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)

You need to get a new doctor. It says "C(IV)" on the commercial bottle that it comes in (generic or brand). You can also have 5 refills on a xanax prescription, which is more evidence that it isn't a CII, since CII's only get 1 fill total. If it's that important to you, you can always show the doctor ANY nurses drug handbook which will clearly state that it's a C(IV)... but to be honest I would just get a competent doctor.

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

Image:XanaxHologramAd.png is being used on this article. I notice the image page specifies that the image is being used under fair use but there is no explanation or rationale as to why its use in this Wikipedia article constitutes fair use. In addition to the boilerplate fair use template, you must also write out on the image description page a specific explanation or rationale for why using this image in each article is consistent with fair use.

Please go to the image description page and edit it to include a fair use rationale. Using one of the templates at Wikipedia:Fair use rationale guideline is an easy way to insure that your image is in compliance with Wikipedia policy, but remember that you must complete the template. Do not simply insert a blank template on an image page.

If there is other fair use media, consider checking that you have specified the fair use rationale on the other images used on this page. Note that any fair use images uploaded after 4 May, 2006, and lacking such an explanation will be deleted one week after they have been uploaded, as described on criteria for speedy deletion. If you have any questions please ask them at the Media copyright questions page. Thank you.

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)

A lot of people use xanax to get really high. Although I know wikiwatch should let you know what's going on, the attacks are most likely the result of someone getting high on xanax, maybe splash in some alcohol there, and some antipsychotic medications and a clearer image of the potential attacker might become clear. I know drug companies want to control information, but the number of people they have doing that versus the number of people who abuse xanax is a winning statistic in favor of drugged out behind the keyboard. —Preceding unsigned comment added by 76.89.223.250 ([[User talk:76.89.223.250|talk]]) 08:01, 11 June 2009 (UTC)

... seriously? You must be from Roche or one of the other sleazy pharmaceutical companies if you're actually insinuating that people are getting high on xanax and then editing wiki articles about xanax. I've been prescribed xanax at doses people take to get "high", and I can tell you right now that editing a wiki article isn't my first (or second or third) priority. When you get so high on xanax that you could lose control of your actions, you're destined to do one of two things. Either you're going to do something incredibly stupid and wake up in jail, or you're going to pass out wherever you are, but you certainly aren't going to be making drug-induced wiki edits. Give me a break.

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

This is an automated message regarding an image used on this page. The image File:Alprazolam2mgresize.jpg, found on Alprazolam, has been nominated for deletion because it does not meet Wikipedia image policy. Please see the image description page for more details. If this message was sent in error (that is, the image is not up for deletion, or was left on the wrong talk page), please contact this bot's operator. STBotI (talk) 17:20, 28 December 2008 (UTC)

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)

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)

I would like to note that I was prescribed alprazolam for a severe panic attack disorder and severe generalized anxiety disorder and most certainly escalated the dose too high. (Discussion of whether or not that was my fault is irrelevant, hah.) As it is known for, the drug has become ineffective and counterproductive as I became physically dependent on it. Although escalation may be rare, it is a very recognizable threat. Personally, in agreement with the article, I do not recommend this drug for long term use to anyone. This is what I would call a sledgehammer drug; it should be used when force that is otherwise excessive is necessary, and it is not by any means precise or gentle in its approach. This is serious drug, even for medical application, and should be approached with caution. Omnimmotus (talk) 19:58, 26 May 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)

Almost every prescription drug handbook mentions the paradoxical side effects of benzodiazepines in its own section. They are rare and only happen in certain individuals. It is not known why it happens, but everyone's body chemistry is unique and for some people these medications can cause stimulation instead of sedation. A few psychiatrists believe this is due to disinhibition, but the majority of textbooks clearly point out the paradoxical syndrome. We should separate it from the list of primary side effects, at least with bold text. 202.152.170.241 (talk) 12:43, 10 March 2009 (UTC)

Withdrawal section

This is unbalanced. In the many years alprazolam has been used, many many people have stopped ordinary therapeutic doses (I don't mean abusive doses) with no problem. I think I can find a reference for this, but it is always more difficult to find references for what, for many years, was simply taken for granted (that there is very little withdrawal except when doses are very high) than it is to find references for recent claims (that it is much more dangerous than we ever thought). I'll work on a reference supporting the overall safety of cessation, but I do think that the sheer number of references exaggerating the difficulty is deceptive.Rose bartram (talk) 00:07, 15 March 2009 (UTC)

The majority of papers on benzodiazepine withdrawal conclude between 30% - 100% of people discontinuing benzodiazepines experience significant withdrawal problems upon discontinuation, even low dose dependence. If the lower bracket of 30% is accurate then 70% discontinue without problems but 30% is still very common and significant. I am not sure what your viewpoint is but if it is that withdrawal is uncommon and insignificant you are going to find it a very tough job finding a ref to back up your belief, even a clinical study never mind a review paper. If your suggestion is that we should shrink the size of the section a bit, that might be an idea. It did cross my mind that the section was a bit large.--Literaturegeek | T@1k? 00:43, 15 March 2009 (UTC)

I just deleted a paragraph to shorten the section down a bit. Looks better now.--Literaturegeek | T@1k? 00:53, 15 March 2009 (UTC)

Imputing a "viewpoint" that withdrawal is "uncommon and insignificant" looks to me like straw-man argumentation. I said only that the section seemed unbalanced. I am actually planning to use pharmacology texts, not articles, as books are a bit more resistant to hype. No, I am not trying to start an editing war. It's just that there are a lot of people whose benzodiazepine use is unhealthy and whose rationalizations are wrapped up in exaggerated beliefs about dependency and withdrawal. It is not NPOV to portray the situation as this article does.Rose bartram (talk) 12:25, 15 March 2009 (UTC)

I am sorry if you felt that I was misrepresenting you or using a straw man argument. Perhaps I misinterpreted your position. I actually think that some balance could be brought to that section. Not everyone gets severe withdrawal and some can discontinue with no withdrawal.--Literaturegeek | T@1k? 23:31, 15 March 2009 (UTC)

Re Litgeek's latest changes, I know when to give up on a hopeless situation. Stahl is well-respected, and you disregard him at your peril. Just because sloppy use of terms, such as using "withdrawal" as a synonym for "discontinuation," is widespread does not mean it is right. Also, there is a link to the "benzodiazepine withdrawal" article at the head of the section, so the added links seem more like advertising than Wikification.Rose bartram (talk) 11:29, 25 March 2009 (UTC)

You seem to be getting agitated. Please remember, WP:CIVIL. I explained in the edit summary that withdrawal is the correct scientific terminology used for drugs of physical dependence. Discontinuation syndrome is used for drugs which have not proved to cause physical dependence eg antidepressants. Why do I need to ignor Stahl at my peril? From the footnotes of this paper Dr. Stahl has been a consultant for, received honoraria from, or conducted clinical research supported by Abbott, Asahi Kasei, AstraZeneca, Bristol-Myers Squibb, Cephalon, Cypress Bioscience, Eli Lilly, GlaxoSmithKline, Organon, Otsuka, Pfizer, Pierre Fabre , and Wyeth. Also several other pharmaceutical companies according to another paper. So basically the World Health Organisation, British National Formulary and Committee on Safety of Medicines are sloppy but Stahl is well respected and should change the designation of scientific terminology. I disagree. The manufacturer of xanax, pfizer also call it withdrawal symptoms and withdrawal syndrome in their product information guide for prescribing doctors. Are they sloppy as well?--Literaturegeek | T@1k? 12:51, 25 March 2009 (UTC)

Schatzberg an author of the other book is a cofounder of a pharmaceutical firm and has been involved in controversy over alledged failure to disclose financial conflicts of interest. According to this paper, In the past 3 years, Dr Schatzberg has served as a consultant for Abbott Laboratories, Inc, Aventis, BrainCells, Bristol-Myers Squibb Co, Corcept Therapeutics, Eli Lilly & Co, Forest Pharmaceuticals, Inc, GlaxoSmithKline, Innapharma, Inc, Janssen Pharmaceutica Products, LP, Neuronetics, Inc, Organon Pharmaceuticals, Inc, Pfizer, Inc, Somaxon Pharmaceuticals, Somerset Pharmaceuticals, Inc, and Wyeth Pharmaceuticals. He has received grants from Bristol-Myers Squibb Co, Eli Lilly & Co, GlaxoSmithKline, Somerset Pharmaceuticals, Inc, and Wyeth Pharmaceuticals. He is also a founder of Corcept Therapeutics. More conflicts documented in this paper.[4] I haven't looked at the other authors but I am sure I would find another similar story. The only reason I am looking into this information is because you have wrongly accused me of using sloppy editing when I was sticking to respected scientific definitions.--Literaturegeek | T@1k? 13:06, 25 March 2009 (UTC)