Alprazolam

Understanding Alprazolam

Originally developed by Upjohn Laboratories, now part of Pfizer, in the late 1960s as a sleep aid, until its effects on anxiety, panic, and mood disorders became clear. Alprazolam was patented in 1976, and FDA-approved for market release in 1981 as Xanax.

It decreases abnormal excitement in the brain by amplifying certain neurotransmitters that block neural signals and prevent overexcitement. Today, it is widely used to treat generalised anxiety disorders, anxiety due to depression, and panic disorders and help manage sudden, unexpected attacks of extreme fear and worry.

Alprazolam provides quick symptomatic relief from the severe agitation of acute panic or anxiety attacks and restores control to those suffering from anxiety or panic attacks. It does not, however, treat or cure the underlying cause of anxiousness, seizures, or withdrawal.

Alprazolam Mechanism of Action

The medication works by increasing the amount of gamma-aminobutyric acid, or GABA, a chemical neurotransmitter that regulates the central nervous system. It inhibits excessive neural activity by blocking pain signals to the brain, decreasing neural stimulation, lowers overall cerebral activity and minimises cognitive function, which reduces agitation and calms anxiety.

Alprazolam binds GABA to GABA-A receptor sites in the brain and spinal cord which are largely responsible for affecting mood and mental stability, muscle relaxation, anticonvulsant activity, memory, breathing and motor coordination. Slowing down brain activity induces tranquillity and reduces anxiety for a relaxing, sleep-promoting sedative effect.

The rapid onset of effect of alprazolam means it's fast-acting effects are typically felt within 15 to 30 minutes of ingestion. The effects can be felt for around 4 to 6 hours before the medication is slowly expelled from the body.

Benzodiazepines: What Are They?

Benzodiazepines are the group of drugs that were developed as an alternative to barbiturates. They were first made available in the middle of the 1950s as a less dangerous substitute for the highly addictive barbiturates. Since the 1970s, they have been effectively used to treat mental health conditions like severe anxiety, neurological conditions like epilepsy and seizures, and sleep disorders like insomnia.

They work by slowing down central nervous system activity and reducing overall brain function by blocking neural signals. An indirect effect of this process is the uncontrolled release of dopamine in the brain when alprazolam is taken, resulting in intense feelings of euphoric pleasure and disinhibition that augment the medication's anxiety-reducing soothing effects.

In order to lower the chance of tolerance or reliance, short-term use is usually advised. Only when all other therapies have failed is long-term use recommended under careful monitoring and intensive medical supervision.

Clinical Uses of Alprazolam

Anxiety and Panic Disorders

For short-term management of acute anxiety episodes and panic attacks, alprazolam 1mg is commonly used. The quick onset of action provides fast, effective relief from sudden surges of extreme fear, palpitations, and shortness of breath. It is administered to patients experiencing unexpected panic disorders that interfere with daily functioning.

Seizure Management

A common off-label use is for the management and rapid termination of epileptic seizures. Its capability to prevent muscle spasms and agitation significantly reduces seizures caused by alcohol and drug withdrawals.

Sleep Disorders

Alprazolam isn't a sleeping pill, but like other anti-anxiety medications that manage panic and anxiety disorders, a common off-label use is as a sleeping aid. While it does have a relaxing, sedative effect on the body, it does not target the underlying cause of the sleep disorder.

Premenstrual Syndrome

Effectively reduces the severity of premenstrual mood symptoms such as nervousness, headaches, irritation, crying, anxiousness and depression after 3 to 6 months' treatment. Also relieves associated feelings of fatigue, confusion, cravings for sweets, abdominal bloating and cramps.

Depression

Anxiety-associated depression is responsive to alprazolam, which has a limited effectiveness of about 4 months for anxiety disorders. It provides short-term relief from some of the physical symptoms of depression such as abdominal bloating, abdominal cramps, and headaches.

Special Populations

This medication should not be used by children except under strict specialist guidance and hospital supervision, primarily for seizure emergencies. Older adults who are particularly vulnerable to exaggerated side effects and also more prone to falls and confusion, and those with slower drug clearances may need lower doses than alprazolam 2mg, or require closer monitoring.

Duration and Safety

Alprazolam should only be taken at the lowest effective dose for the shortest amount of time, typically for weeks instead of months. Treatment should be part of a carefully planned, temporary plan in combination with therapy and other non-pharmacologic interventions for the best results.

While regularly taking this treatment for anything over 10 weeks is not ideal, when it does happen, alprazolam should never be stopped suddenly but always gradually reduced under a doctor's supervision to avoid experiencing serious symptoms of withdrawal.

Comparing Benzodiazepines

While benzodiazepines all share similar mechanisms, they differ in how quickly they act, how long they last, and their ideal application. Alprazolam has a quick onset of action and a duration of 4-6 hours. This makes it ideal for providing fast, short-term relief from sudden anxiety or panic attacks before the effects subside, but comes with a higher risk of dependency.

Drug	Onset of Action	Duration	Common Uses	Notes
Alprazolam	30 min	Short - 4-6 hrs	Anxiety disorders and panic attacks	Quick onset time providing short term relief
Lorazepam	20-30 min	Medium - 6-8 hrs	Anxiety disorders, insomnia & pre-procedure sedation	Fast acting and long lasting
Diazepam	30-60 min	Short - 4-6 hrs	Anxiety disorders, insomnia, seizures, muscle spasms & withdrawal	Medium to rapid onset with long lasting effects

This comparison shows alprazolam's advantage for conditions needing fast-acting relief. Other medications may be preferred when a longer duration or extended sedation is important.

Dosage and Usage

Alprazolam should be taken exactly as prescribed, typically several times a day, due to the short-acting nature of its calming, sedative and relaxing effects that tend to wear off within 4-6 hours. Oral tablets should be swallowed whole without chewing or crushing and can be safely taken without food, but may cause an upset stomach.

Alprazolam 1mg and 2mg tablets are higher strengths than the normally recommended initial starting doses of 0.25mg to 0.5mg and are more appropriate for regular users. For the most consistent results in avoiding breakthrough anxiety, this medication should be taken at the same time each day.

Alprazolam 1mg can be taken up to 3 times per day, with a daily maximum of 4mg for up to 4 months. For the treatment of panic attacks, alprazolam 2mg can be taken from 2 to 4 times per day, with a daily maximum of 10mg for up to 10 weeks.

Understanding Alprazolam Side Effects

Following the recommended dosage and usage instructions is important in regards to minimizing the potential side effects. Some of the most common include drowsiness, fatigue, dizziness, poor balance, slowed reflexes, coordination issues, and memory impairment, all of which typically improve after the body adapts to the treatment.

On rare occasions benzodiazepines like alprazolam can block nerve impulses to cause breathing difficulties, slow heart rates, and cause general weakness. If experiencing any of these symptoms, or severe alprazolam side-effects, immediately advise your healthcare provider for evaluation. Doctors can evaluate the suitability of the treatment and recommend an alternative if necessary.

Precautions & Avoiding Dependence

Even the weakest benzodiazepines like alprazolam 1mg, can quickly become habit-forming, with the risk of addiction increasing sharply for those on daily doses of 4mg for longer than 12 weeks. Longer, more regular use can lead to building up a tolerance, which can quickly develop into dependence.

Use with alcohol, opioids, cannabis, or any sedatives can have dangerous interactions and lower doses are recommended for older patients and for those with renal and hepatic impairment. Pregnant and breastfeeding women are also recommended to steer clear, due to the danger of passing to the infant.

Short-term treatment of intermittent use, at the lowest effective dose is the safest approach to using alprazolam. Gradually taper the daily dosage to minimise withdrawal side effects like anxiety, sweating, tremors, insomnia, and in extreme situations, seizures.

Cost of Alprazolam

The cost of alprazolam depends on the strength, amount and the supplier. Internet pharmacies have lower prices than their high street counterparts due to reduced overheads, coupons, and discounts that are available. They also have 24-hour support available to reassure customers who are unfamiliar with ordering their medication online.

Here's a typical price ranges:

Pack Size (Tablets)	Strength	Price Range (GBP)
30	1mg	£39-44
60	1mg	£62-66
90	1mg	£89-94
30	2mg	£45-50
60	2mg	£69-74
90	2mg	£99-104

Other factors influencing the cost of treatment include options to purchase through private health insurance or government schemes. When alprazolam 2mg is recommended by a doctor, a generic version can be requested instead of the branded product, which can have a major impact on the cost and longevity of treatment.