Comprehensive Monograph on Alprazolam (DB00404)

I. Introduction and Executive Summary

Alprazolam is a potent, fast-acting, small molecule drug belonging to the triazolobenzodiazepine class of central nervous system (CNS) depressants.[1] Since its approval by the U.S. Food and Drug Administration (FDA) in 1981, it has become one of the most widely prescribed psychotropic medications in the United States, primarily under the brand name Xanax.[3] Developed by the Upjohn Company, alprazolam was introduced as a therapeutic agent for the management of anxiety disorders and panic disorder, positioned as a potentially safer and more effective alternative to older sedative-hypnotics like barbiturates.[5]

This report provides a comprehensive, evidence-based analysis of alprazolam, exploring the profound dichotomy that defines its clinical profile: its established therapeutic utility versus its significant and often underestimated risks. The central theme of this monograph is the critical examination of this paradox. While the drug offers rapid and effective relief for debilitating anxiety and panic for many patients, it carries a high liability for misuse, physical dependence, and a uniquely severe withdrawal syndrome that can be life-threatening.[7] Furthermore, its pharmacokinetic profile makes it highly susceptible to dangerous drug interactions, a risk magnified by its widespread use in a polymedicated population.[10]