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)

Love this sentence: "Overdose deaths caused by alprazolam alone are seldom fatal." —Preceding unsigned comment added by 71.75.53.236 (talk) 03:08, 20 November 2007 (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: but also PMID 10907671. Colin°^Talk 22:49, 18 April 2006 (UTC)

DM: yea, if you check the benzodiazepam article i think it says citrus, specifically grapejuice, reduces the body's ability to metabolize it and extends the effects. —Preceding unsigned comment added by 69.248.83.175 (talk) 21:41, 6 February 2008 (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)

I think that alprazolam does have some antidepressant properties but that they are largely mild effects. I have updated the article with some citations on the antidepressant properties of alprazolam.--Literaturegeek | T@1k? 19:53, 9 December 2008 (UTC)

I read an abstract about a double-blind placebo-controlled study on PubMed conducted by Japanese researchers in 2007 with regards to alprazolam being used as monotherapy for MDD (Major Depressive Disorder) with success. I did not bookmark that site. Can anyone else find it? If so, that information should be posted. It is well-known that alprazolam, in higher doses, causes 5-HT (serotonin) release with some action on norepinephrine and beta-adrenergic receptors. Benzodiazepines other than alprazolam do not have this effect. 202.152.170.241 (talk) 09:48, 10 March 2009 (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.

--

Fatigue/joint pain/flu-like symptoms are listed as a side effect, but I have not seen it listed in any of the section's footnote sources. What is the source of this information? —Preceding unsigned comment added by 149.175.43.40 (talk) 23:20, 17 January 2008 (UTC)

I think that the side-effects should be presented in a more reasonable order. The side-effects listing would be more effective and understandable if the side-effects were listed more in order of likelihood. Pharmaceutical commercials advertise uncommen side-effects for personal (i.e. corporate) liability, wheras we are simply tring to provide first hand information. —Preceding unsigned comment added by Maozim (talk • contribs) 17:43, 24 April 2008 (UTC)

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.

There is a potential for pharmacokinetic interaction with several agents, most notably ketaconazole and erythromycin, potent 3A4 inhibitors. Alprazolam is a 3A4 substrate. This should be in the pharmacokinetic section. Luke dm5 (talk) 00:23, 21 April 2008 (UTC) luke_dm5

Also... I noticed that SSRI's (including Prosac) may amplify the effects of Alrazolam, this should be mentioned because these two drugs are often administered togather —Preceding unsigned comment added by 68.35.234.96 (talk) 23:33, 25 June 2008 (UTC)

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)

other trade names

in Brazil alprazolam is sold under the name of "Frontal" (as the main brand name), but there are generic forms of it, just named "alprazolam" —Preceding unsigned comment added by 201.24.137.52 (talk) 09:55, 9 October 2007 (UTC)

I have my own experience... me and a friend kept taking alcohool, lorazepam and xanax one night, i dont know how many we had, i had a small bottle with 5mg lorazepam pills and a box with 0.5mg xanax. We had 2 bottles of wine during the night.

Not only i cant rememeber anything from a certain point in the night, but i cant remember anything at all the next day (although i was in a semi-conscious state and was functionating, cause i know i went shoping for clothes, but cant remember buying them). And in the 2nd day after that night i had a period of about 1 hour experiencing double vision... My friend went to the hospital at the 2nd day. He spent 4 hours sleeping while waiting to be attended, after some tests they sent him home, though they wanted him to stay overnight to be observed he refused. —Preceding unsigned comment added by 89.152.211.72 (talk) 04:11, 6 November 2007 (UTC)

I know that Busebar is not a trade name for alprazolam. It is just anothe anti anxiety pill that greatly resembles a 2mg alprazolam pill. Insted of being a long white pill that can be split into fours like xanax is can only be split into thirds. —Preceding unsigned comment added by 72.154.39.178 (talk) 03:57, 5 June 2008 (UTC)

Fair use rationale for Image:XanaxHologramAd.png

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BetacommandBot (talk) 05:46, 30 November 2007 (UTC)

History of alprazolam

LevelTubes tried to delete a section of History because it was based on the book by David Healy "The Psychopharmacologists III", because "the claim that "patients" running to buy pfizer stock is unsubstantiated except in the anti-psychiatrist's "cited" book".

First of all, "Psychopharmacologists III" is a book of interviews, which was only edited by Healy, and I took the information on the history of alprazolam directly from the Sheehan's words so no possible bias by Healy could be introduced. The story is clearly attributed in Sheehan in the body of the Alprazolam article: "Sheehan describes that the first group of patients..." etc.

Secondly, David Healy is not "antipsychiatrist" he is a conventional psychiatrist (see David Healy (psychiatrist)), one-time secretary of the British Association for Psychopharmacology and currently professor of Psychological Medicine in Cardiff [3]. Regardless of his views on the SSRIs and suicide, he is certainly the leading expert on the history of psychopharmacology—he authored nine books in this area with two of them published by the prestigious Harvard University Press. Paul gene 18:14, 2 December 2007 (UTC)

I agree the deletion was unfair. Prof David Healy is not antipsychiatry at all. He is a very well respected doctor in the UK. Just because he raised the profile of SSRI's having dependence and withdrawal problems (and his views are now confirmed and contained in the patient information leaflets about withdrawal reactions when stopping SSRIs) does not make him antipsychiatry and for someone to suggest such a thing about Prof Healey is ridiculous. All that can be said about Prof Healey is that he is a stern supporter of more open research and less conflict of interest in medicine. He is pro-improving scientific openess in research in drugs and that is all. --Literaturegeek 21:26, 2 December 2007 (UTC)

Use of Cquote and RQquote templates in articles is discouraged

Template:Rquote is a is a variant of the {{Cquote}} quotation template. According to Template:Cquote, "this template should not be used for block quotes in article text." This point of view is supported by WP:MOS—"Block quotes are not enclosed in quotation marks (especially including decorative ones such as those provided by the {{cquote}} template, used only for "call-outs", which are generally not appropriate in Wikipedia articles). Use a pair of <blockquote>...</blockquote> HTML tags." Paul gene (talk) 11:24, 14 December 2007 (UTC)

-- Random Deletion ==

Deleted "xanax bars fuck you up mah nigga.. fuck wit em. they good" from the links section. —Preceding unsigned comment added by 24.147.170.95 (talk) 08:21, 26 December 2007 (UTC)

Drug companies

I have suspicions that drug companies are targeting this article. I recommend editors keep this page on their watch list. There have been over a dozen "attacks" on the article in the past month or so with cited data or even entire sections deleted. 6 attacks by one ip address. They tend to get obsessed with removing anything which associates their product with illicit drug use or drug abuse. This has happened on other benzo pages recently, particularly Roche benzos. They try over and over again to remove any reference to say cross tolerance with barbiturates (which have a bad name). Only way to stop them is to just keep reverting their edits until they realise that they are wasting their time, which they are. I have contributed very little to this particular benzodiazepine article and the edits under attack are not edits that I made. Just letting the wiki community know. I can usually tell the difference between a genuine editor who has a POV or genuine opinion or suggestion and someone who has an agenda to protect their product, even via falsification or complete removal of sections and encylopedic cited data.--Literaturegeek (talk) 11:47, 9 May 2008 (UTC)

Half-Life discrepency between IR & XR in sources/improper reference

When examining the references for the half life in both the Xanax XR and IR, they cite the same figures "Using a specific assay methodology, the mean plasma elimination half-life of Alprazolam has been found to be about 11.2 hours (range: 6.3-26.9 hours) in healthy adults." The site is misleading by saying 'specific' methodology, however, since the numbers are the same its obvious its a study of the drug independently (IR package).

So we either need to correct the numbers or the references if there was another source used. —Preceding unsigned comment added by Jmoore2333 (talk • contribs) 19:33, 29 July 2008 (UTC)

GA nomination

I have removed this article from Wikipedia:Good article nominations, as it is not yet ready for a review. There are five "citation needed" tags and a cleanup banner. Before renominating the article, I recommend dealing with the tags and banners, ensuring that the article is fully sourced, expanding the lead section, and formatting the references, preferably with Template:Cite web (many are missing information — the should have at least a title, url, publisher, and accessdate). Best wishes, GaryColemanFan (talk) 21:55, 27 October 2008 (UTC)

I have just done quite a bit of work to the article. The tags have been dealt with and the banners are no longer needed and have been removed. I have sourced the unsourced sections of the article and I have expanded the lead section. All references are placed in the citation template format now.--Literaturegeek | T@1k? 21:53, 9 December 2008 (UTC)

Availability

I think we should remove the availibility section. Half of these named I never even heard of, and Google doesn't have alot of info. I believe this horrible section is what is keeping Alprazolam from being a good article. If you need to contact me on my talk page, please feel free.Cssiitcic (talk) 21:38, 31 October 2008 (UTC)

I changed it to english only brand names greatly shortening the section and added a web citation.--Literaturegeek | T@1k? 22:56, 31 October 2008 (UTC)

An image on this page may be deleted

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Dose Escalation

Dose escalation most certainly is characteristic of this drug 74.131.16.117 (talk) 10:01, 7 January 2009 (UTC)

I agree, I will delete the sentence.--Literaturegeek | T@1k? 20:56, 28 January 2009 (UTC)

GA Review

This review is transcluded from Talk:Alprazolam/GA1. The edit link for this section can be used to add comments to the review.

Will not start a formal review but just have some concerns about the number of lists in this article. Might be better to change some of it to prose.--Doc James (talk · contribs · email) 20:12, 29 January 2009 (UTC)

I think that sometimes lists are easier to understand than prose writing. It's more streamlined.--Cssiitcic (talk) 20:49, 2 February 2009 (UTC)

After looking at the article, I have noticed that it is constantly edited by individuals who do not have an account. Some things in the article are totally false and many 'references' are either from an unreliable source or they're completely misinterpreted. It is my opinion that at least 3 out of every 4 of those anonymous editors are drug abusers. Alprazolam is by far the most prescribed benzodiazepine in the U.S, and one of the most commonly prescribed drugs, as a result, it has become a somewhat popular drug of abuse in the United States. Outside the US, however, it's abuse is limited, if not non-existent. Benzodiazepines with a higher abuse potential and much more toxic profiles, especially temazepam and nimetazepam are the two worlds most abused benzodiazepines, followed by nitrazepam, flunitrazepam, diazepam, triazolam, and midazolam. In the alprazolam article, it states that it is the most addictive benzodiazepine and it produces euphoria (which is false, FDA studies showed that 0.000% of human subjects reported euphoria as a side effect during trials), and they list it as the most toxic, etc. The article needs clean up. VeronicaPR (talk) 6:25, 7 February 2009 (UTC)

Should we semi-protect the page from the unregistered editors? We can attempt cleanup, but I think the page needs to be semi protected first, so the unregistered editors don't mess the page up over and over.Cssiitcic (talk) 20:43, 7 February 2009 (UTC)

If the article is not stable (not due to vandalism), then it cannot become GA, see criterion 5 at Wikipedia:Good_article_criteria. Xasodfuih (talk) 14:55, 13 February 2009 (UTC)

I would regard this article as "stable", which according to the quoted guideline means that "it does not change significantly from day-to-day because of an ongoing edit war or content dispute." (see Wikipedia:Good_article_criteria) The Sceptical Chymist (talk) 16:04, 14 February 2009 (UTC)

Alprazolam is widely abused in other countries. An example is Australia, where it is I believe either the 1st or 2nd most abused benzodiazepine. In the UK its abuse is almost nonexistent because it is not available on the National Health System. It is available via private prescription but its use in the UK would be less than 1%, perhaps less than 0.1% of benzos. 2 mg of alprazolam is equivalent to 40 mg of diazepam, making it a very potent benzodiazepine. Alprazolam is one of the most dangerous benzos in overdose and is one of the worst for causing withdrawal seizures. I do not know about euphoria incidence but this would likely increase if the drug was abused in higher than therapeutic doses.--Literaturegeek | T@1k? 22:01, 7 February 2009 (UTC)

I deleted this paragraph which seemed to be original research.

"Long term daily use of high or even low doses may totally eliminate the euphoric properties of the drug due to drug tolerance, leaving the user the desire to take it to only delay withdrawal symptoms or because of a "placebo" euphoric effect that is actually not due to the drug itself but due to psychological conditioning."--Literaturegeek | T@1k? 14:36, 8 February 2009 (UTC)

Alprazolam can certainly be dangerous in overdose, but then again every benzodiazepine is dangerous in overdose. Poison Control Centers in the United States note that despite being by far the #1 most commonly prescribed benzodiazepine, it has a lower rate of emergency related visits, overdose incidents, and deaths than benzodiazepines that are much less frequently prescribed (ie. temazepam, for example had the highest rate of emergency related visits and overdose deaths from 2003-2005, despite being only the 5th most prescribed benzodiazepine). Similarly, triazolam had a higher overdose rate, and triazolam is rarely prescribed in the U.S. This is also true of lorazepam, and I believe clonazepam also has a higher overdose rate, but I am not certain on the clonazepam. Alprazolam may have a higher over tally, but the rate at which overdose occurs is peanuts compared to triazolam and temazepam. So, clearly, it's completely false for the article to state that alprazolam is the "most toxic". However, it's true that alprazolam causes a very bad physical dependence, not unlike other short to medium acting benzodiazepines. Psychological dependence on the other hand is a different issue. It's desirability as a drug of abuse was ranked slightly lower than lorazepam according to Darke, Hall, and Ross, and it was significantly surpassed by diazepam, temazepam, nitrazepam, nimetazepam, and several others in overall 'liking'. VeronicaPR (talk) 05:40, 9 February 2009 (UTC)

Hi Veronica, I do agree that really there is not a big degree of differences between the various benzos. I think if one was to take an equivalent dose of diazepam in overdose that there would really be little difference between the two benzos in overdose symptomatology and severity. This study from New Zealand suggests alprazolam is more dangerous in overdose than other benzodiazepines. This study suggests that alprazolam is more difficult to confirm in tests than other benzodiazepines. Could this explain the discrepancy, I dunno? I can't explain the poison control statistics. Do you have a link as I would be interested in reading their statistics? This study shows that alprazolam is the most common drug overdose seen in emergency room visits in the USA. Are you sure that temazepam has such a high overdose rate in the USA? I could imagine it in a country where it is more commonly prescribed eg the UK or perhaps australia. Also the volume of temazepam dispensed in the USA must be very low with ambien, lunesta etc taking the majority of the hypnotic market over there. It shows that it is seen twice as often as the next most common overdosed prescription benzo which is clonazepam in the USA. I am not aware of any head to head comparison with nitrazepam, nimetazepam, temazepam comparing abuse potential. I just checked pubmed and could not locate any such studies. There has been a lot of misinfo put into wikipedia regarding temazepam and other benzodiazepines which has caused a lot of headache for me and other editors in trying to either defend articles from being gutted or having to read through tonnes of references to validate or invalidate the data. I wonder if your views on the benzos have been shaped by the misinfo put into wikipedia articles (not by me) by some editors? Maybe you assumed their summary of citations was accurate? Lorazepam is a very potent benzodiazepine which is why it is preferred for status epilepticus but also has very severe problems of physical dependence, withdrawal and abuse potential. With that said I do think that temazepam, nitrazepam, lorazpam and alprazolam are worse than say oxazepam, chlordiazepoxide, diazepam etc partly due to potency and pharmacokinetics as well as toxicity and abuse potential.--Literaturegeek | T@1k? 18:11, 9 February 2009 (UTC)

In response to this discussion, I added the following to the "Misuse section": "Alprazolam, together with lorazepam and diazepam, have the highest abuse liability among the benzodiazepine medications.[42]" The Sceptical Chymist (talk) 15:56, 14 February 2009 (UTC)

I think the statement that alprazolam has the highest abuse liability is misleading because it is stating it as fact, as if that applies to every country in the world. Perhaps it is most abused in the United States, but this wikipedia article is for the entire world to read and must reflect the reality in the world, not just the United States. It would be ok to say, "Alprazolam, together with lorazepam and diazepam, have the highest abuse liability among the benzodiazepine medications in the United States" and source that, but leaving out the countries' name makes the reader think it applies to the entire world, which is untrue. There are many countries where alprazolam is not even available. 202.152.170.241 (talk) 12:53, 10 March 2009 (UTC)

Listitis. This article has bit too many lists, some of which use, ugh, bold text! At least for the brand names you could put them in a box like the article on paracetamol does. Xasodfuih (talk) 12:44, 13 February 2009 (UTC)

I have fixed this issue.--Literaturegeek | T@1k? 00:44, 14 February 2009 (UTC)

History. I find the writing style there quite convoluted and confusing. If you have access to the source (The Psychopharmacologists) I strongly suggest you rewrite that section. Xasodfuih (talk) 14:23, 13 February 2009 (UTC)

Please specify what you want clarified.The Sceptical Chymist (talk) 00:32, 14 February 2009 (UTC)

This the worst part: "Sheehan describes that the first group of patients treated by alprazolam was so impressed by its action that they knew outright—this drug was going to be a hit. A few of those patients actually pooled their money and purchased stock in Upjohn. Several months later, when alprazolam was approved by the FDA, they sold out and made a profit." I trust I don't need to explain why it's confusing. The rest of that section isn't much better. Xasodfuih (talk) 03:02, 14 February 2009 (UTC)

Yes, you do have to describe what confuses you in this excerpt, if you want to make the article better. Do you have any concrete suggestions on how to improve this and other parts of the History section? How would you re-write the paragraph in question? The Sceptical Chymist (talk) 15:16, 14 February 2009 (UTC)

That very part I deleted, but someone reverted me. A few patients from a clinical trial or whatever investing their money isn't notable which was why I deleted it before. I can't make recommendations though on this review as I have contributed quite a bit to the article, just saying that I did try deleting it. I also thought it was a bit promotional and unencylopedic content. I am not opposed to deleting that sentence again.--Literaturegeek | T@1k? 17:26, 14 February 2009 (UTC)

To me the History part does not look more convoluted than Penicillin#History. It makes the article more interesting, though. Are there other examples of patients liking the drug so much that they invest in it? Not that I know of. The fact is certainly notable. As for being promotional, the fact that the first patients in the trials really really liked alprazolam is a double-edged sword. It clearly suggested the future abuse potential.The Sceptical Chymist (talk) 23:49, 14 February 2009 (UTC)

Yea but the penicillin article is a B class article, not a good article. Fair points. I guess though it is the reviewers though ultimately about what is a pass and a fail.--Literaturegeek | T@1k? 02:27, 15 February 2009 (UTC)

Before reviewing the article, the reviewer should read WP:Reviewing good articles guideline, which recommends: "When reviewing an article, keep in mind that nominators want guidance on improving an article which is not yet up to standard, and appreciate especially specific comments on how to bring the article up to standard. Reviewing is a serious responsibility, and the most dedicated reviewers spend considerable time on each article." The Sceptical Chymist (talk) 12:46, 15 February 2009 (UTC)

Side effects. Given the very long list of side effects given, these should individually sourced; it's not reasonable to give 5 sources, and expect reviewers/readers to cross-check all of them. Xasodfuih (talk) 14:28, 13 February 2009 (UTC)

That is incorrect. WP guidelines, e.g. WP:MEDMOS, WP:RS recommend using reviews. So it is very reasonable to give 5 sources for any number of side effects. The Sceptical Chymist (talk) 15:32, 14 February 2009 (UTC)

You didn't understand my objection. The difficulty is cross-checking. Reference them (the side effects) individually from whichever review they appear in. See for instance how this is done for the list of medications that can produce serotonin syndrome#Drugs which may contribute. Xasodfuih (talk) 16:41, 15 February 2009 (UTC)

I got a bit sidetracked this weekend (by the serotonin syndrome review and Libby Zion expansion), and didn't manage to review this more in depth. I'll try to do it over the week, but no promise I'll be done before the next week end. Xasodfuih (talk) 00:44, 16 February 2009 (UTC)

• Lists- Can someone please tell me what's so wrong with lists? I don't get it? Don't you agree that some lists are nice?Cssiitcic (talk) 19:45, 17 February 2009 (UTC)
• Someone else take over this. I'm removing myself as official reviewer for this due to lack of time. Xasodfuih (talk) 06:07, 25 February 2009 (UTC)

Dose escalation is rare in those prescribed alprazolam for legitimate medical conditions. You can find abstracts on Pubmed which demonstrate that panic disorder patients on alprazolam for 10 years never escalated the dose. In fact, the article goes on to say that they tended to reduce the dose over the ten year period. Alprazolam also maintained its anxiolytic efficacy over the same time period. The vast majority of those who abuse alprazolam are persons with preexisting substance abuse disorders, including alcoholism (which includes those who indulge in "recreational use", which is simply a flowery name for abuse). Alprazolam does not make the average person euphoric. If someone experiences euphoria from taking alprazolam, then they are abusing the medication or taking it in conjunction with other illicit substances. I think the entire article is written by benzophobes who just want to bash alprazolam.

I've been on benzodiazepines including alprazolam for 20 years and have never increased the dose or experienced any "euphoria" or any habituation. 202.152.170.241 (talk) 10:46, 10 March 2009 (UTC)

Unsourced statements

I am moving the tagged unsourced statements here, This way they will not hold up the GA nomination and can be addressed later. The Sceptical Chymist (talk) 16:14, 14 February 2009 (UTC)

• However, long-term maintenance therapy on alprazolam is not unheard-of in the medical community, and, if a genuine therapeutic need exists, benefits must be weighed against risks.[citation needed]

• However, many physicians and practictioners prescribe a benzodiazepine (i.e. alprazolam, diazepam, etc.) in conjunction with an antidepressant not to augment such a medication, as may be done with methylphenidate, but to lessen the severity of common side effects associated with an antidepressant regiment (i.e. anxiety, insomnia, restlessness, etc.).[citation needed][dubious – discuss]

• Some off-label uses for Alprazolam are: Insomnia and Sedative for Minor Medical/Dental Procedures.[citation needed]

• Paradoxical side effects

Paradoxical side effects occasionally occur. Severe paradoxical effects such as seizures only rarely occur.[citation needed]

   * hyperactivity
   * nervousness
   * restlessness
   * sleeplessness
   * muscle twitching
   * tremor
   * seizure (convulsions)

• Patients from the aforementioned groups should be monitored very closely during therapy for signs of abuse and development of dependence because it may cause addiction. Discontinue therapy if any of these signs are noted, if a physical dependence has developed therapy will need to be discontinued gradually. Long-term therapy in these patients is not recommended, unless the net benefit to the patient outweighs the net risk.[citation needed]

The Sceptical Chymist (talk) 16:14, 14 February 2009 (UTC)

Paradoxical side effects are referenced in the references above the side effects list. Perhaps the paradoxical side effects should not be in a subsection, but the paradoxical heading should be just in bold text, like this.

Paradoxical side effects

   * hyperactivity
   * nervousness
   * restlessness
   * sleeplessness
   * muscle twitching
   * tremor
   * seizure (convulsions)

Bolding instead of making it a subsection should stop making it look like uncited data.--Literaturegeek | T@1k? 17:35, 14 February 2009 (UTC)

I wonder if there is a specific reference that addresses the paradoxical side effects of alprazolam. Or may be one of the 5 references for the "Side effects" chapter has more information on the paradoxical side effects. It would be nice to have such reference(s) included and even repeated for the "Paradoxical side effects" part. The Sceptical Chymist (talk) 00:53, 15 February 2009 (UTC)

There is the option of individually sources each side effect. What I did was added back the paradoxical side effects for now, without the header. If we can individually source them then we could add back the paradoxical subsection header. I don't think the citations seperate paradoxical side effects from other side effects.--Literaturegeek | T@1k? 01:45, 15 February 2009 (UTC)

Agree with that. Good decision. The Sceptical Chymist (talk) 12:34, 15 February 2009 (UTC)

GA Review 2

This review is transcluded from Talk:Alprazolam/GA2. The edit link for this section can be used to add comments to the review.

I've finished him initial GA review of this article. Before we begin I'd like to say that I have absolutely no knowledge on the subject but if this article is indeed good enough then I shouldn't feel totally lost ;) I'm just going to run down the various comments I have as I go along reviewing the article so sometimes it may be a bit jumbled, bear with him and please feel free to ask for any clarifications you may need. I've also tried to look at the Style guide & Manual of style of the projects listed on the talk page to make sure I don't misjudge something that may be normal with these types of articles.

First off I'll take the list of comments from Doc James and repeat those I think are warranted still.

• Number of lists - can't totally disagree with that, 8 lists in the article is a problem. I can agree that some lists are fine, some subjects are best organized in lists, but something could be better in prose form. I'd suggest the lists in the sections Therapeutic uses, Patients at a high risk for abuse and addiction and the last list in the Physical dependence and withdrawal section be turned into prose - more would be good but this would bring it down a bit into the more acceptable range.

Fixed.--Literaturegeek | T@1k? 18:50, 10 March 2009 (UTC)

• Stability - it's a concern that it's a frequent vandal target, even more so if it's to become an article that's supposed to represent Wikipedia. But vandalism is NOT covered by the "Stability" section so I'm not too worried about that part. Although I might suggest you seeking out semi-protection to keep the IP vandalism down. Just a comment.

I and other editors have in the past requested temporary blocks when the article is getting vandalised. This can easily be resolved at times of high vandalism by requesting page protection. There have been no major content disputes of the article. Vandalism I don't think is part of the criteria for good article? I think it is content dispute.--Literaturegeek | T@1k? 18:50, 10 March 2009 (UTC)

• Convoluted - well a bit here and there, it's a hard subject and will at times be a bit convoluted - I'll list any specific problems I might find.

I think there was more stuff but I'd rather just get to my own review.

• Under "Legal status" in the drug box you've got to fix the link, it should go to "#Schedule IV controlled substances" to work the way it was intended.

Fixed.--Literaturegeek | T@1k? 18:50, 10 March 2009 (UTC)

• History section: From the Pharmacology Style guide I found the following "If available, there should be a timeline of first synthesis, approval dates (U.S., Europe, UK, etc), when marketing stopped or ownership transferred, etc." - this article is totally US centric in the history part, a few international details would make this section more rounded.

Can't locate information at the the moment.--Literaturegeek | T@1k? 18:50, 10 March 2009 (UTC)

• The Style guide mentions a section I cannot see: "Indications"? Also it says that in "Availability" there should be a section that describes "what forms the drug is available in"?

I changed therapeutic uses to indications.--Literaturegeek | T@1k? 18:50, 10 March 2009 (UTC) I have also fixed the lack on info on forms alprazolam is available in.--Literaturegeek | T@1k? 19:39, 10 March 2009 (UTC)

• WP:Jargon - I know it's not an easily accessible subject but I can't see if there have even been attempts at making the text more easily accessible to people that don't already know the subject. Pharmacology & Pharmacokinetics jumps out at me where some of the terms could be explained in layman's terms instead of the more textbook-y version there is now.

I added a sentence about GABA being the calming chemical and system in the body so that the lay reader can now understand the general gist of that section. Pharmacokinetics I don't think can be made much more understandable as it is by definition a rather technical aspect to the drug article.--Literaturegeek | T@1k? 18:50, 10 March 2009 (UTC)

• "younger patients" - term falls under the category "Signs of writing for (other) healthcare professionals:" found in the Wikipedia:Manual of Style (medicine-related articles) (Patient is used more places too and a Doctor or two).

I fixed "in younger patients", changed it to younger adults.--Literaturegeek | T@1k? 18:50, 10 March 2009 (UTC)

• Contraindications in this section there is a list of conditions but only one line has a source. If the source on the last line covers the entire list I'd recommend turning it into prose and then use the source at the end of the paragraph to cover the whole thing, that way it's clear what the source covers.

Fixed.--Literaturegeek | T@1k? 18:50, 10 March 2009 (UTC)

• Food and drug interactions: reads like a series of short, telegram style lines - almost like a list but without the bullets, these short paragraphs makes the section seem choppy.
• Citations at the end of the sentences - always.

Fixed I think.--Literaturegeek | T@1k? 18:50, 10 March 2009 (UTC)

• Food and drug interactions: Contains this sentence "Cimetidine, erythromycin, fluoxetine, fluvoxamine, itraconazole, ketoconazole, nefazodone, propoxyphene and ritonavir all interact with alprazolam leading to a delayed clearance of alprazolam which may result in excessive accumulation of alprazolam." - I read it and then I go "Yes and? Maybe explain why that could be a problem? That section has more examples where it'd be nice to have a bit more explanation because I'm left wondering "yes but what does that mean/matter?"

Fixed.--Literaturegeek | T@1k? 18:50, 10 March 2009 (UTC)

• Food and drug interactions: Big sufferer of Jargonitis.

Fixed or improved?--Literaturegeek | T@1k? 18:50, 10 March 2009 (UTC)

• Common Withdrawal Symptoms & Possible/Less Common Withdrawal Symptoms don't seem to be sourced and neither is the last list in that section?

It was sourced. I fixed it.--Literaturegeek | T@1k? 18:50, 10 March 2009 (UTC)

• As I read I'm left with the impression that either I'm stupid (and I don't generally think that) or this is written way too inaccessibly for anyone that does not know the subject matter that well. This is honestly the article's biggest problem.

I'm placing the review on hold to give people a chance to these problems. If you have questions feel free to ask. MPJ-DK (talk) 04:54, 9 March 2009 (UTC)

I have made improvements to the article that you suggested. The history section is difficult to improve. Maybe it can pass Good Article status but to get up the a featured article the history section could be one of the recommendations to get it up to featured article? I dunno. I think hiring out books from the library might be necessary to get the history of alprazolam although maybe it can be tracked down online with some hard looking I dunno. I have made changes and other editors have made changes according to your suggestions. Perhaps you can suggest what needs more work or state whether it now passes good article status?--Literaturegeek | T@1k? 18:50, 10 March 2009 (UTC)

I've gone over the improvements, I'm glad to see that you guys have taken my criticism constructively and made good use of it. Less lists, more accessible in parts and everything. I also understand that parts of this article will invariably come off a bit technical because of the subject and that's acceptable. So congratulations I've passed the article for GA. MPJ-DK (talk) 09:07, 14 March 2009 (UTC)