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Alprazolam, sold under the brand name Xanax among others, is a fast-acting, potent tranquilizer of moderate duration within the triazolobenzodiazepine group of chemicals called benzodiazepines. Alprazolam is most commonly prescribed in the management of anxiety disorders, especially panic disorder and generalized anxiety disorder (GAD).

Other uses include the treatment of chemotherapy-induced nausea, together with other treatments. GAD improvement occurs generally within a week. Alprazolam is generally taken orally.

Common side effects include sleepiness, depression, suppressed emotions, mild to severe decreases in motor skills, hiccups, dulling or declining of cognition, decreased alertness, dry mouth (mildly), decreased heart rate, suppression of central nervous system activity, impairment of judgment (usually in higher than therapeutic doses), marginal to severe decreases in memory formation, decreased ability to process new information, as well as partial to complete anterograde amnesia, depending on dosage. Some of the sedation and drowsiness may improve within a few days.

Benzodiazepine withdrawal symptoms may occur if use is suddenly decreased.

Alprazolam was invented by Jackson Hester Jr. at the Upjohn Companyand patented in 1971 and approved for medical use in the United States in 1981.

Alprazolam is a Schedule IV controlled substance and is a common drug of abuse.

It is available as a generic medication. In 2022, it was the 41st most commonly prescribed medication in the United States, with more than 14 million prescriptions.

Medical uses

Alprazolam pills in boxes, as sold in France; both the original Pfizer brand product Xanax and various generic forms of alprazolam are depicted here.

Alprazolam is used in the management of anxiety disorders and nausea due to chemotherapy.

Alprazolam is indicated for the treatment of generalized anxiety disorder (GAD) and panic disorder with or without agoraphobia in adults.

Panic disorder

Alprazolam is effective in the relief of moderate to severe anxiety and panic attacks.

In Australia, alprazolam is not recommended for the treatment of panic disorder because of concerns regarding tolerance, dependence, and abuse.

Most evidence shows that the benefits of alprazolam in treating panic disorder last only four to ten weeks. However, people with panic disorder have been treated on an open basis for up to eight months without apparent loss of benefit.

Alprazolam is recommended by the World Federation of Societies of Biological Psychiatry (WFSBP) for treatment-resistant cases of panic disorder where there is no history of tolerance or dependence.

A 2023 meta-analysis of published and unpublished FDA-submitted regulatory trials of alprazolam extended-release for panic disorder found that only one of five clinical trials showed a positive efficacy outcome (20%), while the rest were negative and did not demonstrate effectiveness.

In the published literature, three trials were published conveying a positive outcome (100%), but of these, only one was positive and the other two were considered to have been inappropriately spun as positive.

The effect size (Hedges's g) of alprazolam for the treatment of panic disorder based on the five clinical trials was 0.33 (a small effect) and based on the published trials was 0.47 (a moderate effect), equating to an increase of 0.14 or 42%.

The authors concluded that publication bias substantially inflated the effectiveness of alprazolam for panic disorder.

Anxiety disorders

Anxiety associated with depression is responsive to alprazolam. Clinical studies have shown that the effectiveness is limited to four months for anxiety disorders.

However, the research into antidepressant properties of alprazolam is poor and has only assessed its short-term effects against depression. In one study, some long term, high-dosage users of alprazolam developed reversible depression.

In the US, alprazolam is indicated for the treatment of generalized anxiety disorder and panic disorder with or without agoraphobia.

In the UK, alprazolam is indicated for short-term symptomatic treatment of anxiety in adults.

Alprazolam may be used in combination with other medications for chemotherapy-induced nausea and vomiting.