Talk:Alprazolam

History section

Could someone please include a history section? - 5/14/2006

This page lists "Irreversible (non repairable) cognitive deficits and lasting loss of personality" as a possible side effect. Nowhere else have I seen this described as a side effect of Xanax. Could someone please provide substantiation for this claim?

This page is a major target for spam. I just reverted some more. NSR (talk) 20:31, 31 July 2005 (UTC)

I've added a request to deal with this spam at [1]. Yelyos 07:41, August 8, 2005 (UTC)

Request has been dealt with - the spammer should not be able to operate any longer. Yelyos 07:54, August 8, 2005 (UTC)

I'm not a good writer, but I felt that I should make some changes. Alprazolam's uniqueness is in it's panic suppressant qualities, and this is what makes it different from other benzodiazipines. Other forms of anxiety disorders can often be treated equally well with other benzos. Someone may wish to "clean up" my writing style, though.

All benzodiazepines suppress anxiety but alprazolam is more useful in this role because of its short duration of effect. I've tried a little "cleaning up" but feel free to tinker more if you don't like it. I removed the SPEICAL RISK PATIENTS section because I think that it's misleading; benzodiazepines are popular in large part because they are safe on overdose - they don't suppress breathing and so deaths from BZD overdose alone is almost unheard of, and overdose with these agents is common (of course in combination they're more dangerous). ben

This page is beginning to look better, although all the other benzo pages still need a great deal of work. I organized the trade names into a list in an attempt to make them easier to read through. Let me know what you think. - Fuzzform 21:07, 13 December 2005 (UTC)

abuse by cocaine users

• I have it on (unfortunately) good authority that some habitual cocaine users sometimes use xanax to calm themselves when they're 'tweaking' (too high). Does anyone know where I can find a source for this?--PharmerJoe 17:54, 28 January 2006 (UTC)

Drug and food interaction

What about drug interaction? Does this drug interact with other prescription drugs or over the counter medications? —The preceding unsigned comment was added by 65.80.43.119 (talk • contribs).

You can get that information from the prescribing info link on the article [2]. OhNoitsJamie^Talk 03:39, 23 March 2006 (UTC)

>>> Nice pickup on the CYP3A4 (Tagamet) interaction -- I missed it. Dan Schwartz Discpad 16:01, 30 May 2007 (UTC)

Dosage

Alprazolam is taken as needed (PRN); 4 to 6 doses per month are the acceptable limit.

This dosage information HAS to be incorrect. A lot of ppl take Alprazolam daily as directed.

This has now been corrected. It should have been 4 to 6 doses a day.

This is not right either: most commonly for Anxiety Disorders, Alprazolam is administered twice a day "BID" (or less commonly three times a day "TID"). The most common prescription is for 1mg BID. Panic Disorder sufferers whose symptoms are not diminished by the common prescription of 1mg BID are sometimes taken up to 2mg TID.

Availability

Alprazolam is generally sold in generic form in the United States. It is also sold under many other brand names, depending on the country:

Xanax is also sold as a liquid in the US.

fruity reactions?

I had a scrip for generic xanax several months ago. On the bottle were three warning stickers. The first two were the standard "don't drink alcohol" and "may cause intense dizziness/drowsiness" warnings. The third was a warning about possible interactions with citrus juices. Anyone know what that was about? ZekeMacNeil 21:01, 18 April 2006 (UTC)

Did it specifically mention grapefruit juice? See the grapefruit article, this blog: Drug Interactions—Grapefruit juice and Xanax but also PMID 10907671. Colin°^Talk 22:49, 18 April 2006 (UTC)

Absorbtion Through Mucous Membranes

Xanax can be absorbed through mucous membranes. People put xanax in the anuses.

[Skidoo here:] This is most likely inaccurate. Or rather, people may very well take alprazolam rectally, but it is not soluble in water, so the likelihood that anyone would experience an appreciable effect from this sort of administration is very slim.

Xanax is available as a suppository: One use is for children travelling by air if they get a panic attack. Discpad 15:04, 20 May 2007 (UTC)

Insufflation?

[Note: All comments below refer to "standard" alprazolam, not the extended-release pills being marketed under the name "Xanax XR."]

I have read in several sources that alprazolam is not water-soluble; ergo snorting it (isufflation) does not enhance its effectiveness. In fact, snorting alprazolam actually REDUCES its bioavailability, because the powder has to make the relatively circuitous journey through your sinuses and down the back of your throat into your stomach. So not only will it take you longer to feel the effects, but the effects will be diminished, as the dose will be absorbed over a greater length of time versus swallowing a pill.

Plus, alprazolam pills taste horrible. They're very, very bitter. They can leave a nasty bitter stripe on your tongue if you're not careful. And alprazolam is a potent drug. A 2MG dose is usually coveyed in a pill that itself can weigh an entire gram. Which means that the great bulk of what you snort if you crush an alprazolam pill is just filler.

My on-line sources are sparse, but I'll try to work this info into the article and remove the incorrect assertions.

"...Fillers can be bad for your nasal passages, and can do serious damage to the lungs when inhaled. Many pills contain cellulose and chalk, which pass through your intestines harmlessly when taken orally, but can be very destructive if they get into the lungs...since they are not water soluble." http://www.erowid.org/ask/ask.cgi?ID=2698

"Alprazolam is a white crystalline powder, which is soluble in methanol or ethanol but which has no appreciable solubility in water at physiological pH." http://www.xanax.com/xanax.pdf

Insufflation / Grapefruit Juice and Alprazolam

I also agree with the above poster: the effects of alprazolam are NOT increased by insufflation. If anything potency is reduced as described above. Only water soluble substances are absorbed through the nasal membranes, and as http://www.xanax.com/xanax.pdf and other sources show, alprazolam is only slightly soluble in water.

There are also no sources to back up the claim made in the recreational use area of the page regarding increased potency.

Also, numerous sources have verified that the bioavalability of alprazolam is not significantly increased in a statistically meaningful way by the consumption of grapefruit juice, however, the decreased metabolic effects caused by grapefruit juice and/or other citrus juices can cause an increase in blood serum levels and can increase the longevity of the elimination half-life of alprazolam, possibly to toxic levels, although, is generally unlikely unless copious amounts are consumed; however, toxicity resulting from consumption of grapefruit juice or other citrus fruits is unlikely while administering aplrazolam; this is often more characteristic of medications that interact with grapefruit juice (i.e. opioids, benzodiazepines) that have a lower binding percentage to blood plasma proteins since alprazolam is approximately eighty percent bound in human plasma therefore, it does not have much more potential to increase to cause lethal toxicity. (Refer to Clinical Pharmacology at RXList.com)

"Grapefruit juice altered neither the steady-state plasma concentration of alprazolam nor the clinical status in patients. The present study shows that grapefruit juice is unlikely to affect pharmacokinetics or pharmacodynamics of alprazolam due to its high bioavailability."

-- http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10907671&dopt=Abstract

"Effects of repeated ingestion of grapefruit juice on the single and multiple oral-dose pharmacokinetics and pharmacodynamics of alprazolam; Psychpharmacology (Berl). 2000 Jun; 150(2):185-90"

-- http://www.druginteractioncenter.org/consu.php?interaction_category=9&detail=61

Link

How can one suggest a site to get listed as a "reference" or an "external link"? If I edit and add it to the page it automaticaly gets reverted?

I have been in touch with "Daniel" at wikipedia and he suggested I add the link to the page first and if the link is removed, then leave it that way and maybe mention the link on the discussion page. If others see value in having the link, it will eventually get put into the article?

May I suggest the link here in the discussion page so you can see the value of the site? The site list many books on alprazolam! Thanks. 8/29/06 —The preceding unsigned comment was added by Drmarilyn (talk • contribs). (moved by Dirk Beetstra ^{T C} 18:12, 29 August 2006 (UTC))

What is the site? --Dirk Beetstra ^{T C} 18:12, 29 August 2006 (UTC)

I saw it, Anxietybookstore.com - Alprazolam. Well, I reverted that edit, because the reference was added without any data, hence, the page was not used as a reference. It could be in a external-link section, but then it would have to point directly to a page giving more data. Therefore, I don't think the link is appropriate. Sorry. --Dirk Beetstra ^{T C} 18:16, 29 August 2006 (UTC)

Ok "Dirk" thanks for the taking the time to check it out though,just thought that maybe it would be useful to wikipedia users that want to learn more on alprazolam, hopefully in the future there will be more info added to the page in order to be listed as a "reference" or even as an "external-link" in wikipedia. Thanks again and wikipedia ROCKS!!!!!!!!!

Invention Credit/History of Chemical Class/Purported "Antidepressant" Effects

The article credits Pfizer with the invention of alprazolam; in fact, the first two triazolobenzodiazepines introduced in the US, alprazolam and triazolam (Halcion) were invented by Upjohn, as was the prototype drug of this class, adinazolam. The rights to alprazolam and triazolam were subsequently sold to Pfizer. Adinazolam -- which, contrary to what is thought to be typical for the triazolos, is a low-potency drug, with a typical dose of ~ 60 mg -- was never sold in the US.

There is something wrong with stating that alprazolam may have an antidepressant effect, but that there is no evidence of this. What does that even mean? Nothing. In fact, it was initially thought (one should say, "hoped," especially by Upjohn) that the triazolo-BZs were going to turn out to represent a whole new class of drug, with properties distinct from the "classical" BZs. In fact, today it is known that there is nothing special about triazolo-BZs, and in fact a variety of fused heterocyclic ring structures can replace the typical 2-carbonyl (or occassionally, thionyl) moiety in meeting the structure-activity requirements for a benzodiazepine. The notion that alprazolam exerts "antidepressant" effects that are distinct from its anxiolytic effects was a marketing hypothesis, not a scientific hypothesis, and it no longer holds water as either one. Any such idea should be deleted from Wikipedia.

--EatonTFores 15:35, 8 October 2006 (UTC)

Small issue under Contraindications

I have a small issue with a statement made under the subheading "Patients at a high risk for abuse and dependence," "Patients with chronic pain or other physical disorders." Is there a source for this statement?

I'm a chronic pain patient, and from my own research, people with chronic pain are at a higher risk for physical tolerance simply because we tend to take medications for longer lengths of time than the average person. Since we are on these medications for a long period of time, we are more susceptible to becoming tolerant of the medication, not having a dependancy on the medication. I would like to see the source for this statement simply so that I can take a look at it myself to see the author's supporting facts for the statement. There is a big difference between misuse, abuse and dependence, and physical tolerance, especially because of the negatice connotations attached to "misuse, abuse and dependence." It seems to say to some that people with chronic pain are almost assuradly addicts who misuse, abuse, and are dependent on these kinds of medications, which is far from the truth. Our bodies may be tolerant of the medication, which is why occassionally we need increases in dosage levels or even to change medications so that they are effective for our pain, but that's really different from dependence.

If you have a moment, I think it would help a lot to add a source for this section especially, simply so that readers can do further research if they see fit and see the information that proves the statements, and then evaluate it for themselves.

Thank you!! --ErinENj 04:57, 8 January 2007 (UTC)

Side Effects

I have heard from physicians that long term use of BDZs can cause Heartburn but I have no reference for you. I and a co-worker both developed these symptoms after years of use and was told this was common.

Drug Interactions

I didn't notice any information about the interactions with anti-fungal drugs. There is a good reference on xanax.com. PS. Thank you for all of this information it was quite helpful.

History

When I was first perscribed Xanax in 1986 the PDR said that Xanax was going to be less habit forming than Valuim (The current information of xanax.com does not sugest this any more). It also was going to be less likely to cause an overdose. I guess the "Marketing Hype" is of interest as well as the history of pharmacology.

Also does anyone else think this article needs more Lil Wayne?

--

There's a little bit of a grey area there. Alprazolam has one of the shortest half lives, whereas diazepam has one of the longest half lives. Often, when one is addicted to one benzo, if its a short acting one, a doctor might change them to diazepam which has a longer half life, so the symptoms of withdrawal they suffer are relieved, and they can taper off the diazepam. Having used both, I can say that Alprazolam is more addictive due to its more exagerated effects on the body. The problem is, diazepam having a long half life, it takes a long time for it to leave your system, like, several days sometimes. Even if you arent taking one daily, the diazepam is building up, so when you stop taking the drug, you might experience withdrawal symptoms. Timeshift 19:20, 4 March 2007 (UTC)

Off-Label Use

While suffering from a sinus infection, my left eye lid muscles began to twitch for days on end. I saw my doctor and he prescribed Xanax "as a muscle stabilizer." The off-label use as a potential systemic muscle/nerve stabilizer could be mentioned. My pharmacist also was aware of this off-lable use and talked to me about how it would essentially reduce the nervous activity throughout the CNS, and hopefully reduce the twitch with it.

Teratogenicity and non-teratogenic effects

I added in a section on effects during pregnancy, gleaned from the Rx List warnings. Dan Schwartz Discpad 15:07, 20 May 2007 (UTC)

Verification of DEA Schedule?

Could someone please verify that Xanax is DEA Schedule IV? My Doctor believes it is Schedule II, which means among other things, in the United States, an Rx cannot be phoned in... Discpad 15:11, 20 May 2007 (UTC)

Effects

Why are effects like agitation, hostility, hallucinations, sleeplessness, and convulsions listed under side effects? Xanax was made to prevent exactly these types of things. Unless these are supposed to be withdrawal symptoms, in which case that should be clarified. Also, in first hand experience I've never noticed any nausea, sweating, depression or changes in urination. Maybe it's just me.

Hello,

They are known as paradoxical reactions. Some side effects are rare and some are common. --Carpetman2007 16:34, 12 August 2007 (UTC)

Memory Loss

I added the information about Memory Loss, with a reference to an Erowid Experience, this was the best that I could find. There has to be more information about this 'side effect' of Xanax, because it is real. If anyone can find better references, it'd be great. JavaDog 14:37, 15 September 2007 (UTC)