[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Benzodiazepines](https://durgical.com/en/pharmacology/classes/benzodiazepines/) › Alprazolam

[Pharmacology](https://durgical.com/en/pharmacology/) · [Benzodiazepines](https://durgical.com/en/pharmacology/classes/benzodiazepines/)

# Alprazolam

A triazolobenzodiazepine used for panic disorder and anxiety. Anxiety between doses, dependence and withdrawal are particular concerns.

Updated 2026-11-01

- Class: [Benzodiazepines](https://durgical.com/en/pharmacology/classes/benzodiazepines/)
- Receptor: GABA-A receptor, benzodiazepine site
- ATC code: N05BA12

◎**GABA-A receptor, benzodiazepine site**Alprazolam

ⓘ The figure shows alprazolam itself bound to the human GABA-A receptor (α1β3γ2L) with GABA.

**Target in 3D:** GABA-A receptor, benzodiazepine site. PDB structure 6HUO (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/6HUO) · Drag to rotate · pinch to zoom

## Mechanism of action

Alprazolam binds the benzodiazepine site of the GABA-A receptor and makes GABA open the chloride channel more often, reducing anxiety and panic attacks. CYP3A4 breaks it down, so strong CYP3A inhibitors raise its levels sharply.

- Binds the benzodiazepine site of the GABA-A receptor
- GABA opens the chloride channel more often
- Fear circuits are damped: fewer panic attacks

## Pharmacokinetics

**Absorption**
Peak about 1 to 2 hours after a dose by mouth

**Metabolism**
By CYP3A4 to 4-hydroxy- and alpha-hydroxyalprazolam

**Half-life**
About 11 hours on average, with wide variation

## Indications

- Panic disorder, with or without agoraphobia [Panic disorder →](https://durgical.com/en/conditions/panic-disorder/)
- Generalized anxiety disorder (short-term) [Generalized anxiety disorder →](https://durgical.com/en/conditions/generalized-anxiety-disorder/)

## Adverse effects

### Common

- Drowsiness and light-headedness
- Poor coordination
- Memory problems
- Anxiety between doses or early in the morning in panic disorder

### Serious (rare, important)

- Profound sedation, respiratory depression, coma and death when combined with opioids
- Abuse, misuse and addiction
- Physical dependence; stopping suddenly can cause life-threatening withdrawal, including seizures
- Withdrawal seizures after a rapid dose reduction

## Contraindications

- Hypersensitivity to benzodiazepines
- Use with strong CYP3A inhibitors such as ketoconazole or itraconazole

## Key interactions

**Opioids**
Profound sedation, respiratory depression, coma and death

**Alcohol and other central nervous system depressants**
Additive sedation and breathing depression

**Strong CYP3A inhibitors (ketoconazole, itraconazole)**
Much higher alprazolam levels: contraindicated

**CYP3A inducers (carbamazepine, phenytoin)**
Lower alprazolam levels

**Digoxin**
Digoxin levels may rise

## What is monitored

- Sedation and breathing, especially with opioids
- Signs of misuse, dose escalation or early refills
- Withdrawal symptoms during tapering

## Administration and safety

- Given by mouth; immediate- and extended-release tablets are not interchangeable
- Controlled medicine: stored securely and counted
- Tapered gradually when stopped

## Nursing care

- Before each dose, check level of alertness, breathing rate and oxygen saturation
- Ask about opioids, alcohol and other sedatives
- Prevent falls, especially in older adults (unsteadiness, confusion)
- Teach not to drive or drink alcohol and not to stop the medicine suddenly
- Teach to avoid grapefruit and to report other new medicines (CYP3A)

## Pregnancy and breastfeeding

Use late in pregnancy can cause sedation and withdrawal symptoms in the newborn, who is watched after birth.

## Memory aid

Alprazolam: «ALarm PRAZOLAM» – for the panic alarm, but it rings again between doses and on withdrawal.

## Test yourself

Think of the answer, then tap the question to see it.

## Which antifungals are contraindicated with alprazolam, and why?

Ketoconazole and itraconazole: they block CYP3A4 and raise alprazolam levels sharply.

## What is interdose anxiety with alprazolam?

Early-morning or between-dose anxiety in panic disorder as levels fall.

## What can a rapid dose reduction of alprazolam cause?

Withdrawal reactions, including seizures.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/alprazolam/)

## Related drugs

- [Clonazepam](https://durgical.com/en/pharmacology/clonazepam/)
- [Lorazepam](https://durgical.com/en/pharmacology/lorazepam/)
- [Buspirone](https://durgical.com/en/pharmacology/buspirone/)
- [Flumazenil](https://durgical.com/en/pharmacology/flumazenil/)

## Related conditions

- [Panic disorder](https://durgical.com/en/conditions/panic-disorder/)
- [Generalized anxiety disorder](https://durgical.com/en/conditions/generalized-anxiety-disorder/)

[← Back to the class: Benzodiazepines](https://durgical.com/en/pharmacology/classes/benzodiazepines/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - ALPRAZOLAM tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a23063c0-099a-4256-b95f-3a857bbf704b) (DailyMed (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N05BA12) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [6HUO: CryoEM structure of human full-length heteromeric alpha1beta3gamma2L GABA(A)R in complex with alprazolam (Xanax), GABA and megabody Mb38.](https://www.rcsb.org/structure/6HUO) (RCSB Protein Data Bank, 2019).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/alprazolam/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/alprazolam/