Many of you reading this article will probably know or have heard of the drug it refers to. And it is alprazolam, one of its best known commercial names being Trankimazin , which is one of the most common psychoactive drugs in the treatment of anxiety, one of the most common mental problems in the population.

Throughout this article we will see, among other aspects, what type of substance it is, its mechanism of action and some of its main uses.

Alprazolam: type of substance and main characteristics

Alprazolam is a medicine with psychoactive properties or psychopharmaceutical that is classified among the anxiolytics , substances used to treat anxiety and its manifestations. Among the anxiolytics, it is part of the benzodiazepines, being one of the most popular and consumed types of psychopharmaceutical by the population (being much safer, effective and with fewer side effects than its predecessors the barbiturates).

In the specific case of alprazolam, we are dealing with an intermediate-acting benzodiazepine , which means that it needs less time to start working in the body compared to a long-acting benzodiazepine, but at the same time its effects last less time than these, and vice versa in the case of a short-acting benzodiazepine.

Its duration is approximately between 12 and 24 hours. This duration of effect is advantageous, since it generates a lower probability of dependence and addiction to the substance and fewer doses are needed to cause a prolonged anxiolytic effect, in addition to making the medication take too long to take effect.

Mechanism of action of this benzodiazepine

Like the other benzodiazepines, alprazolam’s main mechanism of action is based on its interaction with gamma-aminobutyric acid or GABA , one of the main inhibitory neurotransmitters of the central nervous system.

Alprazolam acts as an agonist of this neurotransmitter at GABA A receptors, favouring its action in such a way that it hinders the realisation of action potentials by the neurons. In other words, they make the neuronal activation of certain areas of the brain less effective. This action is carried out predominantly on the limbic system (highly activated in anxiety) and the cerebral cortex.

Disorders and problems for which it is used

Alprazolam is an effective psychoactive drug that has been found to have multiple indications, especially in the area of anxiety. Some of the best known and most common are the following.

1. Anxiety disorders

The main indication for alprazolam is its use in anxiety disorders. Among them we often find panic disorder (with or without agoraphobia) and generalized anxiety disorder.

2. Adaptive disorders

Adaptive disorders, those in which some type of symptoms appear that can be explained by the experience of a specific event or by psychosocial stress, are also often treated with alprazolam and other benzodiazepines.

3. Depression

Although it is not its priority use, alprazolam has sometimes been used in depressive disorders, especially in those with high anxiety or mixed anxiety-depressive symptoms. However, this application should be assessed and applied with great caution in patients with suicidal thoughts and severe depression , as it may increase the symptoms.

4. Social phobia

One of the indications for alprazolam is found in patients suffering from social phobia, helping to reduce the level of anxiety at the prospect of exposure to other people.

5. Chemotherapy

Alprazolam has also been shown to be useful in treating the discomfort and anxiety generated by chemotherapy in patients who must undergo it because of some type of tumour.

Alprazolam Side Effects and Risks

The use of alprazolam can be very useful in the treatment of various symptoms, especially with regard to anxiety. However, it is a psychodrug that can generate different adverse effects, so its use must always be indicated and supervised by the physician.

Among them, the most common is the presence of drowsiness and sedation, occasionally together with headache and dizziness . Concentration and attention are diminished. Nausea and vomiting, fatigue, blurred vision, hypotension, urinary incontinence, tremors, or sexual alterations may also occur. Much less common is the presence of adverse reactions such as increased intraocular pressure, confusion, hallucinations, irritability, agitation or aggression.

Another adverse effect to be considered is that the use of alprazolam and other benzodiazepines may cause specific memory problems, both at the retrograde and antegrade level. It may cause difficulties in remembering previous information , or make it difficult to learn new information. It can also be found that on occasions suicidal ideations may appear. In rare cases, paradoxical reactions also appear, that is, reactions contrary to those expected after the administration of the treatment (restlessness, anxiety, agitation, etc.).

In addition to these symptoms, it should be noted that benzodiazepines are potentially addictive substances and there is a risk of becoming dependent on them. In the case of alprazolam this risk exists, although it is lower than for short-acting benzodiazepines. It is also essential to take into account that the consumption of psychopharmaceuticals should not be stopped all at once , since there is a possibility of withdrawal or even rebound anxiety.

Similarly, there is a risk of overdose, which can lead to cardiorespiratory arrest or failure. These overdoses can sometimes be treated with flumazenil.


The use of alprazolam is not recommended for all types of patients, but there are circumstances that may make this psychoactive drug contraindicated. One of these is in patients with narrow angle glaucoma , as well as in those subjects who suffer from alterations in the respiratory tract or respiratory failure, as it may be dangerous for them. It is also contraindicated in myasthenia.

Similarly, it should not be consumed during pregnancy or while breastfeeding. Likewise , patients with renal or hepatic insufficiency should not take this medicine either , or the doses should be very much regulated taking into account such insufficiency.

Bibliographic references:

  • Gómez, M. (2012). Psychobiology. Manual CEDE de Preparación PIR.12. CEDE: Madrid
  • Salazar, M.; Peralta, C.; Pastor, J. (2011). Manual of Psychopharmacology. Madrid, Editorial Médica Panamericana.
  • Stevens, J.C. & Pollack, M.H. (2005). Benzodiazepines in clinical practice: consideration of their long-term use and alternative agents. J Clin Psychiatry; 66 (Suppl 2):21-7.