Overview
Alprazolam is a benzodiazepine medication indicated for the acute treatment of generalized anxiety disorder and panic disorder in adults. It acts as a central nervous system depressant by enhancing GABA activity, producing anxiolytic, sedative, and muscle relaxant effects. Due to its potential for abuse, dependence, and withdrawal, it should be prescribed at the lowest effective dose for the shortest duration possible.
Mechanism of Action
Alprazolam is a benzodiazepine that potentiates the effects of gamma-aminobutyric acid (GABA), the major inhibitory neurotransmitter in the central nervous system. It binds to specific sites on GABA-A receptors, enhancing GABA-mediated chloride ion channel opening, resulting in neuronal hyperpolarization and reduced neuronal excitability.
Indications
- Acute treatment of generalized anxiety disorder (GAD) in adults
- Treatment of panic disorder (PD), with or without agoraphobia in adults
Common Doses
- 0.25 mg
- 0.5 mg
- 1 mg
- 2 mg
Dosage
Individualized based on diagnosis and patient response. For anxiety disorders: initial dose typically 0.25-0.5 mg three times daily, maximum 4 mg daily. For panic disorder: initial dose typically 0.5 mg three times daily, may be increased gradually. Elderly or debilitated patients should start with lower doses. Taper gradually when discontinuing to avoid withdrawal symptoms.
Contraindications
- Known hypersensitivity to alprazolam or other benzodiazepines
- Patients with acute narrow-angle glaucoma
- Concomitant use with strong CYP3A inhibitors (except ritonavir)
- Patients with severe respiratory insufficiency
- Patients with myasthenia gravis
- Patients with sleep apnea syndrome
Side Effects
- Drowsiness, sedation, fatigue
- Dizziness, lightheadedness
- Impaired coordination, ataxia
- Memory impairment, confusion
- Slurred speech
- Paradoxical reactions (agitation, irritability, aggression)
- Withdrawal symptoms (anxiety, insomnia, tremors, seizures)
- Respiratory depression (especially with other CNS depressants)
- Dependence and addiction potential
Interactions
- Strong CYP3A inhibitors (ketoconazole, itraconazole) increase alprazolam levels
- Opioids increase CNS depression and respiratory depression risk
- Alcohol increases CNS depression effects
- Other benzodiazepines and sedative-hypnotics
- Antidepressants may increase sedation
- Anticonvulsants may have additive CNS effects
Counseling Points
- Take exactly as prescribed; do not increase dose without medical advice
- Avoid alcohol and other CNS depressants
- May cause drowsiness; avoid driving or operating machinery until effects are known
- Do not stop abruptly; taper gradually under medical supervision
- Store securely to prevent misuse by others
- Report any thoughts of self-harm or unusual behavior changes
- Use caution in elderly patients due to increased sensitivity