stressful procedures (e.g. endoscopy)
- Anticonvulsant effects. Alprazolam is used in the treatment of seizure disorders. It also has a muscle relaxant effect, but this occurs at doses that produce considerable sedation
- Benzodiazepines all have a similar side-effect profile. The short-term adverse effects are similar to that of alcohol intoxication namely: motor incoordination, dizziness, slurred speech and excessive drowsiness. They impair concentration, judgment, planning and interfere with psychomotor skills. They also have a mild euphoric effect and can reduce behavioral inhibitions (very similar to alcohol).
Long term Effects:
- When used long term, the amnesic properties can have an adverse effect on a patient’s ability to function. This has been mostly associated with triazolam.
- Physical dependence, the severity proportional to the dosage & duration of the drug. If treatment is stopped abruptly, people experience withdrawal symptoms. Abrupt withdrawal with alprazolam has been associated with seizures
- Chronic use during pregnancy is not recommended and most benzodiazepines are classified as category D by the FDA. This medicine can cause birth defects. As with adults, the fetus may become dependent and suffer from withdrawal when born. The benefits may warrant use in pregnant women despite the potential risks.