Alprazolam 43Although the drug normally encourages eating, about 20% of persons in
one study experienced weight loss, along with unwanted effects such as dif-
ficulty in controlling muscles (including urinary incontinence), peevishness,
bellicosity, and lowering of inhibitions. Researchers generally believe the drug
interferes with sexual function in men and women. A case report tells of the
drug causing mania with euphoria, high self-confidence, increased energy,
and trouble with getting proper sleep—all rather untypical effects. Despite
such possibilities, one team reviewing scientific literature found reports of
unwanted actions to be uncommon for alprazolam, and another team con-
cluded that alprazolam generally has fewer such reports than other benzodi-
azepine class drugs. Analysts who examined medical records of 10,895
alprazolam patients found little mention of unwanted effects. In evaluating
the infrequent accounts of mania, aggression, hallucinations, or other unex-
pected psychological reactions to alprazolam, we should remember that many
such cases involve persons already exhibiting psychiatric disturbances for
which they are receiving the drug. Such reactions may be far less likely in a
psychiatrically normal person.
Abuse factors.An experiment showed no tendency for abuse of alprazolam
among users even though it is a controlled substance. A 1993 review of human
and animal studies of the drug concluded that scientific experimental evidence
failed to support a popular belief that abuse of alprazolam was more likely
than abuse of other benzodiazepine class drugs. Another 1993 report dis-
agreed but described alprazolam abuse as minuscule and limited to persons
already misusing other drugs, particularly opiates and alcohol. Brainwave and
other measurements imply that alprazolam has more appeal to alcoholic men
than it does to nonalcoholics. Experiments show that persons with a family
history of alcoholism tend to experience more pleasure (even euphoria) when
taking alprazolam than do persons lacking such a history. Tests find the drug
to have stronger effects (positiveandnegative) on women whose fathers were
alcoholics, compared to women whose immediate family background does not
include alcoholism. When experiments gave drug abusers a choice between
diazepamor alprazolam, the abusers tried both but found alprazolam more
pleasant.
Craving and tolerance do not seem to develop, but alprazolam can produce
bodily dependence, which is a traditional sign of addictive potential. Sudden
stoppage can cause seizures or delirium, so practitioners customarily wean
their patients with tapering dosages. Withdrawal symptoms may include per-
spiration, tremors, cramps, vomiting, diarrhea, cloudy eyesight, prickling sen-
sations on the skin, and general befuddlement. Convulsions and seizures are
reported. One experiment noted that withdrawal signs cleared up in a week.
Drug interactions.Kava is an intoxicating drink prepared from the kava
plant, suspected of interacting so seriously with alprazolam that a coma may
result. Persons taking antifungus drugs such as itraconazole or ketoconazole
are supposed to avoid alprazolam, as those two drugs increase the power and
prolong the effect of an alprazolam dose. The heartburn medicine cimetidine
(Tagamet), the antidepressant fluoxetine (Prozac), and the pain-relieving
opioidpropoxypheneeach lengthen the time an alprazolam dose lasts, and
ritonavir (used against the human immunodeficiency virus in AIDS [acquired