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  • Critical Perspectives on Prescribing Alprazolam

    When used as directed, alprazolam can be safe and effective and is used to treat a variety of mood disorders such as anxiety, insomnia, depression and panic disorders. However, when taken without medical supervision or in larger amounts than prescribed, it can lead to serious health consequences. In a recent ruling, Alabama was on track to become the first state in the country to move alprazolam (Xanax, Xanax XR, Niravam) from a DEA CIV substance to a CII substance. In addition to alprazolam, the ruling would have rescheduled zolpidem (Ambien) and all other benzodiazepines to a CIII from their previous CIV classification. Ultimately, the Alabama Legislative Council voted to disapprove the proposed rule, due to evidence presented on potential challenges for patients, complications facing pharmacists and increased costs to pharmacy business associated with dispensing, wholesaling and tracking alprazolam.1

    This type of debate and outcome casts a stronger light on the need to prevent the abuse of opioid and anti-anxiety medications. Healthcare providers prescribing alprazolam should warn and educate patients against combining alprazolam with other medications, the dangers of overdosing or sharing prescription medications, and methods for properly disposing of remaining dosage units once the treatment period has passed. Nonmedical use of prescription opioids and other controlled substances such as benzodiazepines is a dangerous practice. With benzodiazepines such as alprazolam, even short-term use has been associated with dependence, causing withdrawal symptoms such as tremors and seizures. Furthermore, alprazolam can be significantly more toxic than other benzodiazepines if a patient takes more than the prescribed amount. When combined with other drugs that depress the central nervous system, such as narcotic pain relievers, the individual effects of these drugs on the body can be dangerously enhanced.2

    In recent years, the national Substance Abuse and Mental Health Services Administration (SAMHSA) published a report that focused on emergency department visits due to the nonmedical use of alprazolam. Using national estimates in the Drug Abuse Warning Network, the estimated number of alprazolam-related emergency department visits involving nonmedical use doubled from 57,419 visits in 2005 to 123,744 visits in 2011. In analyzing trends by age, the study also found that during the same span of time, the nonmedical use of alprazolam among patients aged 25 to 34 tripled and emergency room visits in this age group accounted for 32% of all visits in 2011. These results suggest that adults in this age group may have the greatest need for interventions addressing nonmedical use of alprazolam.2 Healthcare provider awareness of emerging drug information is critical, in order to be prepared to educate patients on proper usage of prescribed medications. Please update or register your profile to receive email alerts and other critical drug information updates from PDR. You can also stay current by using the official PDR app, available now for free from your favorite app stores.

    References: 1) 2017 Latest announcements: Xanax Announcement. Alabama Board of Pharmacy website. http://www.albop.com/LatestAnnouncements.aspx. Accessed August 3, 2017. 2) Bush DM. Emergency Department Visits Involving Nonmedical Use of the Anti-anxiety Medication Alprazolam. The CBHSQ Report: May 22, 2014. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Rockville, MD.