Alprazolam and Talk:Missaukee County, Michigan: Difference between pages
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{| border="1" cellpadding="3" cellspacing="0" width="250px" align="right" style="border-collapse: collapse; margin: 0 0 0 0.5em" |
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[[Image:alprazolam.png|200px|alprazolam chemical structure]]<br/> |
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''Alprazolam'' |
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|- |
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| align="center" colspan="2" | ''[[IUPAC nomenclature|IUPAC]] name'' |
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|- align="center" style="border-bottom: 3px solid gray" |
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| '''[[CAS number]]''' <br/> 28981-97-7 |
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| '''[[ATC code]]''' <br/> N05BA12 |
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|- |
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| bgcolor="#eeeeee" | [[Chemical formula]] |
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| bgcolor="#ddeeff" | C<sub>17</sub>H<sub>13</sub>ClN<sub>4</sub> |
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|- |
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| bgcolor="#eeeeee" | [[Molecular weight]] |
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| bgcolor="#ddeeff" | 308.8 |
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|- |
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| bgcolor="#eeeeee" | [[Bioavailability]] |
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| bgcolor="#ddeeff" | 80-90% |
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|- |
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| bgcolor="#eeeeee" | Metabolism |
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| bgcolor="#ddeeff" | Liver |
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|- |
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| bgcolor="#eeeeee" | [[half life|Elimination half life]] |
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| bgcolor="#ddeeff" | 6-27 hours (11 hour avg.) |
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|- |
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| bgcolor="#eeeeee" | [[Excretion]] |
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| bgcolor="#ddeeff" | Urine |
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|- |
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| bgcolor="#eeeeee" | [[Pregnancy category (pharmaceutical)|Pregnancy category]] |
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| bgcolor="#ddeeff" | D |
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|- |
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| bgcolor="#eeeeee" | [[Controlled Substance Act|Legal status]] |
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| bgcolor="#ddeeff" | USA FDA/DEA [[Schedule IV]] |
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|- |
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| bgcolor="#eeeeee" | Route of administration |
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| bgcolor="#ddeeff" | Oral |
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<table bgcolor="#ffffff" border="1" cellpadding="3" cellspacing="0" width="167px" align="right" style="border-collapse: collapse; clear: right; margin: 0 0 0 0.5em"> |
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|'''Indicated for:'''<br/> |
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*Anxiety |
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*Panic attacks |
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'''Abuse:'''<br/> |
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* Benzodiazepines have been used as date-rape drugs |
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|- |
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|'''[[Contraindication]]s:'''<br/> |
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*[[Myasthenia gravis]] |
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*Sensitivity to [[benzodiazepine]]s |
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*Acute angle closure [[glaucoma]] |
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*History of drug dependance or abuse (increased likelihood of addiction) |
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|- |
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|'''[[Side effect]]s:''' |
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<div style="background: #ffcc99"> |
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'''''{{red|Severe:}}''''' |
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*? |
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</div> |
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'''''Atypical [[sensation]]s:''''' |
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*? |
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'''''[[Cardiovascular]]:''''' |
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*Tachycardia |
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'''''[[Ear]], [[nose]], and [[throat]]:''''' |
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*Nasal congestion |
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'''''[[Endocrinal]]:''''' |
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*changes in [[plasma]] [[cortisol]] and [[ACTH]] levels |
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'''''[[Eye]]:''''' |
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*Blurred vision |
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*Difficulty in depth perception |
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'''''[[Gastrointestinal]]:''''' |
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*Decreased salivation |
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*Increased salivation |
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*Diarrhea |
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*Constipation |
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*Nausea |
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'''''[[Hematological]]:''''' |
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*? |
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'''''[[Muscle|Musculo]][[skeletal]]:''''' |
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*Tremor |
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'''''[[Central Nervous]]:''''' |
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*Drowsiness |
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*Headache |
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*Dizziness |
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*Insomnia |
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*Confusion |
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*Nervousness |
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*Obsessive thoughts |
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*More often than with other benzodiazepines : paradox reactions including confusion, agitation up to rage, increased anxiety, insomnia, muscle spasms and rigidity (stop treatment immediately!) |
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*Memory impairment |
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*Irreversible (non repairable) cognitive deficits and lasting loss of personality (loss of social abilities, interest in work, spare-time activities, intellectual preoccupations) |
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'''''[[Psychological]]:''''' |
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'''''[[Respiratory]]:''''' |
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*? |
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'''''[[Skin]]:''''' |
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*Dermatitis |
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'''''[[Urogenital]] and [[reproductive]]:''''' |
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*Menstrual disorders |
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*Incontinence |
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'''''Miscellaneous:''''' |
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*? |
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|} |
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'''Alprazolam''' is a short acting [[benzodiazepine]] used for its [[anxiolytic]] effects to treat [[anxiety]] disorders. It is sold under several brand names such as '''Xanax''', '''Xanax XR''' (an extended release formulation), '''Xanor''', '''Alplax''', '''Tranquinal''', '''Trankimazin''', and '''Tafil'''. |
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Alprazolam has a calming effect, with potential side effects of drowsiness, clumsiness, fatigue, and headache. The drug can also have more severe side effects, such as blurred vision, slurred speech, and changes in normal behavior. The drug is habit forming, and users develop a tolerance. Physical and psychological dependence after several weeks or months of alprazolam treatment is common. There is now a general consent among psychiatrists that alprazolam (a so-called 'highly-potent' benzodiazepine) poses a particularly high risk for abuse, misuse and addiction/dependence. Withdrawal after weeks or months of use is a complicated matter, because agitation, (rebound-)anxiety, insomnia, muscle cramps and even epileptic seizures frequently result from too quick of a dose reduction. As a result, long-term alprazolam treatment cannot be abruptly terminated; the dosage must instead be slowly reduced over a course of weeks. |
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== Indications == |
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The main medical indications are as follows: |
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1. Treatment of [[Panic Disorder]] (with or without [[agoraphobia]]). Alprazolam is a very effective "panic suppressant", and this is one of the main features which sets it aside from other benzodiazepines.However, despite its' clear effectiveness in reducing panic attacks, many psychiatrists are reluctant to use alprazolam for this condition, since this population is very addiction-prone. |
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2. As needed (PRN) therapy of [[panic attacks]], 4 to 6 single doses per months are the acceptable limit. If addiction seems to develop and/or the limit is exceeded therapy is stopped. |
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3. The short-time relief of acute and severe anxiety if psychotherapy alone is not sufficient. Duration of therapy in this case is limited from days up to 4 weeks. Dose reductions leading to early stop of medication are attempted as soon as possible. Note that stress and anxiety in the absence of some external factor or event usually does not justify the use of alprazolam. |
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4. Initial therapy together with other non-addictive drugs for example [[selective serotonin reuptake inhibitor]] medicines such as [[paroxetine]], [[sertraline]], or [[fluoxetine]] or [[buspirone]](partial 5-HT1A-Agonist, different class) to tighten anxiety control while waiting for the non-addictive agent to begin working (the effect of these demonstrates latency). |
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5. Long term treatment of severe generalized anxiety disorders if other therapies either do not work or are contraindicated. Duration of therapy in this case is often 4 months or longer. The indication must be cautiously made by a spezialized psychiatrist taking into account both the individual suffering, loss in social performance and the risk of addiction on the other hand. |
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6. The drug may be used by specialists to treat severe cases of [[Borderline Personality Disorder]]. Some studies have shown positive results. |
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== Narcotic regulations == |
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In the [[United States]], the sale of alprazolam is regulated by the [[Food and Drug Administration]], and requires a doctor's prescription. Internationally, alprazolam is a Schedule IV drug under the [[Convention on Psychotropic Substances]][http://www.incb.org/pdf/e/list/green.pdf]. |
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== Mechanism of action == |
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Alprazolam is a ''triazolobenzodiazepine'', that is, a benzodiazepine with a triazolo-ring attached to its structure. Alprazolam binds to the [[GABA receptor|GABA<sub>A</sub> subtype of the GABA recpetor]], increasing inhibitory effects of [[GABA]] within the central nervous system. The binding site for benzodiazepines is ''distinct'' from the binding site for GABA on the GABA receptor. |
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Unlike other benzodiazepines, alprazolam also has some [[antidepressant]] activity. |
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== Pharmacokinetics == |
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Alprazolam is readily absorbed from the gastrointestinal tract. The peak [[plasma]] concentration is achieved in 1-2 hours. Most of the drug is bound to plasma protein, mainly [[albumin]]. Alprazolam is [[hydroxylation|hydroxylated]] in the liver to α-hydroxyalprazolam, which is also active. This and other [[metabolite]]s are later excreted in urine as [[glucuronide]]s. Some of alprazolam is also excreted in unchanged form. |
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== Special risk patients == |
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Suicidal prone patients should receive the smallest amount feasable. Suicidal attempts with Alprazolam may result in death, if Alprazolam is deliberately overdosed and taken together with alcohol or other central depressive drugs. |
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== Recreational use == |
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As with all benzodiazepines, Alprazolam offers relaxing sedative effects that many find suitable to recreational environments. The drug is almost always administered by ingestion, as alprazolam is a non-polar molecule and thus ineffective when "snorted" (insufflation). Some believe, contrary to popular belief, that Xanax is more potent but lasts for a shorter time period when snorted. Oral ingestion results in decreased inhibition, decreased social anxiety, and a general feeling of well-being. It is often combined with other drugs such as alcohol, cannabis, and cocaine. |
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Alprazolam or similar benzodiazepines are also used on the come-down of certain drugs, such as the longer-lasting hallucinogens like [[LSD]], and stimulants such as [[cocaine]] and [[methamphetamines]], as it can allow an otherwise intoxicated person to relax at the end of the drug's effects and possibly fall asleep, which they would not be able to do otherwise. It is also occasionally taken, sometimes self-administered, during a [[Dysphoria|dysphoric]] experience on hallucinogens such as [[LSD]] or [[psilocybin]], because it will often tone down the experience, allowing the user to cope with a dysphoric hallucinogenic experience better. |
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==External links== |
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* [http://www.xanax.com/ www.xanax.com] Official Xanax Website |
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* [http://www.erowid.org/pharms/alprazolam/ Alprazolam at erowid.org] Alprazolam page with experiences reports |
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* [http://www.duchs.com/information/xanax Xanax Education] Frequently Asked Questions |
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* [http://lexington-on-line.com/naf_xanax.html Guidelines for Discontinuing Xanax] by Stephen Cox MD, Asst Clinical Professor of Psychiatry, UKMC |
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* [http://counsellingresource.com/medications-research/category/alprazolam/ http://counsellingresource.com/medications-research/category/alprazolam/] Current research abstracts on alprazolam (Xanax) |
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* [http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?sid=361524 PubChem Substance Summary: Alprazolam] National Center for Biotechnology Information |
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[[Category:Benzodiazepines]] |
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[[Category:Anxiolytics]] |
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[[Category:Muscle relaxants]] |
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[[de:Alprazolam]] |
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Revision as of 21:57, 13 November 2005
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