Alprazolam
Standing risks
| Risk | Recorded values | Confidence | Article section |
|---|---|---|---|
| Dangerous withdrawal, taper carefully |
| high | View in article: Dangerous withdrawal, taper carefully |
| High dependence, taper carefully |
| high | View in article: High dependence, taper carefully |
Lethal interactions
| Combination | Type | Severity | Mechanisms | Confidence |
|---|---|---|---|---|
| Opioids | Drug class | lethal | 2 | high |
Dangerous interactions
21 dangerous interactions recorded for this substance.
See the full interactions tableContraindications
| Condition | Severity | Note |
|---|---|---|
| Respiratory | ||
| severe respiratory insufficiency | absolute | Alprazolam is contraindicated in patients with severe respiratory insufficiency due to its CNS depressant effects on respiratory centers. |
| sleep apnea syndrome | absolute | Alprazolam worsens both obstructive and central sleep apnea by reducing respiratory drive and pharyngeal muscle tone. |
| Psychiatric | ||
| post-traumatic stress disorder | relative | Alprazolam is specifically associated with worsening of PTSD symptoms — a concern not shared uniformly across the benzodiazepine class. Use in PTSD patients should be avoided or closely monitored. |
| borderline personality disorder | relative | Increased impulsivity reported specifically with alprazolam in BPD patients. Risk of dangerous impulsive acts under disinhibition. |
| bipolar disorder | relative | Risk of mania or hypomania induction. More commonly reported with alprazolam than other benzodiazepines. |
| Hepatic | ||
| severe hepatic impairment | relative | Clearance markedly reduced in cirrhosis and severe hepatic disease. Dose reduction essential or avoidance recommended. |
| Pregnancy & Breastfeeding | ||
| pregnancy | relative | Benzodiazepine class risk of neonatal complications. No alprazolam-specific pregnancy safety data available in published literature. |
| Age | ||
| elderly | relative | Reduced clearance in elderly patients necessitates dose reduction. Increased fall risk and cognitive vulnerability. |
| Other | ||
| known hypersensitivity to benzodiazepines | absolute | Patients with documented hypersensitivity to any benzodiazepine should not receive alprazolam. |
| acute narrow-angle glaucoma | absolute | Contraindicated in acute narrow-angle glaucoma; benzodiazepine class effect. |
| concurrent opioid use | absolute | FDA black box warning for concomitant benzodiazepine-opioid use. Fatal respiratory depression documented at subtherapeutic alprazolam concentrations when combined with opioids. |