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Alprazolam, trade name Xanax, is a short-acting drug in the benzodiazepine class used to treat anxiety disorders and as an adjunctive treatment for depression. Alprazolam is also effective in the treatment of activity depression or panic attacks.

It can also be useful when treating irritable bowel syndrome and anxiety due to a neurosis. The trouble with this medication is that, both tolerance and dependence can occur with the use of Xanax and person may experience withdrawal symptoms the using of the drug stops abruptly. The drug dosage should be gradually reduced and only doctor should advise on how to discontinue or change dose.

Biochemical structure

From the biochemical structure point of view, Xanax is a triazolobenzodiazepine, which means that it is a simple benzodiazepine with a triazolo-ring attached to its structure.
Basically, alprazolam binds to the specific receptor called GABA-A, which is a subtype of the GABA receptor. That’s why it increases the inhibitory effects of GABA within the central nervous system. What is so special about this medication? Unlike other benzodiazepines, alprazolam may also have some antidepressant activity, although there is no clinical evidence of this.

Mechanism of action

The real mechanism of action is not yet fully understood. The advantage of this drug is that it is easily absorbed from the gastrointestinal tract and only after an hour or two, the blood concentration peak is reached. When it enters the blood stream it attaches to plasma proteins, mainly to albumin.

Indications for usage

There are several medical indications for the use of Xanax and the most common are:

Treatment of panic disorder

It is clinically proven that Alprazolam is very effective in preventing panic attacks. However, many psychiatrists refuse prescribing it because of the possibility of dependence due to its short-acting nature.

Treatment of panic attacks

Alprazolam, if taken as advised, is also very effective panic attack treatments.

Long-term treatment of severe generalized anxiety disorders

Alprazolam may be used for a long-term treatment of anxiety if other therapies do not work or are contraindicated. The duration of therapy in this case is often four months or longer. The decision to use alprazolam for this purpose must be carefully made by a specialized psychiatrist, taking into account the individual's suffering, quality of life, loss of social performance and risk of dependence.

    * Adjunctive treatment of depression

Alprazolam is sometimes used together with other medications such as paroxetine, sertraline, or fluoxetine to alleviate the symptoms of depression. However, it is proven that this may cause sexual dysfunction. In these cases, a tricyclic antidepressant should be used instead.

Other indications

Xanax may help the symptoms of PMS if extreme, and, if given with various narcotics, the pain from some cancer forms. It can also relieve symptoms of fibromyalgia and ringing ears.

Contraindications for the usage

Using alprazolam should be avoided in individuals with the following conditions:

  • Myasthenia gravis
  • Acute intoxication with alcohol, narcotics, or other psychoactive substances
  • Ataxia
  • Severe hypoventilation
  • Acute narrow-angle glaucoma
  • Severe liver deficiencies  
  • Severe sleep apnea
  • Hypersensitivity or allergy to any drug in the benzodiazepine class

Possible side effects of Xanax

There are several possible side effects that could occur when using this medication and some of them happen often and some rarely!
More common side effects:
·          Abdominal discomfort,
·          abnormal involuntary movement,
·          agitation,
·          allergies,
·          anxiety,
·          blurred vision,
·          chest pain,
·          confusion,
·          constipation,
·          decreased or increased sex drive,
·          depression,
·          diarrhea,
·          difficult urination,
·          dream abnormalities,
·          drowsiness,
·          dry mouth,
·          fainting,
·          fatigue,
·          fluid retention,
·          headache,
·          hyperventilation,
·          inability to fall asleep,
·          increase or decrease in appetite,
·          increased or decreased salivation,
·          impaired memory,
·          irritability,
·          lack of or decreased coordination,
Less common side effects:
·          Abnormal muscle tone,
·          arm or leg pain,
·          concentration difficulties,
·          dizziness,
·          double vision,
·          fear,
·          hallucinations,
·          hot flushes,
·          inability to control urination
·          infection,
·          itching,
·          joint pain,
·          loss of appetite,
·          muscle cramps,
·          muscle spasticity,
·          rage,
·          seizures,
·          shortness of breath,
·          sleep disturbances,
·          slurred speech,
·          stimulation,
·          talkativeness,
·          taste alterations,
·          temporary memory loss,
·          tingling or pins and needles,
·          uninhibited behavior,
·          urine retention,


Xanax abuse and dependence

Xanax is extremely addictive, and thus it is only approved for up to 8 weeks of use by the FDA or even 4 weeks in Great Britain. It is proven that, the greater the dose the patient is taking, the faster he or she may become dependant.

If one uses these drugs for a longer period, the body will develop tolerance for the drugs, and larger doses will be needed to achieve the initial effects. Patients typically notice a relief of insomnia initially, followed by a gradual loss of efficacy. In addition, continued use can lead to physical dependence and, when use is reduced or stopped the body goes through a very difficult period.

Xanax is rarely abused as a sole drug. Almost 80 percent of benzodiazepine abuse is part of a poly-drug abuse, most commonly with opioids. There is also a very expressed and present co-abuse with alcohol. Studies indicate that 3 to 41 percent of alcoholics report that they have abused benzodiazepines at some time, often to modulate intoxication or withdrawal effects. As potential drugs of abuse, short-acting benzodiazepines seem to be preferred among the addicts because of the rapidity of their onset of action.

Incidence of prescription drugs abuse

A  report made by the National Institute of Drug Abuse (NIDA) in 2001 stated that the number of people who abuse prescription drugs is getting bigger each year. This report also showed that the number of Americans who began to misuse sedatives, especially Xanax, practically doubled between 1990 and 1998. The latest statistics indicate that in 2002, 2.6 percent of the population, or 6.2 million Americans, aged 12 or older were currently abusing prescription drugs. The highest numbers of new users are 12 to 17-year-olds and 18 to 25-year-olds.  Also, visits to hospital emergency rooms for benzodiazepine related episodes increased significantly between 1998 and 2002.

Patients at a High Risk for Abuse and Dependence

Patients at a particularly high risk for Xanax misuse, abuse, and dependence are:

  • Patients with a history of alcohol or drug abuse and/or dependence
  • Emotionally unstable patients
  • Patients with severe personality disorders
  • Patients with chronic pain or other physical disorders

Xanax detoxification and rehabilitation

Drug rehabilitation is a multi-phased, multi-faceted and  long term process.
Not only is it difficult for the addict, it is extremely hard on those helping them.

The most difficult part of a rehab program for addicts is usually admitting that they have an addiction. Painful as this may be, it must be acknowledged as the first step in overcoming the problem. The next hurdle is being willing to seek and accept help from the professionals.

Most people think that detox-therapy is enough to overcome the addiction. Unfortunately that isn’t true.  Detoxification is only the first step on the road of addiction treatment. Physical detoxification alone is not sufficient to change the patterns of behaviour of a drug addict.

During the rehab period, the addict needs new tools in order to deal with situations and problems which will eventually arise in the perspective.
Most of the addicts, even when they do admit that they have problem, choose not to talk to the professional about it. According to the statistics, when an addict makes an attempt at detoxification and discontinues drug use without the aid of professional help, the results do not last long. In specialized Detox Centers, addicts are treated with respect. The usage of the drug is gradually reduced and the help is given to battle all the possible withdrawal symptoms. Not only that this battling suppresses the usage of drugs, but it is also restimulating their past and changes the way their brain functions. Therefore, it is no wonder that quitting drugs without professional help is an uphill battle.

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Xanax withdrawal

The withdrawal symptoms from Xanax and other benzodiazepines are quite similar. The only exception is that Xanax has a much higher incidence of panic attacks and a bereavement type of emotional liability.

When we talk about the withdrawal effects from therapeutic dosages of benzodiazepines, we should know that they are mainly restricted to anxiety. Some people also experienced autonomic instability, insomnia and sensory hypersensitivity. The most serious acute withdrawal symptoms are seizures and delirium tremens, which most commonly occur with the abrupt discontinuation.

The symptoms of Xanax abuse withdrawal are much more dramatic because they include effects which occur after a much longer period of usage. The most common are:
anxiety, blurred vision, decreased concentration, decreased mental clarity, depression, diarrhea, headache, heightened awareness of noise or bright lights, hot flushes, impaired sense of smell, insomnia, loss of appetite, loss of reality, muscle cramps, nervousness, rapid breathing, seizures, tingling sensation, tremor, twitching, weight loss etc.