Alprazolam
A triazolobenzodiazepine used to treat panic disorder and generalized anxiety disorder.
Drug card
- Class
- Benzodiazepine
- How it works
- Boosting GABA at GABA-A receptors, so chloride channels open more often
- Used for
- Generalized anxiety disorder
- Panic disorder, with or without agoraphobia
- Known for
- Drowsiness and sedation
- Dependence, misuse and addiction
- Withdrawal reactions, even seizures, if stopped suddenly
- Its name
- -azepam, -azolam means a benzodiazepine
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does alprazolam work?
Alprazolam, a triazolobenzodiazepine, binds the benzodiazepine site of GABA-A receptors and strengthens GABA-mediated inhibition. CYP3A4 clears it, with a half-life of about 11 hours in healthy adults, so strong CYP3A inhibitors such as ketoconazole raise its levels sharply.
Like other benzodiazepines: Benzodiazepines bind their own site on the GABA-A receptor, apart from the GABA site, and increase the receptor's affinity for GABA. The chloride channel then opens more often, hyperpolarizing neurons and damping their firing. Depending on the drug and dose, the result is anxiety relief, sedation, muscle relaxation, seizure control and amnesia.
Uses
What is alprazolam used for?
- Generalized anxiety disorder
- Panic disorder, with or without agoraphobia
Side effects
Side effects of alprazolam
- Drowsiness and sedationKnown for
- Dependence, misuse and addictionKnown forSerious
- Withdrawal reactions, even seizures, if stopped suddenlyKnown forSerious
- Poor coordination and slurred speech
- Low blood pressure
- Light-headedness and dizziness
- Memory problems
- Confusion
- Slowed breathing, especially with opioidsSerious
- Mania or hypomania in people with depressionSerious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Contraindicated with strong CYP3A inhibitors such as ketoconazole and itraconazole (ritonavir excepted).
- Alcohol, opioids and other CNS depressants add to its sedation and can dangerously slow breathing.
- Reduce the dose gradually when stopping, because abrupt withdrawal can cause seizures.
- Use late in pregnancy can cause sedation and withdrawal in the newborn.
Good to know: The only benzodiazepine here licensed for panic disorder; because CYP3A4 clears it, many interacting drugs change its levels.
Remember it
A way to remember it
CALMS
- C
- Convulsions controlled
- A
- Anxiety relief
- L
- Loss of memory for events after a dose (amnesia)
- M
- Muscle relaxation
- S
- Sedation
Written for biofideX
Its name
-azepam, -azolam means benzodiazepine
Diazepam and lorazepam end in -azepam; alprazolam and midazolam, with an added triazole or imidazole ring, end in -azolam. Clobazam and chlordiazepoxide are benzodiazepines too.
- Every drug name stem
Its class
Benzodiazepines
Easily mixed up with Z-drugs.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
- Alprazolam tablets: label (DailyMed)
- Alprazolam (NCI Thesaurus)
- FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class (FDA)
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Depression, anxiety and sleep
Alprazolam is one of 15 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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