Alprazolam, most commonly known by the trade name Xanax, is a benzo (benzodiazepine) drug that has anti-anxiety effects in addition to sedative, hypnotic, amnesic, anticonvulsant, muscle relaxant and gamma-aminobutyric acid enhancing qualities. It is commonly prescribed and FDA-approved for treatment of medical conditions including generalized anxiety disorder (GAD), panic attacks, and social anxiety disorder (SAD). The United States Drug Enforcement Agency (DEA) classifies the drug as a schedule IV drug, meaning it is unlikely to be abused by those prescribed it for proper reasons; however, it is a commonly abused drug due to its rapid onset and peak effects and is more often seen abused by purchasers who acquire medication on the black market.
As with all benzodiazepine drugs, it is named for its core chemical structure, which is a benzene ring fused with a diazepine ring. Other well-known drugs in this class are diazepam (Valium) and clonazepam (Klonopin). Alprazolam and other benzodiazepines have strong interactions with foods and other drugs, including alcohol, primarily due to two factors. First, the metabolization of the drug is handled by the enzyme Cytochrome P450 3A4 (commonly abbreviated CYP3A4) and this enzyme's function can be inhibited (to increase sedation effects) or extended (to increase euphoric side effects) using commonly available prescription and nonprescription drugs including fluoxetine (Prozac) and cimetidine (Tagamet). Secondly, drugs that also create sedation or hypnotic effects including alcohol, z-drugs (like zolpidem, trade name Ambien) or herbs like kava create a synergistic effect and can lead to a semi-comatose state.
Alprazolam is known to cause dependence and many patients experience withdrawals or rebound effects upon discontinuation. Doctors are trained to deal with these problems by tapering off the use of the drug for patients who have used the drug for long periods. In spite of these safety concerns, alprazolam has a very high toxicity level (meaning even an extremely high dose is unlikely to be fatal) and, when used properly, is a superior treatment to most other drugs in its class.
Alprazolam/methadone Overdose, Interaction: Encephalopathy and Other Toxicities, Treated with Naloxone: Case Report
Dec 15, 2012; A 22-year-old man developed encephalopathy, bradycardia, hypotension, loss of consciousness and difficulty breathing following an...