Alprazolam : Understanding Uses, precautions, and interactions

Research Based
Medically reviewed by - Dr. MESSANGA Dimitri, MD Written by - Dr. Shilpa R


What is Alprazolam?

Alprazolam is a member of the class of medications known as benzodiazepines (anxiety-relieving medicines). It is used in adults to treat anxiety symptoms which are severe, debilitating or causing them substantial suffering. Additionally, it is applied to the management of panic disorders and depression-related anxiety.1Overview| Researched based study from

Alprazolam is a member of the class of medications known as benzodiazepines (anxiety-relieving medicines). It is used in adults to treat anxiety symptoms which are severe, debilitating or causing them substantial suffering.


What is alprazolam used for?

  • Anxiety – A state in which a person experiences excessive worry, fear, and other unpleasant emotions
  • Panic disorder – A person with panic disorder experiences sudden, frequently unjustifiable episodes of severe fear or anxiety
  • Anxiety associated with depression 2Indications| Researched based study from


Alprazolam mechanism of action

  • Alprazolam have an effect on the brain and central nervous system (CNS). Pharmacologically, they are referred to as GABAergic drugs, mild tranquillizers, or sedative-hypnotics.
  • Gamma-aminobutyric acid, or GABA, is a crucial neurotransmitter that is enhanced by benzodiazepines at the GABA A receptor. This leads to the sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxing effects for which the medicines are recommended.
  • Benzodiazepine receptors BNZ1 and BNZ2 are the targets of alprazolam’s action
  • Alprazolam breaks down into two different active metabolites: 4-hydroxyprazolam and –hydroxyprazolam
  • Sedation and anti-anxiety benefits result from BNZ1 action, whereas BNZ2 action has an impact on memory, coordination, muscle relaxation, and anticonvulsant properties
  • Alprazolam also has a calming effect when it binds to GABAA receptors, which increases GABA binding to the receptors and inhibits the nervous system 3Mechanism| Researched based study from

Side effects

Side effects of alprazolam

If any of these symptoms are severe or do not subside, consult your doctor for advice:

Mild side effects

  • Constipation
  • Nausea
  • Dizziness or drowsiness
  • Light-headedness
  • Headache
  • Tiredness
  • Difficulty in concentrating
  • Dry mouth
  • Irritability
  • Increased salivation
  • Change in weight
  • Trouble urinating
  • Joint pain4Side effects| Researched based study from

Serious side effects

Consult your doctor right immediately if you experience any of these symptoms since you will need to stop your medication. Your physician will then suggest how to discontinue the treatment:

  • Serious psychiatric or behavioural changes include aggression, restlessness, irritation, violent anger, delusion, nightmares, and hallucinations or other inappropriate behavior
  • Sudden wheezing, breathing difficulties, swelling of the lips, face, or eyelids, rash, or itching (notably impacting the entire body)1Side effects| Researched based study from


Contraindications of alprazolam

Alprazolam is not recommended for use if you are suffering from any of the following conditions below:

  • Breathing problems or severe respiratory problems (such as chronic bronchitis or emphysema)
  • Severe liver problems
  • Acute narrow angle glaucoma
  • Myasthenia gravis (neuromuscular disorder cause weakness in the skeletal muscle)
  • Sleep apnea (a condition marked by interruptions in breathing while you’re asleep)
  • Hypersensitive to alprazolam or other benzodiazepines with similar effects such as diazepam, lorazepam, etc.1Contraindications| Researched based study from ,2Contraindications| Researched based study from


Warnings and precautions

Before taking alprazolam inform your doctor if you have any of the following conditions or problems:

  • If you are having complications with your liver, kidneys, or lungs
  • If you suffer from any mental illness that needs hospitalization
  • If you had severe depression that you considered killing themselves
  • If you have a prior history of drug or alcohol addiction or difficulty quitting using drugs, alcohol, or prescription medications1Precautions| Researched based study from

Precautions to special population


  • The use of alprazolam during pregnancy is not advised unless the woman’s clinical situation requires it. If the patient takes alprazolam while pregnant or gets pregnant while taking it, the patient should be made aware of the potential risk to the unborn.


  • Alprazolam is excreted in small amounts in breast milk and may cause serious adverse reactions including sedation and withdrawal symptoms in breastfed neonates and infants, hence alprazolam is not recommended for use in breast-feeding women

Children and adolescents

  • Because it is not safe or effective, alprazolam is not advised for usage in children or adolescents under the age of 18


  • Due to the possibility of drowsiness and/or muscular weakness, alprazolam should be administered with caution in elderly patients as falls in this population are frequently fatal 1Precautions| Researched based study from , 2Precautions| Researched based study from


Interactions of alprazolam

Drug interactions

Many medications can interact with alprazolam, and some medications shouldn’t be taken concurrently. Tell your doctor about all other medications you take. This includes vitamins, herbal goods, and prescription and over-the-counter medications.

  • Medicines used to treat anxiety or depression – nefazodone, fluoxetine
  • Strong pain killers – opioids such as morphine, codeine
  • Antifungal agents – ketoconazole
  • Antibacterial ( to treat bacterial infections) – erythromycin
  • Medicines for high blood pressure and chest pain – diltiazem
  • Medicines used to treat epilepsy – sodium valproate, levetiracetam
  • Medicines for stomach ulcers – cimetidine
  • Drugs for treating HIV infection – ritonavir or other similar medicines
  • Antiallergics for treating allergies – cetirizine
  • Medicines used to treat mental illnesses like schizophrenia – lurasidone, risperidone
  • Cardiac drugs used to treat various heart conditions – digoxin
  • Medicines used to prevent pregnancy – ethinylestradiol, norethindrone 1Interactions| Researched based study from

Disease interactions


  • Alprazolam use in people with seizure disorders may increase the frequency of generalized tonic-clonic seizures (grand mal) or hasten their onset. Patients with a history of seizures who abruptly stop taking alprazolam are at risk of developing status epileptics

Respiratory depression

  • When used at high doses or via intravenous administration, alprazolam may result in respiratory depression and apnea. Alprazolam therapy should be used with caution in these patients

Closed-angle glaucoma

  • Alprazolam should not be used by patients who have open-angle glaucoma or acute angle-closure glaucoma. Although this medication lack anticholinergic effect, they have very infrequently been linked to elevated intraocular pressure.

Renal/liver disease

  • In patients with compromised renal and/or hepatic function, alprazolam therapy should be taken with caution and at lower beginning dosages

Paradoxical reactions

  • Alprazolam has been associated with paradoxical reactions in psychiatric and paediatric patients with hyperactive aggressive disorders, including aggressive behaviour, agitation, nervousness, excitability, irritability, hostility, sleep disturbance, anxiety, nightmares, and vivid dreams.
  • When taking alprazolam, such individuals should be watched for any indications of paradoxical stimulation5Interactions| Researched based study from

Alprazolam interaction with food


  • Do not drink alcohol while taking alprazolam as it may increase it effects. Because alprazolam and alcohol can both depress the central nervous system, severe respiratory depression and even death are possible effects


  • Alprazolam may interact with grapefruit and grapefruit juice, which could result in potentially harmful side effects. You should consult your doctor before changing the amount of grapefruit products in your diet.5Interactions| Researched based study from


Takeaway tips

  • Alprazolam can become habit-forming, so only the individual for whom it was given should take it
  • Do not reduce your dosage or stop using this medicine without first consulting your doctor. Stopping alprazolam abruptly can make your situation worse and result in withdrawal symptoms that could last anywhere from a few weeks to over a year. Your dosage of alprazolam will likely be gradually reduced by your doctor
  • If you miss a dose, take it right away unless it’s time for your next dose. To make up for a missing dose, avoid taking two doses at once
  • Do not start any new prescription medications, over-the-counter medications, or herbal therapies without first consulting your doctor
  • If your symptoms or health issues do not improve or worsen, consult your doctor
  • This medication is frequently prescribed for as-needed use. Do not take more frequently than prescribed by your physician 1Takeaway| Researched based study from ,6Takeaway| Researched based study from ]
Disclaimer: The user acknowledges that this article's information is being offered for informational purposes only. Every attempt has been made to guarantee that the article is informational and correct. If they have any doubts or questions about their health, we firmly advise our readers to visit a doctor or other healthcare professional.

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