What Is Xanax/Alprazolam?

Xanax (Alprazolam) is a commonly prescribed drug to help alleviate symptoms of anxiety and panic. It's manufactured by Pfizer Inc.

Xanax belongs to a class of drugs called benzodiazepines, which are central nervous system depressants that work by enhancing the effect of the neurotransmitter "gamma-aminobutyric acid" (GABA).

GABA is essentially the brain's tranquilizing neurotransmitter. Xanax binds to certain sites on the GABAA gamma-amino-butyric acid receptor, slowing down activity in the brain, producing a calming effect.

Xanax is a benzodiazepine with a very fast onset of action. Most people feel its effects kick-in within 20 minutes of ingestion - peak effects of the drug are normally achieved within an hour.

Initially approved by the US FDA in 1981 for the treatment of anxiety, Xanax became the first FDA-approved drug for panic disorder therapy in 1990.

Since its approval the drug has become one of the most prescribed, yet also one of the most misused benzodiazepines available - because of its high potential for abuse and dependence.

Medical uses of Xanax

Xanax is one of America's most popular anti-anxiety medications.

Xanax is primarily used to treat panic and anxiety disorders, such as social anxiety disorder (SAD) and generalized anxiety disorder (GAD). Xanax is also used to alleviate nausea after chemotherapy.

According to the FDA, "Demonstrations of the effectiveness of XANAX by systematic clinical study are limited to 4 months duration for anxiety disorder and 4 to 10 weeks duration for panic disorder."

Managing anxiety

The FDA has approved Xanax for short-term treatment of anxiety and for the management of certain anxiety disorders. Several high quality studies have demonstrated its efficacy in reducing anxiety.

A large-scale double blind study found that Xanax was effective in improving symptoms of anxiety in 151 anxious outpatients; the results of the study, published in the American Journal of Psychiatry, revealed that "alprazolam and diazepam produced similar clinical improvement, which was significantly larger than improvement produced by placebo and was clearly evident after only 1 week of treatment."

Panic disorder

Xanax is considered to be an effective medication for panic attacks. However, due to its potential for abuse it is not a first line treatment option. One study, published in the Journal of Clinical Psychopharmacology, concluded that "evidence fails to demonstrate alprazolam as superior to other benzodiazepines for the treatment of panic disorder."

A report in the Primary Care Companion Journal of Clinical Psychiatry noted that for treatment of panic disorder "four drug classes have similar efficacy (tricyclic antidepressants, selective serotonin reuptake inhibitors [SSRIs], benzodiazepines, and monoamine oxidase inhibitors)."

The World Federation of Societies of Biological Psychiatry (WFSBP) only recommends the use of Xanax for the treatment of panic disorder when the patient shows no history of tolerance or dependence.

Precautions

Pregnant women should not take Xanax as it can cross the placenta and affect the fetus, increasing the risk of congenital abnormalities. In addition, taking Xanax during the last trimester of pregnancy can result in fetal drug dependence.

Doctors should be especially careful with patients who have a history of drug dependence when considering Xanax therapy.

Side effects of Xanax may include:

- Dry mouth
- Slurred speech
- Drowsiness
- Disinhibition
- Skin rash
- Constipation
- Hallucinations (very rare)

Dependence and withdrawal

Xanax - like all other benzodiazepines - binds to certain GABA receptors (called benzodiazepine receptors), prolonged use of the drug can eventually cause adaptive changes in these receptors, making them less sensitive to the drug's effect. When this occurs a higher dosage of Xanax is required for the same initial effect to be felt, increasing the risk of physical dependence and tolerance.

According to a paper published in the journal Addiction:

"Physiological dependence on benzodiazepines can occur following prolonged treatment with therapeutic doses, but it is not clear what proportion of patients are likely to experience a withdrawal syndrome."

"Withdrawal from normal dosage benzodiazepine treatment can result in a number of symptomatic patterns. The most common is a short-lived "rebound" anxiety and insomnia, coming on within 1-4 days of discontinuation, depending on the half-life of the particular drug. The second pattern is the full-blown withdrawal syndrome, usually lasting 10-14 days; finally, a third pattern may represent the return of anxiety symptoms which then persist until some form of treatment is instituted."

Signs and symptoms of Xanax dependence include:

- Being unable to cope without the medication
- Severe withdrawal symptoms in between doses
- Tolerance to the effects of the drug
- Unsuccessful attempts to stop taking the drug

Withdrawal symptoms include:

- Increased anxiety
- Depression
- Trouble sleeping
- Depersonalization
- Tremors
- Headache
- Muscle pains
- Hypersensitivity to touch
- Shakiness
- Twitching

It is important to taper off Xanax gradually, otherwise there is a risk of benzodiazepine withdrawal syndrome.

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Lynn Evans: Drop boxes part of prescription drug abuse battle

The Centers for Disease Control calls it an epidemic. The Mississippi Department of Public Safety calls it Mississippi’s No. 1 drug threat. Prescription drug abuse is killing men and women from all walks of life. The CDC reports that the deaths of women from prescription drugs has risen most dramatically: about 400 percent since 1999. Marshall Fisher of the Mississippi Bureau of Narcotics estimates that 90 percent of the 206 drug overdose deaths in this state in 2012 were due to the abuse of prescription narcotics.

Prescription narcotics, especially opioids such as Oxycontin and hydrocodone, are almost always prescribed for chronic pain — but medical science now shows that opioids are not a reliable treatment for noncancerous chronic pain. In other words, they mask but do not stop the pain.

The CDC reports that the sale of opiate pain relievers has increased by 300 percent since 1999. In 2008, there were more U.S. deaths from opiate pain relievers that from cocaine and heroin combined.

The misuse of prescription painkillers cuts across all social strata and is becoming as big a public health problem for people in the prime of life as heart disease and cancer. The CDC estimates that for every death due to prescription painkillers, there are 32 visits to the emergency room, 130 people who are addicted users, and 825 people who are so-called nonmedical users — people taking prescription painkillers without a medical reason. The total cost is staggering: about $28 billion for the estimated 40 million Americans with addiction.

Opiates, as well as the other commonly abused drugs such as benzodiazepines (Valium, Xanax, Ativan) and ADHD-treating drugs like Adderall and Ritalin, can be incredibly addictive. Although only some 12 percent to 20 percent of people who ever use these drugs become addicted, once addicted their brain chemistry has changed enough to overrule all reason and social pressure telling them to stop. Addiction is a disease that can both rule and ruin the addict’s life because it affects the production of dopamine, the brain’s “happy juice.” For that reason, the best way to stop prescription pain medication abuse is not to take it for non-cancer pain in the first place.

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