Alprazolam drug withdrawal

Klein E, Uhde TW, Post RM Preliminary evidence for the utility of carbamazepine in alprazolam withdrawal. Am J Psychiatry 143 235—236, 1986 Kouyanou K, Pither CE, Wessely S Medication misuse, abuse and dependence in chronic pain patients. J Psychosom Res 43 497-304, 1997 Kryspin-Exner K [Misuse of bezodiazepine derivatives in alcoholics] (German). Br J Addict Alcohol Other Drugs 61 283-290, 1966 Kryspin-Exner K, Demel 1 The use of tranquilizers in the treatment of mixed drug abuse. Int J Clin Pharmacol Biopharm 12 13-18, 1973... 

The onset of withdrawal from long-acting BZs may be up to 7 days after discontinuation of the drug. Detoxification is approached by initiating treatment at usual doses and maintaining this dose for 5 days. The dose is then tapered over 5 days. Alprazolam withdrawal may require a more gradual taper. 

Substance-Induced Anxiety Disorder. Numerous medicines and drugs of abuse can produce panic attacks. Panic attacks can be triggered by central nervous system stimulants such as cocaine, methamphetamine, caffeine, over-the-counter herbal stimulants such as ephedra, or any of the medications commonly used to treat narcolepsy and ADHD, including psychostimulants and modafinil. Thyroid supplementation with thyroxine (Synthroid) or triiodothyronine (Cytomel) can rarely produce panic attacks. Abrupt withdrawal from central nervous system depressants such as alcohol, barbiturates, and benzodiazepines can cause panic attacks as well. This can be especially problematic with short-acting benzodiazepines such as alprazolam (Xanax), which is an effective treatment for panic disorder but which has been associated with between dose withdrawal symptoms. 

The speciflc clinical use of the numerous available benzodiazepines depends on their individual pharmacokinetic and pharmacodynamic properties. Drugs with a high affinity for the GABAa receptor (alprazolam, clonazepam, lorazepam) have high anxiolytic efficacy drugs with a short duration of action (temazepam) are used as hypnotics to minimise daytime sedative effects. Diazepam has a long half-life and duration of action and may be favoured for long-term use or when there is a history of withdrawal problems oxazepam has a slow onset of action and may be less susceptible to abuse. 

Alprazolam has caused a lower incidence of drowsiness, light-headedness and depression than diazepam. Alprazolam, like other benzodiazepines, has the potential for the development of tolerance and withdrawal symptoms, although the incidence is lower than that seen with other benzodiazepines. Alprazolam s potential for drug dependence is less in comparison to other benzodiazepines. 

The withdrawal syndrome occurred earlier and was more severe for short half-life (alprazolam, lorazepam) than for long half-life drugs (diazepam, clorazepate). 

Brown JL, Hauge KJ. A review of alprazolam withdrawal. Drug Intell Clin Pharm 1986 20 837-884. 

The experience of pregnancy itself is often anxiety provoking, and symptoms sufficient to warrant drug therapy are common in this group ( 16). Although this discussion primarily focuses on the benzodiazepines (BZDs), antidepressants and buspirone may also be used for women of childbearing age with certain anxiety-related disorders. Perhaps the best-documented adverse effect of the BZDs is a neonatal withdrawal syndrome, which has been reported to occur with several of the agents (e.g., diazepam, alprazolam, and triazolam). In addition, there is a weak positive relationship between diazepam exposure and oral clefts ( 17). 

Alprazolam (Xanax), lorazepam (Ativan), and oxazepam (Serax) are metabolized and cleared from the body more quickly than the other members of this family, and are therefore more likely to produce withdrawal symptoms when they are discontinued. These three drugs, however, are less likely to produce side effects such as impaired coordination, concentration, and memory and muscular weakness or sedation. 

In addition to the three more recent withdrawals of Merital, Serzone, and Cylert, I have also reviewed the entire list of serious adverse reactions to psychiatric drugs detected during the postmarketing period in the GAO (1990) study. It seems probable that every one of them was discovered and confirmed through a combination of the SRS, individual case reports, and general clinical experience. As far as I can ascertain, not one of these adverse reactions was primarily, if at all, identified by means of a controlled clinical trial. As a result of postmarket discoveries, alprazolam (Xanax) had rage added to the label as a paradoxical reaction, and amoxapine (Asendin) had NMS added. 

Risk of seizure is greatest during the first 3 days after discontinuation of alprazolam, especially in those with prior seizures, head injuries, or withdrawal from drugs of abuse... 

Slower falls in plasma drug levels for alprazolam XR have the potential to facilitate drug discontinuation by reducing withdrawal symptoms, but this has not been proven... 

Treatment. The choice lies between a fast-acting benzodiazepine such as alprazolam (1-3 mg/day p.o.) and a drug with delayed efficacy but fewer problems of withdrawal such as a TCA, e.g. clomipramine (100-250 mg/day p.o.) or an SSRI, e.g. paroxetine (20-50 mg/day p.o.). The different time course of these two classes of agent in panic disorder is depicted in Fig. 19.5 (see also Tables 19.5 and 19.6). 

Other clinical uses Tricyclic drugs are also used in the treatment of bipolar affective disorders, acute panic attacks, phobic disorders (compare with alprazolam Chapter 22), enuresis, and chronic pain states. Clomipramine and the selective serotonin reuptake inhibitors, including fiuvoxamine, are effective in obsessive-compulsive disorders. SSRls are also effective in patients who suffer from panic attacks, social phobias, bulimia, and premenstrual syndrome (PMS) and may also be useful in the treatment of alcohol dependence. Bupropion is used for management of patients attempting to withdraw from nicotine dependence. 

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