A Review of Alprazolam Use, Misuse, and Withdrawal

Abstract

Alprazolam is one of the most widely prescribed benzodiazepines for the treatment of generalized anxiety disorder and panic disorder. Its clinical use has been a point of contention as most addiction specialists consider it to be highly addictive, given its unique psychodynamic properties which limit its clinical usefulness, whereas many primary care physicians continue to prescribe it for longer periods than recommended. Clinical research data has not fully shed light on its “abuse liability,” yet it is one of the most frequently prescribed benzodiazepines. “Abuse liability” is the degree to which a psychoactive drug has properties that facilitate people misusing it, or becoming addicted to it, and is commonly used in the literature. We have replaced it in our manuscript with “misuse liability” as it reflects a more updated terminology consistent with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In this paper, we have reviewed alprazolam’s indications for use, its effect on pregnant women, misuse liability, withdrawal syndrome, pharmacodynamic properties, and suggest better clinical prescription practice of alprazolam by presenting an indepth theory of its clinical effects with use and withdrawal.

Incidence of and Characteristics Associated With Long-term Benzodiazepine Use in Finland

“…This study’s finding that alprazolam was associated with a lower risk for long-term use was somewhat surprising, as alprazolam has been associated with increased risk of long-term use in previous studies 29 , 33 and is suspected to be more likely to cause physical dependence because of its high potency and short half-life. 44 , 45 It is possible that alprazolam was prescribed selectively or restrictively in the whole study population owing to concerns of dependence and was avoided in persons judged to have a high liability for dependence. This selection may also apply to other specific BZDRs, and thus, the association with relative safety does not imply that any BZDR would be resistant to misuse or abuse.…”

Nonmedical use of alprazolam in the UK: Results from a nationally representative survey

“…Alprazolam has a similar mechanism of action to diazepam but is approximately 10–20 times more potent, is reported to have greater propensity for nonmedical use (NMU), causes more severe withdrawal symptoms and is more toxic in overdose compared to other benzodiazepines . Despite alprazolam not being readily available, there has been growing concern that alprazolam is being obtained for NMU in the UK, especially by young people .…”

Association of alprazolam with major cardiovascular events in patients with hypertension

“…Fifth, we did not investigate the relationship between the overdosing of alprazolam and all‐cause mortality in our study. Misuse of alprazolam is common, and incidents of fatal deliberate self‐poisoning involving alprazolam have been reported . Thus, the effect of alprazolam in reducing all‐cause mortality in this study may be underestimated.…”