PsychRounds: The Psychiatry Podcast Alprazolam (Xanax)
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Oct 29, 2025 This discussion dives into the history of Xanax, tracing its approval for anxiety and panic in the '80s. The hosts explore its rapid effects on the GABA-A receptor and highlight safety concerns, including addiction and withdrawal risks. They emphasize its suitable use for acute anxiety rather than long-term treatment. Intriguingly, they touch on its potential antidepressant effects and regulatory challenges, including a denied depression indication. Comparative efficacy against other medications offers more insight into its role in anxiety management.
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Rapid Onset And Short Half-Life
- Alprazolam is fast-acting with onset as quick as 15 minutes and peak plasma at 1–2 hours.
- It has high lipid solubility, a 10–12 hour half-life, and is metabolized primarily by CYP3A4.
Prefer PRN Dosing And Conservative Start
- Start adults at 0.25–0.5 mg up to three times daily and observe the FDA max of 4 mg/day.
- Prefer PRN dosing to minimize long-term dependence and withdrawal risk.
High Potency And Rapid Dependence
- One milligram of alprazolam roughly equals 10 mg of diazepam, reflecting high potency.
- Rapid onset and short duration make tolerance, reinforcement, and severe withdrawal more likely within weeks.