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alprazolam tablets, USP
DESCRIPTION
XANAX Tablets contain alprazolam which is a triazolo analog of the 1,4 benzodiazepine
class of central nervous system-active compounds.
The chemical name of alprazolam is 8-Chloro-1-methyl-6-phenyl-4H-s-triazolo [4,3-?] [1,4]
benzodiazepine
Alprazolam is a white crystalline powder, which is soluble in methanol or ethanol but which
has no appreciable solubility in water at physiological pH.
Each XANAX Tablet, for oral administration, contains 0.25, 0.5, 1 or 2 mg of alprazolam.
XANAX Tablets, 2 mg, are multi-scored and may be divided as shown below:
Inactive ingredients: Cellulose, corn starch, docusate sodium, lactose, magnesium stearate,
silicon dioxide and sodium benzoate. In addition, the 0.5 mg tablet contains FD&C Yellow
No. 6 and the 1 mg tablet contains FD&C Blue No. 2.
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While the epidemiologic trends concerning alprazolam (Xanax®) are unknown, the use of benzodiazepines, in general, has increased in popularity among youth within recent years. To shed light on the drug problem, the current pilot study used a qualitative approach to investigate relevant beliefs, norms, and perceived addiction associated with alprazolam initiation among 46 youth who were attending an inpatient drug treatment program during the spring of 2004. Overwhelmingly, most participants stated that addiction to alprazolam occurs as early as initial consumption. Most youth in the study stated that their friends felt it was normal to use alprazolam. In addition, their control beliefs revealed that if someone wanted to stop it would be difficult because of the widespread use in their communities and family social reinforcement involved with its use. In this study, a majority of students stated that medical professionals such as doctors and pharmacists were the greatest facilitator of alprazolam acquisition. Implications for these results are discussed.
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Panic attack
Triggers and causes
* Long-Term, Predisposing Causes - Heredity. Panic disorder has been found to run in families, and this may mean that inheritance genes plays a strong role in determining who will get it. However, many people who have no family history of the disorder develop it. Various twin studies where one identical twin has an anxiety disorder have reported an incidence ranging from 31 to 88 percent of the other twin also having an anxiety disorder diagnosis. Environmental factors such as an overly cautious view of the world expressed by parents and cumulative stress over time have been found to be causes (Bourne 2005).
* Biological Causes - Generalized anxiety, obsessive compulsive disorder, Post Traumatic Stress Disorder, hypoglycemia, hyperthyroidism, Wilson’s Syndrome, mitral valve prolapse, pheochromocytoma and inner ear disturbances (Labyrinthitis). (Bourne 2005) Vitamin b deficiency from inadequate diet or caused by periodic depletion due to parasitic infection from Tape worm can be a trigger of anxiety attacks.
* Phobias - People will often experience panic attacks as a direct result of exposure to a phobic object or situation.
* Short-Term Triggering Causes - Significant personal loss, life transitions, significant life change, stimulants such as caffeine or nicotine, or the drugs marijuana or psilocybin, can act as triggers (Bourne 2005).
* Maintaining Causes - Avoidance of panic provoking situations or environments, anxious/negative self-talk (”what if thinking”), mistaken beliefs (”these symptoms are harmful and/or dangerous”), withheld feelings, lack of assertiveness. (Bourne 2005)
* Medications - Sometimes panic attacks may be a listed side effect of medications such as Ritalin (methylphenidate). These may be a temporary side effect, only occurring when a patient first starts a medication, or could continue occurring even after the patient is accustomed to the drug, which likely would warrant a medication change in either dosage, or type of drug. Nearly the entire SSRI class of antidepressants can cause increased anxiety in the beginning of use. It is not uncommon for inexperienced users to have panic attacks while weaning on or off the medication, especially ones prone to anxiety.
* Hyperventilation Syndrome - Breathing from your chest may cause overbreathing, exhaling excess carbon dioxide in relation to the amount of oxygen in one’s bloodstream. Hyperventilation Syndrome can cause respiratory alkalosis and hypocapnia. This syndrome often involves prominent mouth breathing as well. This causes a cluster of symptoms including rapid heart beat, dizziness, and lightheadedness which can trigger panic attacks. (Bourne 2005)
* Situationally Bound Panic Attacks - Associating certain situations with panic attacks, due to experiencing one in that particular situation, can create a cognitive or behaviorally predisposition to having panic attacks in certain situations (situationally bound panic attacks). It is a form of classical conditioning (Bourne 2005). See PTSD
* Pharmacological Triggers - Certain chemical substances, mainly stimulants but also certain depressants, can either contribute pharmacologically to a constellation of provocations, and thus trigger a panic attack or even a panic disorder, or directly induce one. This includes caffeine, amphetamine, alcohol and many more. Some sufferers of panic attacks also report phobias of specific drugs or chemicals, that thus have a merely psychosomatic effect, thereby functioning as drug-triggers by non-pharmacological means.
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Physiological considerations
While the various symptoms of a panic attack may feel that the body is failing, it is in fact protecting itself from harm. The various symptoms of a panic attack can be understood as follows. First, there is frequently (but not always) the sudden onset of fear with little provoking stimulus. This leads to a release of adrenaline (epinephrine) which brings about the so-called fight-or-flight response wherein the person’s body prepares for strenuous physical activity. This leads to an increased heart rate (tachycardia), rapid breathing (hyperventilation) which may be perceived as shortness of breath (dyspnea), and sweating (which increases grip and aids heat loss). Because strenuous activity rarely ensues, the hyperventilation leads to a drop in carbon dioxide levels in the lungs and then in the blood. This leads to shifts in blood pH (respiratory alkalosis or hypocapnia), which in turn can lead to many other symptoms, such as tingling or numbness, dizziness, burning and lightheadedness. Moreover, the release of adrenaline during a panic attack causes vasoconstriction resulting in slightly less blood flow to the head which causes dizziness and lightheadedness. Lastly, a panic attack can cause blood sugar to be drawn away from the brain and towards the major muscles. This can also cause derealization and lightheadedness.
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The “Panic Trick” (Carbonell 2004)
Many experts and researchers including Dr. David Carbonell describe panic attacks and Panic Disorder as a “trick” (a very effecrive trick) on two crucial fronts. Firstly, it tricks the sufferer into believing what they are experiencing is dangerous (i.e. having a heart attack, fainting, insanity, and/or “doing something crazy”) when a panic attack presents absolutely no danger whatsoever. Secondly, they trick the afflicted into doing anything and everything that they believe will help them when it actually makes the panic attacks worse- the second component of the trick. These activities would include avoidance behaviors, trying to control panic attacks, fighting panic attacks,superstitions and rituals to avoid panic attacks and excessive self-protection. That is to say, what people faced with panic attacks do, most often, perpetuates the panic and sometimes turns panic attacks into Panic Disorder.(Carbonell 2004)