Alprazolam

What Does Alprazolam Do?

Alprazolam, a benzodiazepine, is primarily used for treating anxiety and panic disorders, as well as anxiety related to depression. It operates by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA), thereby offering a calming effect. This medication can also be used off-label for conditions such as insomnia, Alzheimer's induced agitation, chemotherapy-induced nausea, and premenstrual syndrome. 

How Does Alprazolam Work? (the complicated stuff)

Alprazolam manages anxiety disorders by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain, which encourages a calming effect. By binding to GABA-A receptors in the brain, alprazolam escalates the efficiency and duration of chloride ion influx into the neuron. This results in hyperpolarisation, which reduces the neuron's likelihood to fire an action potential. This leads to a diminished excitability of the neurons, provoking sedative, hypnotic, anxiolytic, and muscle relaxant properties.

Drug Type and Category of Alprazolam

Alprazolam is a short-acting benzodiazepine classified as an anxiolytic and sedative-hypnotic.

What dosage of Alprazolam should you be taking?

NICE Dosage Guidelines ¹

• Adults: 250–500 micrograms (0.25–0.5 mg) 3 times a day, increased if necessary up to 3 mg daily
• Elderly or debilitated patients: 250 micrograms (0.25 mg) 2–3 times a day

What are the side-effects of Alprazolam?

Alprazolam, like other benzodiazepines, can cause a range of side effects. Common side effects include drowsiness, dizziness, tiredness, and difficulty concentrating. Some people may also experience changes in appetite, weight gain or loss, dry mouth, and gastrointestinal issues such as nausea or constipation.

Less common but more serious side effects can include mood changes like depression or thoughts of suicide, memory problems, confusion, slurred speech, and difficulty coordinating movements. In rare cases, alprazolam can cause allergic reactions, including rash, itching, swelling, severe dizziness, or trouble breathing.

Long-term use of alprazolam can lead to physical dependence, tolerance, and withdrawal symptoms if the medication is stopped abruptly. It's important to use alprazolam only as prescribed and under the guidance of a healthcare provider.

Drug Interactions

• Other Central Nervous System (CNS) Depressants: Combining alprazolam with other CNS depressants, such as opioids (e.g., morphine, oxycodone), alcohol, barbiturates, or other benzodiazepines, can lead to increased sedation, respiratory depression, and even coma or death.
• Antifungals: Drugs like ketoconazole and itraconazole can increase alprazolam levels in the blood by inhibiting its metabolism, leading to enhanced effects and increased risk of side effects.
• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and sertraline, and other antidepressants, can increase alprazolam's effects and side effects. The combination can also lead to enhanced CNS depression.
• HIV Protease Inhibitors: Medications like ritonavir can increase alprazolam levels by inhibiting its breakdown, which may necessitate dose adjustments.
• Macrolide Antibiotics: Drugs such as erythromycin can also inhibit the metabolism of alprazolam, increasing its concentration and effects.
• Oral Contraceptives: Some birth control pills can reduce the metabolism of alprazolam, leading to prolonged effects.
• Antihistamines: Combining alprazolam with antihistamines like diphenhydramine (Benadryl) can enhance drowsiness and sedation.
• Grapefruit Juice: Consuming grapefruit juice while taking alprazolam can increase blood levels of the drug, leading to enhanced effects and a higher risk of side effects.

Natural Alternatives to Alprazolam

Low mood, depression and anxiety can all be improved through living a healthy lifestyle. Reducing stress, resolving conflict, being stoic, and exercise are key parts of preventing and recovering from depression without the need for drugs. Drugs rarely provide long term benefit in the cases of depression or anxiety, and working on YOU is the main way to improve your life. 

Herbs and supplements such as valerian root, used for centuries to promote relaxation and ease anxiety, may also improve sleep quality. ⁵ Chamomile has soothing properties that can help reduce anxiety and promote better sleep ³,  while lavender, whether in essential oil form or supplements, has been shown to have calming effects and alleviate mild anxiety and stress. ^3,5 L-theanine, an amino acid found in tea leaves, promotes relaxation without causing drowsiness ^3,4, and magnesium, a mineral involved in relaxation and stress reduction, has been linked to increased anxiety when levels are low. ³ Additionally, 5-HTP, involved in serotonin production, contributes to feelings of well-being and happiness ³, and ashwagandha, an adaptogenic herb, may help lower cortisol levels, reducing anxiety and stress. ^3,5 Lemon balm, a member of the mint family, also has calming effects, making it useful for reducing anxiety and promoting relaxation. ^3,4,5 In terms of lifestyle changes, maintaining a healthy diet can assist in managing anxiety, though no diet can completely cure it. ³ Good sleep habits are crucial for anxiety management ², and counseling or therapy, such as cognitive behavioral therapy, can address underlying causes of anxiety. ²

Interesting facts about Alprazolam

Due to its effectiveness and fast action, alprazolam has a higher potential for dependence and abuse compared to some other benzodiazepines. Long-term use can lead to physical dependence and withdrawal symptoms.

In some individuals, especially those with certain psychiatric conditions, alprazolam can cause paradoxical reactions, including increased anxiety, agitation, or aggressive behavior, rather than its intended calming effects.

Alprazolam is one of the many medications affected by grapefruit. Consuming grapefruit or grapefruit juice can increase the levels of alprazolam in the bloodstream, potentially leading to enhanced effects and side effects.

Disclaimer

This article is generated for informational purposes only. It was created in December 2024. Medications and medical guidance can change over time. Therefore, it is essential to consult with your general practitioner or healthcare provider before making any decisions regarding medications or treatment plans. Your GP can provide personalised advice based on your specific health needs and conditions.

References

1. https://bnf.nice.org.uk/drugs/alprazolam/medicinal-forms/
2. https://www.alternativetomeds.com/blog/xanax-alternatives/
3. https://neurowellnessspa.com/alternatives-to-xanax/
4. https://www.northpointcolorado.com/rehab-blog/are-there-natural-alternatives-to-xanax/
5. https://www.optimallivingdynamics.com/blog/19-natural-xanax-alternatives