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A Review of Alprazolam Use, Misuse, and Withdrawal

Ait-Daoud, Nassima, MD; Hamby, Allan, Scott, MD; Sharma, Sana, MD; Blevins, Derek, MD

doi: 10.1097/ADM.0000000000000350

Alprazolam is one of the most widely prescribed benzodiazepines for the treatment of generalized anxiety disorder and panic disorder. Its clinical use has been a point of contention as most addiction specialists consider it to be highly addictive, given its unique psychodynamic properties which limit its clinical usefulness, whereas many primary care physicians continue to prescribe it for longer periods than recommended. Clinical research data has not fully shed light on its “abuse liability,” yet it is one of the most frequently prescribed benzodiazepines. “Abuse liability” is the degree to which a psychoactive drug has properties that facilitate people misusing it, or becoming addicted to it, and is commonly used in the literature. We have replaced it in our manuscript with “misuse liability” as it reflects a more updated terminology consistent with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In this paper, we have reviewed alprazolam's indications for use, its effect on pregnant women, misuse liability, withdrawal syndrome, pharmacodynamic properties, and suggest better clinical prescription practice of alprazolam by presenting an indepth theory of its clinical effects with use and withdrawal.

University of Virginia, Department of Psychiatry and Neurobehavioral Sciences. Charlottesville, VA (NA-D, SS, DB); Sentara RMH Medical Center: 2010 Health Campus Drive, Harrisonburg, VA (ASH).

Send correspondence to Nassima Ait-Daoud, MD, Associate Professor, University of Virginia, Department of Psychiatry and Neurobehavioral Sciences, P.O. Box 800623, Charlottesville, VA 22908. E-mail:

Received 29 March, 2017

Accepted 2 July, 2017

The authors report no conflicts of interest.

© 2018 American Society of Addiction Medicine