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1. Alprazolam: general description of the drug: 1.1. Mechanism of action. 1.2. Indications for use. 1.3. Contraindications and features of use. 1.4. Why Alprazolam is dangerous: side effects and symptoms of overdose.
2. How does addiction to Alprazolam develop?
3. How to relieve addiction to Alprazolam: principles of treatment.

Alprazolam is a drug from the group of benzodiazepines, hypnotics and sedatives that inhibit the activity of the central nervous system. Benzodiazepine tranquilizers became firmly established in medical practice several decades ago, but they are still very often prescribed in psychiatry and neurology. But at the same time

Alprazolam is more likely than other medications of this pharmacological group to cause drug dependence. And often a person continues to take pills even after completing the course of treatment, obtaining them fraudulently in pharmacies or on the illegal drug market. It is not easy to cope with the uncontrolled use of the drug without the help of a narcologist, because a sudden cessation of its use is accompanied by a real withdrawal syndrome. This condition requires mandatory detoxification, psychotherapy and subsequent rehabilitation.

Composition and mechanism of action

The chemical structure of the drug Alprazolam is a benzodiazepine. It depresses the central nervous system, with the greatest effect on the thalamus, hypothalamus, and limbic structures in general. The drug enhances the effect of gamma-aminobutyric acid, the main neurotransmitter of inhibition during the transmission of nerve impulses. After taking the drug, activation of postsynaptic GABA receptors occurs in the reticular formation of the brain stem and in the interneurons of the lateral horns of the spinal cord. As a result, the excitability of the subcortical centers of the brain decreases, polysynaptic spinal reflexes (cough, swallowing and others) are inhibited.

general description

Alprazolam has all the properties of “classical” tranquilizers. The spectrum of its pharmacotherapeutic activity includes the following effects:

• anxiolytic;
• sedative;
• hypnotic;
• muscle relaxant;
• anticonvulsant.

Due to the high affinity for specific endogenous benzodiazepine receptors, the effect of the drug develops faster. It differs from its analogues in less severe adverse reactions: it causes daytime drowsiness, sudden mood swings, and lethargy much less frequently. That is why it is very often used in outpatient practice.

Mechanism of action

The therapeutic effect of Alprazolam is associated with its selective effect on various classes of GABA receptors (GABA or γ-aminobutyric acid is the main “inhibitory” neurotransmitter). They are localized in the cerebellum, hippocampus, spinal cord and other parts of the central nervous system. By interacting with GABA receptors, Alprazolam indirectly affects the functions of the noradrenergic, serotonergic, cholinergic and opioidergic systems. This is what explains the effectiveness of the medication for anxiety and depressive symptoms.

The drug also has lipophilic properties, so it binds well to plasma proteins and easily penetrates the blood-brain barrier. Thanks to this, the therapeutic effect appears very quickly. Up to 75–80% of the drug is excreted unchanged from the body in the urine, the rest is metabolized in the liver.

Indications for use

As practice and clinical research data show, Alprazolam is most effective for pathologies accompanied by anxiety, fear and restlessness. This:

• panic, obsessive-compulsive, acute stress, generalized anxiety disorder;
• some forms of depression;
• phobias;
• alcohol or drug withdrawal (with caution due to the risk of complications);
• severe premenstrual syndrome;
• somatic diseases accompanied by anxiety syndrome.

Contraindications and application features

Based on the characteristics of metabolism, Alprazolam is prescribed with caution in chronic pathologies of the liver and kidneys. In such cases, individual dose selection is required. A gradual accumulation of the drug and a high risk of intoxication cannot be ruled out. Therefore, for such diseases, the medication is prescribed only according to strict indications and the impossibility of choosing a safer analogue.

During the course of treatment with Alprazolam, medications that reduce the activity of liver enzymes are contraindicated. These are the following:

• antiviral;
• antifungal;
• some antibacterials (in particular, erythromycin and ciprofloxacin);
• antidepressants;
• antiulcer (omeprazole), etc.

Due to the risk of overdose, narcotic analgesics, other sedative and hypnotic medications, and alcohol are strictly prohibited. Alprazolam is contraindicated in:

• respiratory failure, obstructive chronic pulmonary diseases;
• individual intolerance and allergic reaction;
• pregnancy due to the risk of severe congenital malformations of the fetus, you should also stop breastfeeding;
• in childhood and adolescence (up to 18 years);
• severe depression with suicide attempts (benzodiazepines increase the symptoms of the disorder).

Why Alprazolam is dangerous: side effects and overdose symptoms

The most common adverse reactions are of a neurological nature. This feeling of fatigue, dizziness, drowsiness, exercise intolerance, general malaise. They are most pronounced at the initial stage of the course of treatment, and then gradually disappear in most patients. Also possible:

• lack of appetite;
• stool disorders, heartburn, flatulence;
• weight gain;
• in women - irregular menstrual cycle.

Overdose is accompanied by severe symptoms:

• slurred speech;
• impaired coordination of movements;
• slowing down the reaction rate;
• respiratory depression.

However, exceeding the daily dose is especially dangerous if you are dependent on Alprazolam, when the person no longer follows the doctor’s recommendations. When combined with alcohol or drugs, an overdose can be fatal.

Alprazolam

Use during pregnancy and breastfeeding

Alprazolam has a toxic effect on the fetus and increases the risk of birth defects when used in the first trimester of pregnancy.
Chronic use during pregnancy can lead to physical dependence with the development of withdrawal syndrome in the newborn. Taken in therapeutic doses in later stages of pregnancy may cause depression of the central nervous system of the newborn. Use immediately before or during childbirth may cause respiratory depression in the newborn, decreased muscle tone, hypotension, hypothermia, and weak sucking (sluggish sucking syndrome of the newborn). Benzodiazepines may be excreted in breast milk, which can cause drowsiness in the newborn and make feeding difficult.

Experimental studies have shown that alprazolam and its metabolites are excreted in breast milk.

Use for liver dysfunction

Alprazolam should be used with caution in patients with impaired liver function.

Use for renal impairment

Alprazolam should be used with caution in patients with impaired renal function.

Use in children

Contraindication: children and adolescents under 18 years of age.

Use in elderly patients

For elderly or weakened patients, the initial dose is 250 mcg 2-3 times / day, maintenance doses are 500-750 mcg / day, if necessary, taking into account tolerability, the dose can be increased.

special instructions

For endogenous depression, alprazolam can be used in combination with antidepressants. When using alprazolam in patients with depression, cases of hypomanic and manic states have been observed.

Alprazolam should be used with caution in patients with impaired liver and/or kidney function.

In patients who have not previously taken drugs that affect the central nervous system, alprazolam is effective in lower doses compared to patients who have received antidepressants, anxiolytics, or those suffering from chronic alcoholism.

With long-term use in high doses, addiction and drug dependence may develop, especially in patients prone to drug abuse.

With a rapid dose reduction or abrupt withdrawal of alprazolam, a withdrawal syndrome occurs, the symptoms of which can range from mild dysphoria and insomnia to a severe syndrome with abdominal and skeletal muscle cramps, vomiting, increased sweating, tremors and convulsions. Withdrawal syndrome is more common in individuals who have been receiving alprazolam for a long time (more than 8-12 weeks).

Other tranquilizers should not be used simultaneously with alprazolam.

The safety of alprazolam in children and adolescents under 18 years of age has not been established. Children, especially at a young age, are very sensitive to the inhibitory effect of benzodiazepines on the central nervous system.

During the treatment period, avoid drinking alcohol.

Impact on the ability to drive vehicles and operate machinery

During the treatment period, you should refrain from engaging in potentially hazardous activities that require increased attention and speed of psychomotor reactions (driving vehicles or working with machinery).

How does addiction to Alprazolam develop?

The standard daily dose of a tranquilizer is 0.75–4.5 mg, which is divided into three doses (it is recommended to take the tablets at the same time). The risk of developing psychological and physical dependence on Alprazolam is especially high if the course of treatment lasts longer than 4–6 weeks.

One of the prerequisites for the safe use of benzodiazepines is their gradual, slow withdrawal with a gradual reduction in the daily dosage. Quitting Alprazolam often takes longer than the therapy itself. Abrupt withdrawal of medication causes:

• recurrence of initial symptoms: feelings of anxiety, fear and other emotional and mental disorders reappear;
• “recoil syndrome”, which is accompanied by insomnia and panic attacks.

But the most difficult to tolerate is withdrawal syndrome, which manifests itself:

• irritability, depression, apathy;
• nausea, vomiting;
• malaise, weakness and weakness;
• increased sensitivity to bright light, loud sounds, strong odors;
• decreased concentration;
• convulsive seizures;
• hallucinosis;
• crazy ideas;
• depersonalization;
• pain syndrome;
• tremor of hands, tongue;
• tinnitus;
• slow speech and general lethargy.

It is these symptoms that force the patient to return to the pills, and often he takes the medicine in a higher dose than was prescribed by the doctor. At the same time, there is a fear of stopping treatment, because this is accompanied by a pronounced deterioration in well-being.

How addiction develops

Addiction develops quickly, within 1-2 months, due to the fact that many drug addicts initially start with a large dose. Psychological dependence first develops when a person takes Xanax to experience euphoria. But after the effect of the drug wears off, withdrawal symptoms appear, which are difficult to bear due to negative symptoms, including:

• aggressive behavior and irritability;
• increased sweating;
• nightmares and insomnia;
• seizures and sensitivity to light and sound;
• urinary incontinence.

Unable to bear his condition, the addict takes a new dose. The interaction of psychological and physical dependence is the basis of drug addiction.

How to break your addiction to Alprazolam

A strict indication for drug detoxification is symptoms of overdose. Cleansing therapy is carried out only in a hospital, it consists of the following stages:

• gastric lavage;
• use of high doses of adsorbents;
• use of medications from the group of benzodiazepine receptor antagonists;
• correction of concomitant somatic disorders.

If there is no effect from the procedures performed, hemodialysis and plasmapheresis are indicated.

However, the vast majority of patients started taking the medication for therapeutic reasons, and detoxification will inevitably lead to relapse. That is why the drug is continued, but in order to relieve dependence on Alprazolam, its dose is gradually reduced over several weeks.

In this condition, round-the-clock medical monitoring and timely pharmacological correction of possible complications are necessary. Therefore, until the end of treatment, the addict must remain in an inpatient drug treatment clinic.

A course of psychotherapy is mandatory. Experts suggest that consultations with a psychologist will help cope with the underlying disease, for the treatment of which Alprazolam was, in fact, prescribed. Sometimes, if psychotherapy is not enough, antidepressants and “mild” sedatives are additionally selected.

Undoubtedly, many diseases cannot be treated without benzodiazepines, but in order to avoid the development of dependence, it is important to strictly follow all the recommendations of the attending physician regarding the dosage regimen. Exacerbation of the condition, emotional discomfort, or any symptoms that bother the patient are mandatory indications for consulting a doctor.

So what is alprazolam?

Wikipedia says that alprazolam or Xanax is an anti-anxiety drug, a medium-acting benzodiazepine derivative that is used to treat panic disorders, anxiety neuroses such as anxiety disorder or social phobia.

And it must be said that it copes with these goals excellently: those who take this medicine as prescribed by a doctor for, for example, relieving severe anxiety or panic attacks are satisfied. But is this substance safe when used systematically and uncontrolled for euphoria?

It is worth noting that all benzadiazepine tranquilizers have one of the most severe withdrawal symptoms, sometimes even surpassing opioids such as heroin. This means that if you use the same Xanax for a long time and constantly, you can get a very strong withdrawal or withdrawal syndrome.

Having an effect on the psyche for a long time as a sedative, relaxing agent, upon withdrawal a number of extremely unpleasant symptoms appear, but the main thing is that a person can no longer fully function without this substance as before. Here's what users of benzodiazepines like Xanax write about it on foreign forums:

“I feel very anxious even after 5 weeks of lowering the dosage and drinking a lot. I still feel it even weeks later. Even when I took Dilaudid and Tramadol every day for 5 weeks, long enough to feel stoned all the time, my withdrawal symptoms were much milder and smoother.

After 4-5 months of using benzodiazepines, I became so ill that I began to hallucinate and feel crazy, like it was a never-ending “bad trip.” Brain zaps from benzodiazepines are even worse than from antidepressants, and a couple of times they even turned into full-blown seizures.

It was as if I heard a loud “BAM” sound, then saw a flash of light, and my body began to convulse. That's how it was! It was like a flashbang went off in my head. Scary as hell!

Literature:

1. Fursov B.B., Papsuev O.O. Use of alprazolam in clinical practice. - Special clinical psychiatry, 2012. - vol. 22, no. 1.
2. Mosolov S.N. Alprazolam is the first benzodiazepine with a thymotranquilizing effect. - Doctor, 1999. - No. 8
3. Kalinin V.V. New data on the use of alprazolam in psychiatry (literature review). - Psychiatry and psychopharmacotherapy, 2000. - T.2, No. 4.
4. Sychev D.A., Zhuchkov A.V., Tereshchenko O.V. Gradual withdrawal (deprescribing) of benzodiazepine tranquilizers. — Neurology, neuropsychiatry, psychosomatics, 2021. — 11(1).

The text was checked by expert doctors: Head of the socio-psychological service of the Alkoklinik MC, psychologist Yu.P. Baranova, L.A. Serova, a psychiatrist-narcologist.

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