Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-22T17:55:35.379Z Has data issue: false hasContentIssue false
  • English
  • Français

Alprazolam: just another benzodiazepine?

Published online by Cambridge University Press:  13 June 2014

Brian O'Shea
Brian O'Shea*
Affiliation:
Newcastle Hospital, Greystones, Co. Wicklow
Get access Rights & Permissions [Opens in a new window]

Abstract

The literature on alprazolam is reviewed. It is concluded that it is an effective anxiolytic but that it is not an antidepressant. When used in sufficiently high dosage it can block panic attacks, but it is not the only antipanic agent available. It may be used as an alternative to other benzodiazepines in the acute detoxification of alcoholics. It should be avoided where there is strong individual likelihood of abuse. Chronic usage (more than a few weeks) demands a very slow tapering of dosage. Carbamazepine may ameliorate withdrawal symptoms. The use of alprazolam in other conditions remains unproven.

Keywords

Alprazolambenzodiazepinetriazolobenzodiazepineanxietypanicagoraphobiadepressionalcohol
Type
Review Articles
Information
Irish Journal of Psychological Medicine , Volume 6 , Issue 2 , September 1989 , pp. 89 - 94
Copyright
Copyright © Cambridge University Press 1989

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Dawson, G W, Jue, S G and Brogden, R N. Alprazolam: a review of its pharmacodynamic properties and efficacy in the treatment of anxiety and depression. Drugs 1984; 27: 132–47.CrossRefGoogle ScholarPubMed
2.Gall, M, Hester, J B, Rudzik, A D and Lahti, R A. Synthesis and pharmacology of novel anxiolytic agents derived from 2 – [(Dialkylamino)methyl-4H-triazol-4-yl] benzophenones and related heterocyclic benzophenones. Journal of Medicinal Chemistry 1976; 19: 1057–64.CrossRefGoogle ScholarPubMed
3.Nakajima, R, Take, Y, Moriya, Ret al.Pharmacological studies on new potent central depressants, 8-chloro-6-phenyl-4H-s-triazolo(4, 3a)(l,4) benzodiazepine (D-65MT). Japanese Journal of Pharmacology 1971; 21: 497–519.CrossRefGoogle Scholar
4.Rudzik, A D, Hester, J B and Friis, W. Pharmacologic activity of a series of 6-phenyl-4H-s-triazolo (4,3-a)(1,4) benzodiazepines in mice. (Abstract) Pharmacologist 1971; 13: 205.Google Scholar
5.Soderpalm, B. Pharmacology of the benzodiazepines; with special emphasis on alprazolam. Acta Psych. Scand. 1987; 76 (supl 335): 39–46.CrossRefGoogle Scholar
6.Smith, R B and Kroboth, P D. Influence of dosing regimen on alprazolam and metabolite serum concentrations and tolerance to sedative and psychomotor effects. Psychopharmacology 1987; 93: 105–12.CrossRefGoogle ScholarPubMed
7.Scavone, J M, Greenblatt, D J and Shader, R I. Alprazolam kinetics following sublingual and oral administration. J. Clin. Psychopharmacol. 1987; 7: 332–4.CrossRefGoogle ScholarPubMed
8.Ueki, S, Watanabe, S, Yamamoto, Tet al.Behavioral and electro-encephalographic effects of alprazolam and its metabolites. Folia Pharmacologica Japonica 1981; 77: 483.CrossRefGoogle Scholar
9.Keller, K J, Cascio, C S, Bergstrom, D Aet al.Electroconvulsive shock and reserpine: effect on β-adrenergic receptors in rat brain. Journal of Neurochemistry 1981; 37: 830–6.CrossRefGoogle Scholar
10.Sethy, V H and Harris, D W. Role of beta-adrenergic receptors in the mechanism of action of second-generation antidepressants. Drug Development Research 1982; 2: 403–6.CrossRefGoogle Scholar
11.Sethy, V H and Hodges, D H. Role of beta-adrenergic receptors in the anti-depressant activity of alprazolam. Research Communications in Chemical Pathology and Pharmacology 1982; 36: 329–32.Google Scholar
12.Aden, G C. Alprazolam in clinically anxious patients with depressed mood. J. Clin. Psychiatry 1983; 44: 22–24.Google ScholarPubMed
13.Feighner, J P, Aden, G C, Fabre, L Fet al.Comparison of alprazolam, imipramine and placebo in the treatment of depression. J.A.M.A. 1983; 249: 3057–64.CrossRefGoogle ScholarPubMed
14.Rickets, K, Cohen, D, Csanalosi, Iet al.Alprazolam and imipramine in depressed outpatients: a controlled study. Current Therapeutic Research 1982; 32: 157–64.Google Scholar
15.Weissman, M M, Prusoff, B A, Sholomskas, A J and Berry, C. A pilot study of alprazolam (Xanax), imipramine (Tofranil) or placebo. In: Burrows, G D, ed. Advances in Neuropsychopharmacology. London: John Libbey and Company, 1983.Google Scholar
16.Rickels, K, Chung, H R, Csanalosi, I Bet al.Alprazolam, diazepam, imipramine, and placebo in outpatients with major depression. Arch. Gen. Psychiatry 1987; 44: 862–66.CrossRefGoogle ScholarPubMed
17.Fawcett, J, Edwards, J H, Kravitz, H M and Jeffries, H. Alprazolam: an antidepressant? Alprazolam, disipramine, and an alprazolam-desipramine combination in the treatment of adult depressed outpatients. J. Clin. Psychopharmacol. 1987; 7: 295–310.CrossRefGoogle Scholar
18.Pyke, R E and Kraus, M. Alprazolam in the treatment of panic attack patients with and without major depression. J. Clin. Psychiatry 1988; 49: 66–8.Google ScholarPubMed
19.Lesser, I M, Rubin, R T, Pecknold, J Cet al.Secondary depression in panic disorder and agoraphobia. I. Frequency, severity, and response to treatment. Arch. Gen. Psychiatry 1988; 45: 437–43.CrossRefGoogle ScholarPubMed
20.Goldberg, S C, Ettigi P, Schulzet al.Alprazolam versus imipramine in out-patients with neurovegetative signs. Journal of Affective Disorders 1986; 11: 139–45.CrossRefGoogle ScholarPubMed
21.Bielski, R J and Friedel, R O. Prediction of tricyclic antidepressant response: a critical review. Arch. Gen. Psychiatry 1976; 33: 1497–9.CrossRefGoogle ScholarPubMed
22.Rush, A J, Erman, M K, Schlesser, M Aet al.Alprazolam vs amitriptyline in depressions with reduced REM latencies. Arch. Gen. Psychiatry 1985; 42: 1154–9.CrossRefGoogle ScholarPubMed
23.Wolkowitz, O M, Breier, A, Doran, Aet al.Alprazolam augmentation of the antipsychotic effects of fluphenazine in schizophrenic patients. Arch. Gen. Psychiatry 1988; 45: 664–71.CrossRefGoogle ScholarPubMed
24.Douyon, R, Angrist, B, Peselow, Eet al.Neuroleptic augmentation with alprazolam: clinical effects and pharmacokinetic correlates. Am. J. Psychiatry 1989; 146: 231–4.Google ScholarPubMed
25.Smith, S, Rinehart, J S, Ruddock, V E and Schiff, I. Treatment of premenstrual syndrome with alprazolam: results of a double-blind, placebo-controlled, randomized crossover clinical trial. Obstetrics and Gynaecology 1987; 70: 37–43.Google ScholarPubMed
26.Clare, A W. Premenstrual syndrome: single or multiple causes? Canad. J. Psychiatry 1985; 30: 474–82.CrossRefGoogle ScholarPubMed
27.Opler, L A and Mickley, D. Alprazolam in the treatment of bulimia. J. Clin Psychiatry 1986; 47: 49.Google ScholarPubMed
28.Fabre, L F and Harris, R T. Pilot open-label study on U-31,889 in anxious in-patients. Current Therapeutic Research 1974; 16: 1010–13.Google Scholar
29.Fabre, L F. Pilot open-label study with alprazolam (U31;889) in outpatients with neurotic depression. Current Therapeutic Research 1976; 6: 661–8.Google Scholar
30.Mendels, J, Chernoff, R W and Blatt, M. Alprazolam as an adjunct to propranolol in anxious outpatients with stable angina pectoris. J. Clin. Psychiatry 1986; 47: 8–11.Google ScholarPubMed
31.Freeman, A M, Fleece, L, Folks, D Get al.Alprazolam treatment of postcoronary bypass anxiety and depression. J. Clin. Psychopharmacol. 1986; 6: 39–41.CrossRefGoogle ScholarPubMed
32.Sheehan, D V. Current perspectives in the treatment of panic and phobic disorders. Drug Therapy 1981; 12: 179–193.Google Scholar
33.Alexander, P E and Alexander, D D. Alprazolam treatment for panic disorders. J. Clin. Psychiatry 1986; 47: 301–4.Google ScholarPubMed
34.Ballenger, J C, Burrows, G D, DuPont, R Let al.Alprazolam in panic disorder and agoraphobia:, results from a multicenter trial. I. Efficacy in short-term treatment. Arch. Gen. Psychiatry 1988; 45: 413–22.CrossRefGoogle ScholarPubMed
35.Klosko, J S, Barlow, D H, Tassinari, R B and Cerny, J A. Alprazolam vs cognitive therapy for panic disorder: a preliminary report. In: Hand, I and Wittchen, H U, eds. Panic and phobias. New York: Springer Verlag, 1988.Google Scholar
36.Tyrer, P, Murphy, S, Kingdon, Det al.The Nottingham study of neurotic disorder: comparison of drug and psychological treatments. Lancet 1988; ii: 235–40.CrossRefGoogle Scholar
37.Hindmarch, I. Measuring the side-effects of psychoactive drugs: a pharmacodynamic profile of alprazolam. Alcohol and Alcoholism 1983; 18: 1–7.Google Scholar
38.Fabre, L F, Gainey, A and Kemple, S. Pilot open-label study of alprazolam (U-31,889) in anxious alcoholic out-patients. Journal of International Medical Research 1977; 5: 26–32.CrossRefGoogle ScholarPubMed
39.McLendon, D M and Fabre, L F. A double-bind comparison of the efficacy of alprazolam and chlordiazepoxide hydrochloride in the chronic withdrawal period from alcohol. Current Therapeutic Research 1979; 26: 430–9.Google Scholar
40.McLendon DM, and Fabre, L F. A double-bind comparison of the efficacy of alprazolam, chlordiazepoxide hydrochloride and placebo in the chronic withdrawal period from alcohol. Current Therapeutic Research 1980; 28: 447–55.Google Scholar
41.Kolin, I S and Linet O, I. Double-blind comparison of alprazolam and diazepam for subchronic withdrawal from alcohol. J. Clin. Psychiatry 1981; 42: 169–73.Google ScholarPubMed
42.Wilson, A and Vulcano, B A. Double-blind trial of alprazolam and chlordiazepoxide in the management of the acute ethanol withdrawal syndrome. Alcoholism: Clinical and Experimental Research 1985; 9: 23–7.CrossRefGoogle ScholarPubMed
43.Tubridy, P. Alprazolam vs chlormethiazole in acute alcohol withdrawal. British Journal of Addiction, 1988; 83: 581–5.CrossRefGoogle Scholar
44.Weddington, W W and Carney, A C. Alprazolam abuse during methadone maintenance therapy. J.A.M.A. 1987; 257: 3363.Google ScholarPubMed
45.Fraser, A D. Alprazolam abuse and methadone maintenance. J.A.M.A. 1987; 258: 2061.CrossRefGoogle ScholarPubMed
46.Weddington, W W. Reply to ref. 34 above. J.A.M.A. 1987; 258: 2061–2.CrossRefGoogle Scholar
47.Juergens, S M and Morse, R M. Alprazolam dependence in seven patients. Am. J. Psychiatry 1988; 145: 625–7.Google ScholarPubMed
48.Noyes, R, DuPont, R L, Pecknold, J Cet al.Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. II. Patient acceptance, side effects, and safety. Arch. Gen. Psychiatry 1988; 45: 423–8.CrossRefGoogle ScholarPubMed
49.Goa, K L and Ward, A. Buspirone: a preliminary review of its pharmacological properties and therapeutic efficacy as an anxiolytic. Drugs 1986; 32: 114–29.CrossRefGoogle ScholarPubMed
50.Cohn, J B and Wilcox, C S. Low-sedation potential of buspirone compared with alprazolam and lorazepam in the treatment of anxious patients: a double-blind study. J. Clin. Psychiatry 1986; 47: 409–412.Google ScholarPubMed
51. Anonymous. Problems associated with alprazolam therapy. International Drug Therapy Newsletter 1988; 23(7): 29–31.Google Scholar
52.Rashid, K, Patrissi, G and Cook, B. Multiple serious symptom formation with alprazolam. Paper presented at 1988 Annual Meeting of the American Psychiatric Association. Montreal, 05 1988.Google Scholar
53.Rosenbaum, J F, Woods, S W, Groves, J E and Klerman, G L. Emergence of hostility during alprazolam treatment. Am. J. Psychiatry 1984; 141: 792–3.Google ScholarPubMed
54.Hall, R C W and Zisook, S. Paradoxical reactions to benzodiazepines. British Journal of Clinical Pharmacology 1981; 11: 99S–104S.CrossRefGoogle ScholarPubMed
55.Rush, A J, Schlesser, M A, Erman, Met al.Alprazolam in bipolar-1 depressions. Pharmacotherapy 1984; 4: 40–2.CrossRefGoogle Scholar
56.Pecknold, J C and Fleury, D. Alprazolam-induced manic episode in two patients with panic disorder. Am. J. Psychiatry 1986; 143: 652–3.Google ScholarPubMed
57.Arana, G W, Pearlman, C and Shader, R I. Alprazolam-induced mania: two clinical cases. Am. J. Psychiatry 1985; 142: 368–9.Google ScholarPubMed
58.Goodman, W K and Charney, D S. A case of alprazolam, but not lorazepam, inducing manic symptoms. J. Clin. Psychiatry 1987; 48: 117–8.Google Scholar
59.Sangal, R. Inhibited female orgasm as a side effect of alprazolam. Am. J. Psychiatry 1985; 142: 1223–4.Google ScholarPubMed
60.Munjack, D J and Crocker, B. Alprazolam-induced ejaculatory inhibition. J. Clin. Psychopharmacol. 1986; 6: 57–8.CrossRefGoogle ScholarPubMed
61.Lydiard, R B, Howell, E F, Laraia, M T and Ballenger, J C. Sexual side effects of alprazolam. Am. J. Psychiatry 1987; 144: 254–5.Google ScholarPubMed
62.Cook, G and Sherlock, S. Jaundice and its relation to therapeutic agents. Lancet 1965; i: 175–9.CrossRefGoogle Scholar
63.Roy-Byrne, P, Vittone, B J and Uhde, T W. Alprazolam-related hepatotoxicity. Lancet 1983; ii: 786–7.CrossRefGoogle Scholar
64.Tyrer, R, Rutherford, D and Huggett, T. Benzodiazepine withdrawal symptoms and propranolol. Lancet 1981; 1: 520–2.CrossRefGoogle ScholarPubMed
65.Petursson, H and Lader, M H. Withdrawal from long-term benzodiazepine treatment. Br. Med. J. 1981; 283: 643–5.CrossRefGoogle ScholarPubMed
66.Noyes, R, Perry, P J, Crowe, R Ret al.Seizures following the withdrawal of alprazolam. J. Ner. Men. Dis. 1986; 174: 50–2.CrossRefGoogle ScholarPubMed
67.Zipursky, R B, Baker, R W and Zimmer, B. Alprazolam withdrawal delirium unresponsive to diazepam: case report. J. Clin. Psychiatry 1985; 46: 344–5.Google ScholarPubMed
68.Levy, A B. Delirium and seizures due to abrupt alprazolam withdrawal: case report. J. Clin. Psychiatry 1984; 45: 38–9.Google ScholarPubMed
69.Naylor, M W, Grunhaus, L and Cameron, O. Myoclonic seizures after abrupt withdrawal from phenelzine and alprazolam. J. Ner. Men. Dis. 1987; 175: 111–4.CrossRefGoogle ScholarPubMed
70.Breier, A, Charney, D S and Nelson, J C. Seizures induced by abrupt discontinuation of alprazolam. Am. J. Psychiatry 1984; 141: 1606–7.Google ScholarPubMed
71.Noyes, R, Clancy, J, Coryell, W Het al.A withdrawal syndrome after abrupt discontinuation of alprazolam. Am. J. Psychiatry 1985; 142: 114–6.Google ScholarPubMed
72.Vital-Herne, J, Brenner, R and Lesser, M. Another case of alprazolam withdrawal syndrome. Am. J. Psychiatry 1985; 142: 1515.Google ScholarPubMed
73.Votolato, N A, Batcha, K J and Olson, S C. Comment: alprazolam withdrawal. Drug Intelligence and Clinical Pharmacy 1987; 21: 754–5.CrossRefGoogle Scholar
74.Klein, E., Uhde, T W and Post, R M. Preliminary evidence for the utility of carbamazepine in alprazolam withdrawal. Am. J. Psychiatry 1986; 143: 235–6.Google ScholarPubMed
75.Björkqvist, S E, Isohanni, M, Mäkelá, R, et al.Ambulant treatment of alcohol withdrawal symptoms with carbamazepine: a formal multicentre double-blind comparison with placebo. Acta Psychiat. Scand. 1976; 53: 333–42.CrossRefGoogle ScholarPubMed
76.Cohn, J B and Noble, E P. Effect of withdrawing treatment after long-term administration of alprazolam, lorazepam, or placebo in patients with an anxiety disorder. Psychopharmacol. Bull. 1983; 19: 751–2.Google Scholar
77.Pecknold, J C and Swinson, R P. Taper withdrawal studies with alprazolam in patients with panic disorder and agoraphobia. Psychopharmacol. Bull. 1986; 22: 173–6.Google ScholarPubMed
78.Pecknold, J C, Swinson, R P, Kuch, K and Lewis, C P. Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. 111. Discontinuation effects. Arch. Gen. Psychiatry 1988; 45: 429–36.CrossRefGoogle Scholar
79.Ries, R K, Roy-Byrne, P P, Ward, N G, et al.Carbamazepine treatment for benzodiazepine withdrawal. Am. J. Psychiatry 1989; 146: 536–7.Google ScholarPubMed
80.Tyrer, P. Treating panic. Br. Med. J. 1989; 298: 201.CrossRefGoogle ScholarPubMed