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buy xanax 3mg online Alprazolam, sold under the trade name Xanax, among others, is a short-acting benzodiazepine.[4] It is most commonly used in short term management of anxiety disorders, specifically panic disorder or generalized anxiety disorder (GAD).[5] Other uses include the treatment of chemotherapy-induced nausea, together with other treatments.[3] GAD improvement occurs generally within a week.[6][7] Alprazolam is available by mouth.[3]

Common side effects include sleepiness, depression, headaches, feeling tired, dry mouth, and memory problems.[3] Some of the sedation and tiredness may improve within a few days.[8] Due to concerns about misuse, some do not recommend alprazolam as an initial treatment for panic disorder.[9] Withdrawal or rebound symptoms may occur if use is suddenly decreased.[3] Other rare risks include suicide, possibly due to loss of inhibition.[10] Gradually decreasing the dose over weeks or months may be required.[6] Alprazolam, like other benzodiazepines, acts through the GABAA receptor.[3]

Alprazolam was patented in 1971 and approved for medical use in the United States in 1981.[3][11] Alprazolam is a Schedule IV controlled substance and is a common drug of abuse.[1][12] It is available as a generic medication.[13] The wholesale cost in the United States is less than US$0.03 per dose as of 2018.[14] In 2016, it was the 19th most prescribed medication in the United States, with more than 27 million prescriptions.[15]

Medical uses[edit]

Alprazolam 0.5mg pills

Alprazolam is mostly used in short term management of anxiety disorderspanic disorders, and nausea due to chemotherapy.[3] Alprazolam may also be indicated for the treatment of generalized anxiety disorder, as well as for the treatment of anxiety conditions with co-morbid depression.[16] The FDA label advises that the physician should periodically reassess the usefulness of the drug.[17]

Panic disorder[edit]

Alprazolam is effective in the relief of moderate to severe anxiety and panic attacks.[17] However, it is not a first line treatment since the development of selective serotonin reuptake inhibitors. Alprazolam is no longer recommended in Australia for the treatment of panic disorder due to concerns regarding tolerance, dependence, and abuse.[9] Most evidence shows that the benefits of alprazolam in treating panic disorder last only 4 to 10 weeks. However, people with panic disorder have been treated on an open basis for up to 8 months without apparent loss of benefit.[16][17]

In the United States, alprazolam is FDA-approved for the treatment of panic disorder with or without agoraphobia.[17] Alprazolam is recommended by the World Federation of Societies of Biological Psychiatry (WFSBP) for treatment-resistant cases of panic disorder where there is no history of tolerance or dependence.[18]

Anxiety disorders[edit]

Anxiety associated with depression is responsive to alprazolam. Clinical studies have shown that the effectiveness is limited to 4 months for anxiety disorders.[17] However, the research into antidepressant properties of alprazolam is poor and has only assessed its short-term effects against depression.[19] In one study, some long term, high-dosage users of alprazolam developed reversible depression.[20] In the US, alprazolam is FDA-approved for the management of anxiety disorders (a condition corresponding most closely to the APA Diagnostic and Statistical Manual DSM-IV-TR diagnosis of generalized anxiety disorder) or the short-term relief of symptoms of anxiety. In the UK, alprazolam is recommended for the short-term treatment (2–4 weeks) of severe acute anxiety.[16][21][22]

Nausea due to chemotherapy[edit]

Alprazolam may be used in combination with other medications for chemotherapy-induced nausea and vomiting.[3]

Contraindications[edit]

Benzodiazepines require special precaution if used in children and in alcohol- or drug-dependent individuals. Particular care should be taken in pregnant or elderly people, people with substance abuse history (particularly alcohol dependence), and people with comorbid psychiatric disorders.[23] The use of alprazolam should be avoided or carefully monitored by medical professionals in individuals with: myasthenia gravis, acute narrow-angle glaucoma, severe liver deficiencies (e.g., cirrhosis), severe sleep apnea, pre-existing respiratory depression, marked neuromuscular respiratory, acute pulmonary insufficiency, chronic psychosishypersensitivity or allergy to alprazolam or other benzodiazepines, and borderline personality disorder (where it may buy xanax 3mg onlineinduce suicidality and dyscontrol).[22][24][25]

Like all central nervous system depressants, alprazolam in larger-than-normal doses can cause significant deterioration in alertness and increase drowsiness, especially in those unaccustomed to the drug’s effects.[26]

Elderly individuals should be cautious in the use of alprazolam due to the possibility of increased susceptibility to side-effects, especially loss of coordination and drowsiness.[27]

Side effects[edit]

Side effects from alprazolam

Sedative drugs, including alprazolam, have been associated with an increased risk of death.[28]

Possible side effects include:

Paradoxical reactions[edit]

Although unusual, the following paradoxical reactions have been shown to occur:

Food and drug interactions[edit]

Alprazolam is primarily metabolized via CYP3A4.[43] Combining CYP3A4 inhibitors such as cimetidineerythromycinnorfluoxetinefluvoxamineitraconazoleketoconazolenefazodonepropoxyphene, and ritonavir delay the hepatic clearance of alprazolam, which may result in its accumulation[44] and increased severity of its side effects.[45][46]

Imipramine and desipramine have been reported to increase an average of 31% and 20% respectively by the concomitant administration of alprazolam tablets.[47] Combined oral contraceptive pills reduce the clearance of alprazolam, which may lead to increased plasma levels of alprazolam and accumulation.[48]

Alcohol is one of the most common interactions; alcohol and alprazolam taken in combination have a synergistic effect on one another, which can cause severe sedation, behavioral changes, and intoxication. The more alcohol and alprazolam taken, the worse the interaction.[31] Combination of alprazolam with the herb kava can result in the development of a semi-comatose state.[49] Plants in the genus Hypericum (including St. John’s wort) conversely can lower the plasma levels of alprazolam and reduce its therapeutic effect.[50][51][52]

Pregnancy and breastfeeding[edit]

Benzodiazepines cross the placenta, enter the fetus, and are also excreted in breast milk. Chronic administration of diazepam, another benzodiazepine, to nursing mothers has been reported to cause their infants to become lethargic and to lose weight.[27][53]

The use of alprazolam during pregnancy is associated with congenital abnormalities,[16][54] and use in the last trimester may cause fetal drug dependence and withdrawal symptoms in the post-natal period as well as neonatal flaccidity and respiratory problems.[55][56] However, in long-term users of benzodiazepines, abrupt discontinuation due to concerns of teratogenesis has a high risk of causing extreme withdrawal symptoms and a severe rebound effect of the underlying mental health disorderSpontaneous abortions may also result from abrupt withdrawal of psychotropic medications, including benzodiazepines.[57]

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