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Alprazolam: Difference between revisions
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Alprazolam has a fast onset of action and symptomatic relief. 90% of peak effects are achieved within the 1st hour of using in preparation for panic disorder and full peak effects are achieved in 1.5 and 1.6 hours respectively.<ref>{{cite journal | vauthors=((Smith, R. B.)), ((Kroboth, P. D.)), ((Vanderlugt, J. T.)), ((Phillips, J. P.)), ((Juhl, R. P.)) | journal=Psychopharmacology | title=Pharmacokinetics and pharmacodynamics of alprazolam after oral and IV administration | volume=84 | issue=4 | pages=452–456 | date= 1984 | issn=0033-3158 | doi=10.1007/BF00431449}}</ref><ref>{{cite journal | vauthors=((Sheehan, D. V.)), ((Sheehan, K. H.)), ((Raj, B. A.)) | journal=Psychopharmacology Bulletin | title=The speed of onset of action of alprazolam-XR compared to alprazolam-CT in panic disorder | volume=40 | issue=2 | pages=63–81 | date= 2007 | issn=0048-5764}}</ref> Peak benefits achieved for GAD may take up to a week.<ref>{{cite journal | vauthors=((Verster, J. C.)), ((Volkerts, E. R.)) | journal=CNS Drug Reviews | title=Clinical Pharmacology, Clinical Efficacy, and Behavioral Toxicity of Alprazolam: A Review of the Literature | volume=10 | issue=1 | pages=45–76 | date=7 June 2006 | url=https://onlinelibrary.wiley.com/doi/10.1111/j.1527-3458.2004.tb00003.x | issn=1080563X | doi=10.1111/j.1527-3458.2004.tb00003.x}}</ref> | Alprazolam has a fast onset of action and symptomatic relief. 90% of peak effects are achieved within the 1st hour of using in preparation for panic disorder and full peak effects are achieved in 1.5 and 1.6 hours respectively.<ref>{{cite journal | vauthors=((Smith, R. B.)), ((Kroboth, P. D.)), ((Vanderlugt, J. T.)), ((Phillips, J. P.)), ((Juhl, R. P.)) | journal=Psychopharmacology | title=Pharmacokinetics and pharmacodynamics of alprazolam after oral and IV administration | volume=84 | issue=4 | pages=452–456 | date= 1984 | issn=0033-3158 | doi=10.1007/BF00431449}}</ref><ref>{{cite journal | vauthors=((Sheehan, D. V.)), ((Sheehan, K. H.)), ((Raj, B. A.)) | journal=Psychopharmacology Bulletin | title=The speed of onset of action of alprazolam-XR compared to alprazolam-CT in panic disorder | volume=40 | issue=2 | pages=63–81 | date= 2007 | issn=0048-5764}}</ref> Peak benefits achieved for GAD may take up to a week.<ref>{{cite journal | vauthors=((Verster, J. C.)), ((Volkerts, E. R.)) | journal=CNS Drug Reviews | title=Clinical Pharmacology, Clinical Efficacy, and Behavioral Toxicity of Alprazolam: A Review of the Literature | volume=10 | issue=1 | pages=45–76 | date=7 June 2006 | url=https://onlinelibrary.wiley.com/doi/10.1111/j.1527-3458.2004.tb00003.x | issn=1080563X | doi=10.1111/j.1527-3458.2004.tb00003.x}}</ref> | ||
The [[Benzodiazepine#Discontinuation|sudden discontinuation of benzodiazepines]] can be potentially dangerous or life-threatening for individuals using regularly for extended periods of time, sometimes resulting in seizures or death.<ref>{{cite journal | vauthors=((Lann, M. A.)), ((Molina, D. K.)) | journal=The American Journal of Forensic Medicine and Pathology | title=A fatal case of benzodiazepine withdrawal | volume=30 | issue=2 | pages=177–179 | date= June 2009 | issn=1533-404X | doi=10.1097/PAF.0b013e3181875aa0}}</ref> It is | The [[Benzodiazepine#Discontinuation|sudden discontinuation of benzodiazepines]] can be potentially dangerous or life-threatening for individuals using regularly for extended periods of time, sometimes resulting in seizures or death.<ref>{{cite journal | vauthors=((Lann, M. A.)), ((Molina, D. K.)) | journal=The American Journal of Forensic Medicine and Pathology | title=A fatal case of benzodiazepine withdrawal | volume=30 | issue=2 | pages=177–179 | date= June 2009 | issn=1533-404X | doi=10.1097/PAF.0b013e3181875aa0}}</ref> It is highly recommended to [[taper]] one's dose by gradually lowering the amount taken each day for a prolonged period of time instead of stopping abruptly.<ref>{{cite journal | vauthors=((Kahan, M.)), ((Wilson, L.)), ((Mailis-Gagnon, A.)), ((Srivastava, A.)) | journal=Canadian Family Physician | title=Canadian guideline for safe and effective use of opioids for chronic noncancer pain. Appendix B-6: Benzodiazepine Tapering | volume=57 | issue=11 | pages=1269–1276 | date= November 2011 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3215603/ | issn=0008-350X}}</ref> | ||
[[File:Xanax (alprazolam) 2 mg.jpg|200px|thumbnail|Xanax (Alprazolam) 2 mg tri-score tablets]] | [[File:Xanax (alprazolam) 2 mg.jpg|200px|thumbnail|Xanax (Alprazolam) 2 mg tri-score tablets]] | ||
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{{toxicity}} | {{toxicity}} | ||
[[File:harmchart.png|thumb|right|300px|Radar plot showing relative physical harm, social harm, and dependence of benzodiazepines in comparison to other drugs.<ref>{{cite journal | vauthors=((Nutt, D.)), ((King, L. A.)), ((Saulsbury, W.)), ((Blakemore, C.)) | journal=The Lancet | title=Development of a rational scale to assess the harm of drugs of potential misuse | volume=369 | issue=9566 | pages=1047–1053 | date=24 March 2007 | url=https://www.sciencedirect.com/science/article/pii/S0140673607604644 | issn=0140-6736 | doi=10.1016/S0140-6736(07)60464-4}}</ref>]] | [[File:harmchart.png|thumb|right|300px|Radar plot showing relative physical harm, social harm, and dependence of benzodiazepines in comparison to other drugs.<ref>{{cite journal | vauthors=((Nutt, D.)), ((King, L. A.)), ((Saulsbury, W.)), ((Blakemore, C.)) | journal=The Lancet | title=Development of a rational scale to assess the harm of drugs of potential misuse | volume=369 | issue=9566 | pages=1047–1053 | date=24 March 2007 | url=https://www.sciencedirect.com/science/article/pii/S0140673607604644 | issn=0140-6736 | doi=10.1016/S0140-6736(07)60464-4}}</ref>]] | ||
Alprazolam has a [[Toxicity::low toxicity]] relative to dose.<ref name="Mandroili2008" /> However, it is [[Toxicity::potentially [[respiratory depression|lethal]] when mixed with [[depressants]] like [[alcohol]] or [[ | Alprazolam has a [[Toxicity::low toxicity]] relative to dose.<ref name="Mandroili2008" /> However, it is [[Toxicity::potentially [[respiratory depression|lethal]] when mixed with [[depressants]] like [[alcohol]], [[opioids]], or [[barbiturates]]]]. Resulting in increased [[Respiratory depression|respiratory depression]] via a synergistic effect.<ref>Weaver MF. Prescription Sedative Misuse and Abuse. Yale J Biol Med. 2015 Sep;88(3):247-56. [[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553644/ PMC free article]] [[https://pubmed.ncbi.nlm.nih.gov/26339207 PubMed]] </ref> | ||
It is strongly recommended that one use [[harm reduction practices]] when using this substance. | It is strongly recommended that one use [[harm reduction practices]] when using this substance. | ||
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*'''Austria''': Alprazolam is legal for medical use under the AMG (Arzneimittelgesetz Österreich) and illegal when sold or possessed without a prescription under the SMG (Suchtmittelgesetz Österreich).{{citation needed}} | *'''Austria''': Alprazolam is legal for medical use under the AMG (Arzneimittelgesetz Österreich) and illegal when sold or possessed without a prescription under the SMG (Suchtmittelgesetz Österreich).{{citation needed}} | ||
*'''Czechia''': Alprazolam is a Schedule IV <ref>https://eur-lex.europa.eu/resource.html?uri=cellar:6b5e9beb-1d9b-11ea-95ab-01aa75ed71a1.0001.02/DOC_1&format=PDF</ref> (List 7) substance. Sold exclusively with a prescription "without a blue stripe" (§ 1, g), 1. of ''Nařízení vlády č. 463/2013 Sb.'') <ref>https://www.zakonyprolidi.cz/cs/2013-463</ref> | *'''Czechia''': Alprazolam is a Schedule IV <ref>https://eur-lex.europa.eu/resource.html?uri=cellar:6b5e9beb-1d9b-11ea-95ab-01aa75ed71a1.0001.02/DOC_1&format=PDF</ref> (List 7) substance. Sold exclusively with a prescription "without a blue stripe" (§ 1, g), 1. of ''Nařízení vlády č. 463/2013 Sb.'') <ref>https://www.zakonyprolidi.cz/cs/2013-463</ref> | ||
*'''France''': Alprazolam is a List I substance and is available for prescription.<ref>https://www.vidal.fr/medicaments/gammes/alprazolam-biogaran-11672.html</ref> It is illegal to buy without a prescription. | |||
*'''Germany''': Alprazolam is controlled under Anlage III BtMG (''Narcotics Act, Schedule III'') as of August 1, 1986.<ref>{{cite web|url=http://www.bgbl.de/xaver/bgbl/start.xav?startbk=Bundesanzeiger_BGBl&jumpTo=bgbl186s1099.pdf|title=Zweite Verordnung zur Änderung betäubungsmittelrechtlicher Vorschriften|publisher=Bundesanzeiger Verlag|access-date=December 26, 2019|language=de}}</ref> It can only be prescribed on a narcotic prescription form, except preparations which contain up to 1 mg alprazolam in each dosage form.<ref>{{cite web|url=https://www.gesetze-im-internet.de/btmg_1981/anlage_iii.html|title=Anlage III BtMG|publisher=Bundesministerium der Justiz und für Verbraucherschutz|access-date=December 26, 2019|language=de}}</ref> | *'''Germany''': Alprazolam is controlled under Anlage III BtMG (''Narcotics Act, Schedule III'') as of August 1, 1986.<ref>{{cite web|url=http://www.bgbl.de/xaver/bgbl/start.xav?startbk=Bundesanzeiger_BGBl&jumpTo=bgbl186s1099.pdf|title=Zweite Verordnung zur Änderung betäubungsmittelrechtlicher Vorschriften|publisher=Bundesanzeiger Verlag|access-date=December 26, 2019|language=de}}</ref> It can only be prescribed on a narcotic prescription form, except preparations which contain up to 1 mg alprazolam in each dosage form.<ref>{{cite web|url=https://www.gesetze-im-internet.de/btmg_1981/anlage_iii.html|title=Anlage III BtMG|publisher=Bundesministerium der Justiz und für Verbraucherschutz|access-date=December 26, 2019|language=de}}</ref> | ||
*'''Ireland''': Alprazolam is a Schedule 4 medicine.<ref>{{Citation | vauthors=((eISB)) | title=Misuse Of Drugs (Amendment) Regulations | url=https://www.irishstatutebook.ie/eli/1993/si/342/made/en/print}}</ref> | *'''Ireland''': Alprazolam is a Schedule 4 medicine.<ref>{{Citation | vauthors=((eISB)) | title=Misuse Of Drugs (Amendment) Regulations | url=https://www.irishstatutebook.ie/eli/1993/si/342/made/en/print}}</ref> | ||