Alprazolam

How it works

It enhances the inhibitory action of GABA at the GABA-A receptor, increasing chloride channel opening and producing anxiolytic, sedative and muscle-relaxant effects.

Prescribing in practice

• Tolerance and dependence develop readily, so prescribe only for short periods and withdraw gradually to avoid a withdrawal syndrome including seizures.
• Combining with opioids or other CNS depressants markedly increases the risk of sedation and fatal respiratory depression.
• Avoid in patients with a history of substance misuse and use cautiously in the elderly and in hepatic impairment.

Monitoring

Monitor for excessive sedation, signs of dependence and the continuing indication, rather than by laboratory testing.

Counselling the patient

• Do not stop suddenly; the dose must be reduced gradually under medical supervision.
• Avoid alcohol and do not drive if you feel drowsy.
• This medicine is intended for short-term use only.

Evidence & guidelines

MHRA and national guidance advise that benzodiazepines such as alprazolam be used only short-term at the lowest effective dose because of dependence.