Alprazolam

Short-acting potent·Neurology - Sedatives & Hypnotics

Panic disorder with/without agoraphobia, severe anxiety disorders

S8BENZOXanax, Kalma, Alprax1 mg tabletTGA

Max Dose

4 mg/day

Half-life

11-15 h

Dependence

SEVERE

Rebound Panic

HIGH RISK

Rapid Summary

Overview

Highly potent, short-acting triazolobenzodiazepine. Unmatched for rapid termination of severe panic attacks, but carries the highest addiction, abuse, and withdrawal risk of the entire class.

Maximum Dose

Max 4 mg/day (Usually 0.5 - 1 mg per dose).

Clinical Focus

Up-scheduled to S8 in Australia due to massive abuse. Prescribing on the ward is extremely restricted and generally avoided.

Bottom Line

Alprazolam is a short-acting benzodiazepine for panic disorder and acute anxiety, but has the highest dependence and withdrawal seizure risk of all benzodiazepines.

Formulation & Access

Brand Names

Xanax, Kalma, Alprax

Oral Routes

Tablets (250 mcg, 500 mcg, 1 mg, 2 mg).

Prescribing & PBS

Highly Restricted (S8). Private script only in most states.

Indications & Use

Primary

TGA

Panic disorder with/without agoraphobia, severe anxiety disorders.

Clinical Place

Largely blacklisted for routine use. Reserved for patients already dependent on it, or extreme, refractory panic disorder under psychiatric care.

Quick reference

Class & Role

Short-acting potent — Highly potent, short-acting triazolobenzodiazepine.

Route / Formulation

Tablets (250 mcg, 500 mcg, 1 mg, 2 mg). (Xanax, Kalma, Alprax)

Usual Dose & Max

PO 0.25 - 0.5 mg TDS. Max 4 mg/day.

Key Indication Doses

Panic Disorder: PO 0.25 - 0.5 mg TDS. Max 4 mg/day. Anxiety: PO 0.25 mg BD to TDS.

Best Uses

Alprazolam is a short-acting benzodiazepine for panic disorder and acute anxiety, but has the highest dependence and withdrawal seizure risk of all benzodiazepines.

Avoid / Cautions

Substance abuse history, severe respiratory failure, Myasthenia Gravis. Pregnancy Category D. Associated with congenital malformations and severe neonatal withdrawal.

Key Risks

Neurological: Extreme psychological euphoria and physical dependence. CRITICAL — Violent withdrawal seizures if stopped abruptly. HIGH — 'Rebound Anxiety' (When the dose wears off in 4 hours, the panic comes back worse than before). Respiratory: Respiratory depression (fatal with opioids).

Key Interactions

Opioids, Alcohol. Co-ingestion is a primary cause of overdose death. Strong CYP3A4 inhibitors (Ketoconazole, Clarithromycin) significantly increase Alprazolam toxicity.

Monitoring

If a patient is admitted taking > 2mg/day chronically, you MUST prescribe it to prevent withdrawal seizures, but seek psychiatric advice to cross-taper to diazepam for safe weaning.

Clinical Pearl

Because it wears off in 4-6 hours, patients wake up in a state of 'rebound panic'. They take another pill to fix it. This creates a vicious, unbreakable cycle of addiction. Avoid starting it.

Access

Xanax, Kalma, Alprax1 mg tablet

Brand: Xanax, Kalma, Alprax
Formulation: Tablets (250 mcg, 500 mcg, 1 mg, 2 mg)

Alprazolam

Short-acting potent·Neurology - Sedatives & Hypnotics

Panic disorder with/without agoraphobia, severe anxiety disorders

S8BENZOXanax, Kalma, Alprax1 mg tabletTGA

Max Dose

4 mg/day

Half-life

11-15 h

Dependence

SEVERE

Rebound Panic

HIGH RISK

Rapid Summary

Overview

Highly potent, short-acting triazolobenzodiazepine. Unmatched for rapid termination of severe panic attacks, but carries the highest addiction, abuse, and withdrawal risk of the entire class.

Maximum Dose

Max 4 mg/day (Usually 0.5 - 1 mg per dose).

Clinical Focus

Up-scheduled to S8 in Australia due to massive abuse. Prescribing on the ward is extremely restricted and generally avoided.

Bottom Line

Alprazolam is a short-acting benzodiazepine for panic disorder and acute anxiety, but has the highest dependence and withdrawal seizure risk of all benzodiazepines.

Formulation & Access

Brand Names

Xanax, Kalma, Alprax

Oral Routes

Tablets (250 mcg, 500 mcg, 1 mg, 2 mg).

Prescribing & PBS

Highly Restricted (S8). Private script only in most states.

Indications & Use

Primary

TGA

Panic disorder with/without agoraphobia, severe anxiety disorders.

Clinical Place

Largely blacklisted for routine use. Reserved for patients already dependent on it, or extreme, refractory panic disorder under psychiatric care.

Quick reference

Class & Role

Short-acting potent — Highly potent, short-acting triazolobenzodiazepine.

Route / Formulation

Tablets (250 mcg, 500 mcg, 1 mg, 2 mg). (Xanax, Kalma, Alprax)

Usual Dose & Max

PO 0.25 - 0.5 mg TDS. Max 4 mg/day.

Key Indication Doses

Panic Disorder: PO 0.25 - 0.5 mg TDS. Max 4 mg/day. Anxiety: PO 0.25 mg BD to TDS.

Best Uses

Alprazolam is a short-acting benzodiazepine for panic disorder and acute anxiety, but has the highest dependence and withdrawal seizure risk of all benzodiazepines.

Avoid / Cautions

Substance abuse history, severe respiratory failure, Myasthenia Gravis. Pregnancy Category D. Associated with congenital malformations and severe neonatal withdrawal.

Key Risks

Key Interactions

Opioids, Alcohol. Co-ingestion is a primary cause of overdose death. Strong CYP3A4 inhibitors (Ketoconazole, Clarithromycin) significantly increase Alprazolam toxicity.

Monitoring

If a patient is admitted taking > 2mg/day chronically, you MUST prescribe it to prevent withdrawal seizures, but seek psychiatric advice to cross-taper to diazepam for safe weaning.

Clinical Pearl

Because it wears off in 4-6 hours, patients wake up in a state of 'rebound panic'. They take another pill to fix it. This creates a vicious, unbreakable cycle of addiction. Avoid starting it.

Access

Xanax, Kalma, Alprax1 mg tablet

Brand: Xanax, Kalma, Alprax
Formulation: Tablets (250 mcg, 500 mcg, 1 mg, 2 mg)