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Alprazolam shares the actions of other benzodiazepines and is used for the management of anxiety disorders or for the short-term relief of symptoms of anxiety or anxiety associated with depressive symptoms. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic. The efficacy of alprazolam for long-term use (i.e., longer than 4 months) has not been evaluated. The need for continued therapy with the drug should be periodically reassessed.

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Alprazolam is used in the management of panic disorder, with or without agoraphobia. Efficacy of alprazolam in the management of panic disorder has been established in short-term (for periods up to 4-10 weeks) controlled studies, although the drug has been used without apparent loss of efficacy for longer periods (e.g., 8 months or longer) in many patients. Following discontinuance of the drug, a relapse of the condition, including a rebound in panic attacks and anxiety, and/or the development of withdrawal frequently occurs. Additional study is needed to establish the optimum duration of alprazolam therapy in the management of panic disorder, and to determine the most appropriate method of tapered withdrawal of the drug.

The potential dependence liability of alprazolam should be considered in weighing the possible risks and benefits of therapy with the drug in this condition. Effective treatment of panic disorder with alprazolam often has required dosages exceeding 4 mg daily, and spontaneous reporting data suggest that the risk and severity of dependence is increased in patients receiving such dosages for prolonged periods (e.g., longer than 12 weeks). In 2 controlled studies of 6- to 8-weeks’ duration in which the patient’s ability to discontinue therapy was assessed, 7-29% of patients with panic disorder did not completely taper off of alprazolam therapy. In a controlled postmarketing study, the ability of patients with panic disorder to discontinue alprazolam therapy was reduced in those receiving dosages exceeding 4 mg daily but did not appear to differ between those receiving the drug for 3 months compared with those receiving the drug for 6 months.

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