DRUG INFORMATION: ALPRAZOLAM

DRUG INFORMATION: ALPRAZOLAM

Definition

Alprazolam is a triazolobenzodiazepine, that is, a benzodiazepine with a triazolo-ring attached to its structure. Benzodiazepines produce a variety of effects by modulating the GABAA subtype of the GABA receptor, the most prolific inhibitory receptor within the brain. The GABAA receptor is made up from 5 subunits out of a possible 19, and GABAA receptors made up of different combinations of subunits have different properties, different locations within the brain and importantly, different activities in regards to benzodiazepines.

There is some evidence for antidepressant treatment of clinical depression in outpatient settings, evidence for inpatients is lacking; other benzodiazepines are not known to have antidepressant activity.

The main medical uses for alprazolam include:

· Alprazolam is FDA-approved for the short term treatment (up to 8 weeks) of panic disorder, with or without agoraphobia. Alprazolam is very effective in preventing moderate to severe anxiety, essential tremor, panic attacks and other types of convulsive behaviors. Physicians who elect to prescribe alprazolam for longer than 8 weeks should be aware that continued efficacy has not been systematically demonstrated beyond 8 weeks use as tolerance to alprazolam's effects may occur after 8 weeks and necessitate discontinuation or physician-directed dose escalation. However, long-term maintenance therapy on alprazolam is not unheard-of in the medical community, and, if a genuine therapeutic need exists, benefits must be weighed against risks.

· Alprazolam is recommended for the short-term treatment (2-4 weeks) of severe acute anxiety. Alprazolam should only very rarely be used for longer periods of time -- the body becomes rapidly tolerant to the drug's effects, which may translate to decreased efficacy. Decreased efficacy can lead to dose escalation, and the use of high doses puts the patient at higher risk for withdrawal if the drug is discontinued suddenly.

· However, in 1992 Romach and colleagues reported that dose escalation was not a characteristic of long-term alprazolam users, and the majority of patients indicated that alprazolam continued to be effective. A 2003 study did not support the hypothesis that long-term use of benzodiazepines frequently results in notable dose escalation. In a 1-year follow-up study of patients with panic disorder continuing treatment with clonazepam, 90% maintained a positive response without developing significant tolerance. In a 2.5-year follow-up study of alprazolam therapy, little evidence of tolerance emerged.

Alprazolam is available in English speaking countries under the following brand names. Alprax, Alprox, Alzam, Anxirid, Apo-Alpraz, Azor, Calmax, Gerax, Kalma, Niravam, Novo-Alprazol, Nu-Alpraz, Xanax, Xanor, Zopax

Side effects

Side effects of alprazolam may occur in patients and are more likely the higher the dosage taken. If signs of an allergic reaction occur such as hives, difficulty breathing, swelling of face, lips, tongue or throat occur medical attention should be sought immediately. Medical attention should also be sought immediately if signs of jaundice appear such as yellowing of the skin or eyes. Other side effects which may occur are as follows

· euphoria

· drowsiness

· decreased inhibitions, no fear of danger (increased risk taking behavior)

· depressed mood with thoughts of suicide or self harm or elevated mood and confidence

· hallucinations, agitation and hostility

· feeling dizziness, light headed or fainting

· urinating less than usual or not at all

· headache, fatigue, joint pain and unusual weakness (flu like symptoms)

· speech problems,

· Short term (anterograde amnesia) and concentration problems

· changes in appetite (including changes in weight)

· blurred vision, unsteadiness and clumsiness (impaired coordination and balance)

· constipation, diarrhea, nausea and vomiting

· decreased or increased sex drive

· dry mouth or. more likely, increased salivation

· sweating

· pounding in the chest or rapid heartbeat

· skin inflammation