Alprazolam
Xanax
BenzodiazepineSchedule IVGeneric availableTDM data
The exact mechanism of action of alprazolam is unknown. Benzodiazepines bind to gamma aminobutyric acid (GABA) receptors in the brain and enhance GABA-mediated synaptic inhibition; such actions may be responsible for the efficacy of alprazolam in anxiety disorder and panic disorder.
Compare Alprazolam →FDA-Approved Indications
- Acute treatment of generalized anxiety disorder (GAD) in adults
- Treatment of panic disorder (PD), with or without agoraphobia in adults
Common Off-Label Uses
- Insomnia
- Premenstrual syndrome
- Chemotherapy-induced nausea (anticipatory)
What Sets This Drug Apart
- Most prescribed benzodiazepine in the US; short-acting (t1/2 6-12h) with distinctive FDA indication for panic disorder
- Clinical effect often shorter than half-life suggests — interdose withdrawal and clock-watching behavior are characteristic problems
- Higher dependence and withdrawal severity than longer-acting benzos; tapering difficulty is well-documented
- CYP3A4 substrate — fluvoxamine approximately doubles plasma levels; ketoconazole and other strong 3A4 inhibitors require dose reduction
- Not recommended for chronic daily use; short-term or as-needed dosing preferred to minimize dependence risk
Boxed Warning
WARNING: RISKS FROM CONCOMITANT USE WITH OPIOIDS