Talk:Alprazolam/Archive 1

Archive 1

Archive 2

Archive 3

Side-Effects Image

I deleted it because it's incredibly biased and incorrect. It also wrongly states certain symptoms known not to be related to alprazolam usage, as common side-effects of the drug. For example, it states that trouble urinating is a side effect of xanax. This is simply not true and there has been no evidence ever, to back up that assertion. Also, in looking at other posters of drug side-effects made by the same company, you can find clear evidence of biased and un-proven claims. The company that manufactures these images is more often than not, incorrect in what they put on their posters as far as the scientific community is concerned, and thus these posters should not be used as reliable sources of information on this, or any other wiki page, ever.

The "company" that "manufactured" the list of symptoms is The American Society of Health-System Pharmacist at the National Institutes of Health, the list is found at MedlinePlus --> Alprazolam, and I regard that source as fairly reliable. Still, no one is perfect, and if you give another side-effects list from a better source, I may do a review on the image. Mikael Häggström (talk) 17:33, 5 July 2009 (UTC)

As a general rule, it's not smart to use images/information from biased authorities with vested interests in specific viewpoints. IE, using the images/information created by NIDA or NIH on marijuana, in a marijuana facts article. I don't need to give another side-effects list from a better source because there is no reason to include a side-effects picture in this article. The article can stand just fine without one. If YOU are interested in finding a better source, I suggest that YOU research the side effects of alprazolam as noted by a non-biased source, but the source that created the image is just plain wrong. I've never seen any evidence that alprazolam causes trouble urinating. There is no evidence to back that assertion up, yet they added it in to the image regardless. I'm removing the image again, and if you can show me evidence that every side effect listed from that source is correct, then feel free to put it back. Until then, leave it out. —Preceding unsigned comment added by 24.251.185.162 (talk) 08:35, 27 July 2009 (UTC)

History section

Could someone please include a history section? - 5/14/2006

This page lists "Irreversible (non repairable) cognitive deficits and lasting loss of personality" as a possible side effect. Nowhere else have I seen this described as a side effect of Xanax. Could someone please provide substantiation for this claim?

This page is a major target for spam. I just reverted some more. NSR (talk) 20:31, 31 July 2005 (UTC)

I've added a request to deal with this spam at [1]. Yelyos 07:41, August 8, 2005 (UTC)

Request has been dealt with - the spammer should not be able to operate any longer. Yelyos 07:54, August 8, 2005 (UTC)

I'm not a good writer, but I felt that I should make some changes. Alprazolam's uniqueness is in it's panic suppressant qualities, and this is what makes it different from other benzodiazipines. Other forms of anxiety disorders can often be treated equally well with other benzos. Someone may wish to "clean up" my writing style, though.

All benzodiazepines suppress anxiety but alprazolam is more useful in this role because of its short duration of effect. I've tried a little "cleaning up" but feel free to tinker more if you don't like it. I removed the SPEICAL RISK PATIENTS section because I think that it's misleading; benzodiazepines are popular in large part because they are safe on overdose - they don't suppress breathing and so deaths from BZD overdose alone is almost unheard of, and overdose with these agents is common (of course in combination they're more dangerous). ben

This page is beginning to look better, although all the other benzo pages still need a great deal of work. I organized the trade names into a list in an attempt to make them easier to read through. Let me know what you think. - Fuzzform 21:07, 13 December 2005 (UTC)

Love this sentence: "Overdose deaths caused by alprazolam alone are seldom fatal." —Preceding unsigned comment added by 71.75.53.236 (talk) 03:08, 20 November 2007 (UTC)

abuse by cocaine users

• I have it on (unfortunately) good authority that some habitual cocaine users sometimes use xanax to calm themselves when they're 'tweaking' (too high). Does anyone know where I can find a source for this?--PharmerJoe 17:54, 28 January 2006 (UTC)

Drug and food interaction

What about drug interaction? Does this drug interact with other prescription drugs or over the counter medications? —The preceding unsigned comment was added by 65.80.43.119 (talk • contribs).

You can get that information from the prescribing info link on the article [2]. OhNoitsJamie^Talk 03:39, 23 March 2006 (UTC)

>>> Nice pickup on the CYP3A4 (Tagamet) interaction -- I missed it. Dan Schwartz Discpad 16:01, 30 May 2007 (UTC)

Dosage

Alprazolam is taken as needed (PRN); 4 to 6 doses per month are the acceptable limit.

This dosage information HAS to be incorrect. A lot of ppl take Alprazolam daily as directed.

— Preceding unsigned comment added by Manos@baz.com (talk • contribs) 03:47, 15 March 2006 (UTC)

This has now been corrected. It should have been 4 to 6 doses a day.

This is not right either: most commonly for Anxiety Disorders, Alprazolam is administered twice a day "BID" (or less commonly three times a day "TID"). The most common prescription is for 1mg BID. Panic Disorder sufferers whose symptoms are not diminished by the common prescription of 1mg BID are sometimes taken up to 2mg TID. — Preceding unsigned comment added by 71.241.75.66 (talk) 01:50, 8 October 2006 (UTC)

Wrong. Alprazolam is most commonly given prn q4-6, not bid. I mean, the drug is designed to stop panic attacks when one comes on, it isn't supposed to be used pre-emptively (though sometimes it is). After a prn dosage, a QD dosage is the next most frequently prescribed schedule (for people who use it to sleep), followed by a TID schedule. BID is rarely, if ever, seen with alprazolam simply because the half life of alprazolam is inappropriately short for a BID dose. Alprazolam really stops working after about 4-6 hours. You would see a TID dosage before a BID dosage because TID works more effectively as a preventative schedule than does BID. Anyone who is prescribing BID or TID isn't prescribing for any reason other than to pre-empt a panic or anxiety issue, and thus BID is inappropriate. Also, the most common dose is 0.5mg ,not 1mg.

— Preceding unsigned comment added by 24.251.185.162 (talk) 11:28, 3 July 2009 (UTC)

Availability

Alprazolam is generally sold in generic form in the United States. It is also sold under many other brand names, depending on the country:

Xanax is also sold as a liquid in the US.

fruity reactions?

I had a scrip for generic xanax several months ago. On the bottle were three warning stickers. The first two were the standard "don't drink alcohol" and "may cause intense dizziness/drowsiness" warnings. The third was a warning about possible interactions with citrus juices. Anyone know what that was about? ZekeMacNeil 21:01, 18 April 2006 (UTC)

Did it specifically mention grapefruit juice? See the grapefruit article, this blog: but also PMID 10907671. Colin°^Talk 22:49, 18 April 2006 (UTC)

DM: yea, if you check the benzodiazepam article i think it says citrus, specifically grapejuice, reduces the body's ability to metabolize it and extends the effects. —Preceding unsigned comment added by 69.248.83.175 (talk) 21:41, 6 February 2008 (UTC)

Absorbtion Through Mucous Membranes

Xanax can be absorbed through mucous membranes. People put xanax in the anuses.

[Skidoo here:] This is most likely inaccurate. Or rather, people may very well take alprazolam rectally, but it is not soluble in water, so the likelihood that anyone would experience an appreciable effect from this sort of administration is very slim.

Xanax is available as a suppository: One use is for children travelling by air if they get a panic attack. Discpad 15:04, 20 May 2007 (UTC)

Depending on the mucous membrane in question, it is typically (high) lipid solubility, not (low) water solubility, that determines the ease with which absorption takes place. 71.229.192.95 (talk) 03:57, 30 March 2010 (UTC)

Insufflation?

[Note: All comments below refer to "standard" alprazolam, not the extended-release pills being marketed under the name "Xanax XR."]

I have read in several sources that alprazolam is not water-soluble; ergo snorting it (isufflation) does not enhance its effectiveness. In fact, snorting alprazolam actually REDUCES its bioavailability, because the powder has to make the relatively circuitous journey through your sinuses and down the back of your throat into your stomach. So not only will it take you longer to feel the effects, but the effects will be diminished, as the dose will be absorbed over a greater length of time versus swallowing a pill.

Plus, alprazolam pills taste horrible. They're very, very bitter. They can leave a nasty bitter stripe on your tongue if you're not careful. And alprazolam is a potent drug. A 2MG dose is usually coveyed in a pill that itself can weigh an entire gram. Which means that the great bulk of what you snort if you crush an alprazolam pill is just filler.

My on-line sources are sparse, but I'll try to work this info into the article and remove the incorrect assertions.

"...Fillers can be bad for your nasal passages, and can do serious damage to the lungs when inhaled. Many pills contain cellulose and chalk, which pass through your intestines harmlessly when taken orally, but can be very destructive if they get into the lungs...since they are not water soluble." http://www.erowid.org/ask/ask.cgi?ID=2698

"Alprazolam is a white crystalline powder, which is soluble in methanol or ethanol but which has no appreciable solubility in water at physiological pH." http://www.xanax.com/xanax.pdf

Just because something has low soluability in water does not mean it lacks any appreciable effects when insufflated. If this were true than taking xanax sublingually would not work, yet it works wonderfully. One formulation of alprazolam, Niravam, is an ODT (orally disintegrating tablet), and if alprazolam wasn't water soluable at all the ODT wouldn't work, but it does. If something can be taken sublingually than it can also be taken intranasally since the same mucous membranes are responsible for absorbtion in both the nasal passages, and under the tongue. —Preceding unsigned comment added by 24.251.185.162 (talk) 11:20, 3 July 2009 (UTC)

Insufflation / Grapefruit Juice and Alprazolam

I also agree with the above poster: the effects of alprazolam are NOT increased by insufflation. If anything potency is reduced as described above. Only water soluble substances are absorbed through the nasal membranes, and as http://www.xanax.com/xanax.pdf and other sources show, alprazolam is only slightly soluble in water.

There are also no sources to back up the claim made in the recreational use area of the page regarding increased potency.

Also, numerous sources have verified that the bioavalability of alprazolam is not significantly increased in a statistically meaningful way by the consumption of grapefruit juice, however, the decreased metabolic effects caused by grapefruit juice and/or other citrus juices can cause an increase in blood serum levels and can increase the longevity of the elimination half-life of alprazolam, possibly to toxic levels, although, is generally unlikely unless copious amounts are consumed; however, toxicity resulting from consumption of grapefruit juice or other citrus fruits is unlikely while administering aplrazolam; this is often more characteristic of medications that interact with grapefruit juice (i.e. opioids, benzodiazepines) that have a lower binding percentage to blood plasma proteins since alprazolam is approximately eighty percent bound in human plasma therefore, it does not have much more potential to increase to cause lethal toxicity. (Refer to Clinical Pharmacology at RXList.com) — Preceding unsigned comment added by 24.169.141.83 (talk) 19:03, 30 January 2007 (UTC)

"Grapefruit juice altered neither the steady-state plasma concentration of alprazolam nor the clinical status in patients. The present study shows that grapefruit juice is unlikely to affect pharmacokinetics or pharmacodynamics of alprazolam due to its high bioavailability."

-- http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10907671&dopt=Abstract

"Effects of repeated ingestion of grapefruit juice on the single and multiple oral-dose pharmacokinetics and pharmacodynamics of alprazolam; Psychpharmacology (Berl). 2000 Jun; 150(2):185-90"

-- http://www.druginteractioncenter.org/consu.php?interaction_category=9&detail=61

— Preceding unsigned comment added by 24.131.58.35 (talk) 22:22, 4 August 2006 (UTC)

Link

How can one suggest a site to get listed as a "reference" or an "external link"? If I edit and add it to the page it automaticaly gets reverted?

I have been in touch with "Daniel" at wikipedia and he suggested I add the link to the page first and if the link is removed, then leave it that way and maybe mention the link on the discussion page. If others see value in having the link, it will eventually get put into the article?

May I suggest the link here in the discussion page so you can see the value of the site? The site list many books on alprazolam! Thanks. 8/29/06 —The preceding unsigned comment was added by Drmarilyn (talk • contribs). (moved by Dirk Beetstra ^{T C} 18:12, 29 August 2006 (UTC))

What is the site? --Dirk Beetstra ^{T C} 18:12, 29 August 2006 (UTC)

I saw it, Anxietybookstore.com - Alprazolam. Well, I reverted that edit, because the reference was added without any data, hence, the page was not used as a reference. It could be in a external-link section, but then it would have to point directly to a page giving more data. Therefore, I don't think the link is appropriate. Sorry. --Dirk Beetstra ^{T C} 18:16, 29 August 2006 (UTC)

Ok "Dirk" thanks for the taking the time to check it out though,just thought that maybe it would be useful to wikipedia users that want to learn more on alprazolam, hopefully in the future there will be more info added to the page in order to be listed as a "reference" or even as an "external-link" in wikipedia. Thanks again and wikipedia ROCKS!!!!!!!!!

Invention Credit/History of Chemical Class/Purported "Antidepressant" Effects

The article credits Pfizer with the invention of alprazolam; in fact, the first two triazolobenzodiazepines introduced in the US, alprazolam and triazolam (Halcion) were invented by Upjohn, as was the prototype drug of this class, adinazolam. The rights to alprazolam and triazolam were subsequently sold to Pfizer. Adinazolam -- which, contrary to what is thought to be typical for the triazolos, is a low-potency drug, with a typical dose of ~ 60 mg -- was never sold in the US.

There is something wrong with stating that alprazolam may have an antidepressant effect, but that there is no evidence of this. What does that even mean? Nothing. In fact, it was initially thought (one should say, "hoped," especially by Upjohn) that the triazolo-BZs were going to turn out to represent a whole new class of drug, with properties distinct from the "classical" BZs. In fact, today it is known that there is nothing special about triazolo-BZs, and in fact a variety of fused heterocyclic ring structures can replace the typical 2-carbonyl (or occassionally, thionyl) moiety in meeting the structure-activity requirements for a benzodiazepine. The notion that alprazolam exerts "antidepressant" effects that are distinct from its anxiolytic effects was a marketing hypothesis, not a scientific hypothesis, and it no longer holds water as either one. Any such idea should be deleted from Wikipedia.

--EatonTFores 15:35, 8 October 2006 (UTC)

I think that alprazolam does have some antidepressant properties but that they are largely mild effects. I have updated the article with some citations on the antidepressant properties of alprazolam.--Literaturegeek | T@1k? 19:53, 9 December 2008 (UTC)

I read an abstract about a double-blind placebo-controlled study on PubMed conducted by Japanese researchers in 2007 with regards to alprazolam being used as monotherapy for MDD (Major Depressive Disorder) with success. I did not bookmark that site. Can anyone else find it? If so, that information should be posted. It is well-known that alprazolam, in higher doses, causes 5-HT (serotonin) release with some action on norepinephrine and beta-adrenergic receptors. Benzodiazepines other than alprazolam do not have this effect. 202.152.170.241 (talk) 09:48, 10 March 2009 (UTC)

Small issue under Contraindications

I have a small issue with a statement made under the subheading "Patients at a high risk for abuse and dependence," "Patients with chronic pain or other physical disorders." Is there a source for this statement?

I'm a chronic pain patient, and from my own research, people with chronic pain are at a higher risk for physical tolerance simply because we tend to take medications for longer lengths of time than the average person. Since we are on these medications for a long period of time, we are more susceptible to becoming tolerant of the medication, not having a dependancy on the medication. I would like to see the source for this statement simply so that I can take a look at it myself to see the author's supporting facts for the statement. There is a big difference between misuse, abuse and dependence, and physical tolerance, especially because of the negatice connotations attached to "misuse, abuse and dependence." It seems to say to some that people with chronic pain are almost assuradly addicts who misuse, abuse, and are dependent on these kinds of medications, which is far from the truth. Our bodies may be tolerant of the medication, which is why occassionally we need increases in dosage levels or even to change medications so that they are effective for our pain, but that's really different from dependence.

If you have a moment, I think it would help a lot to add a source for this section especially, simply so that readers can do further research if they see fit and see the information that proves the statements, and then evaluate it for themselves.

Thank you!! --ErinENj 04:57, 8 January 2007 (UTC)

Side Effects

I have heard from physicians that long term use of BDZs can cause Heartburn but I have no reference for you. I and a co-worker both developed these symptoms after years of use and was told this was common.

--

Fatigue/joint pain/flu-like symptoms are listed as a side effect, but I have not seen it listed in any of the section's footnote sources. What is the source of this information? —Preceding unsigned comment added by 149.175.43.40 (talk) 23:20, 17 January 2008 (UTC)

I think that the side-effects should be presented in a more reasonable order. The side-effects listing would be more effective and understandable if the side-effects were listed more in order of likelihood. Pharmaceutical commercials advertise uncommen side-effects for personal (i.e. corporate) liability, wheras we are simply tring to provide first hand information. —Preceding unsigned comment added by Maozim (talk • contribs) 17:43, 24 April 2008 (UTC)

Drug Interactions

I didn't notice any information about the interactions with anti-fungal drugs. There is a good reference on xanax.com. PS. Thank you for all of this information it was quite helpful.

There is a potential for pharmacokinetic interaction with several agents, most notably ketaconazole and erythromycin, potent 3A4 inhibitors. Alprazolam is a 3A4 substrate. This should be in the pharmacokinetic section. Luke dm5 (talk) 00:23, 21 April 2008 (UTC) luke_dm5

Also... I noticed that SSRI's (including Prosac) may amplify the effects of Alrazolam, this should be mentioned because these two drugs are often administered togather —Preceding unsigned comment added by 68.35.234.96 (talk) 23:33, 25 June 2008 (UTC)

History

When I was first perscribed Xanax in 1986 the PDR said that Xanax was going to be less habit forming than Valuim (The current information of xanax.com does not sugest this any more). It also was going to be less likely to cause an overdose. I guess the "Marketing Hype" is of interest as well as the history of pharmacology.

Also does anyone else think this article needs more Lil Wayne?

--

There's a little bit of a grey area there. Alprazolam has one of the shortest half lives, whereas diazepam has one of the longest half lives. Often, when one is addicted to one benzo, if its a short acting one, a doctor might change them to diazepam which has a longer half life, so the symptoms of withdrawal they suffer are relieved, and they can taper off the diazepam. Having used both, I can say that Alprazolam is more addictive due to its more exagerated effects on the body. The problem is, diazepam having a long half life, it takes a long time for it to leave your system, like, several days sometimes. Even if you arent taking one daily, the diazepam is building up, so when you stop taking the drug, you might experience withdrawal symptoms. Timeshift 19:20, 4 March 2007 (UTC)

Off-Label Use

While suffering from a sinus infection, my left eye lid muscles began to twitch for days on end. I saw my doctor and he prescribed Xanax "as a muscle stabilizer." The off-label use as a potential systemic muscle/nerve stabilizer could be mentioned. My pharmacist also was aware of this off-lable use and talked to me about how it would essentially reduce the nervous activity throughout the CNS, and hopefully reduce the twitch with it.

— Preceding unsigned comment added by 209.234.149.2 (talk) 00:42, 16 May 2007 (UTC)

Teratogenicity and non-teratogenic effects

I added in a section on effects during pregnancy, gleaned from the Rx List warnings. Dan Schwartz Discpad 15:07, 20 May 2007 (UTC)

Verification of DEA Schedule?

Could someone please verify that Xanax is DEA Schedule IV? My Doctor believes it is Schedule II, which means among other things, in the United States, an Rx cannot be phoned in... Discpad 15:11, 20 May 2007 (UTC)

You need to get a new doctor. It says "C(IV)" on the commercial bottle that it comes in (generic or brand). You can also have 5 refills on a xanax prescription, which is more evidence that it isn't a CII, since CII's only get 1 fill total. If it's that important to you, you can always show the doctor ANY nurses drug handbook which will clearly state that it's a C(IV)... but to be honest I would just get a competent doctor. —Preceding unsigned comment added by 24.251.185.162 (talk) 11:14, 3 July 2009 (UTC)

Effects

Why are effects like agitation, hostility, hallucinations, sleeplessness, and convulsions listed under side effects? Xanax was made to prevent exactly these types of things. Unless these are supposed to be withdrawal symptoms, in which case that should be clarified. Also, in first hand experience I've never noticed any nausea, sweating, depression or changes in urination. Maybe it's just me.

Hello,

They are known as paradoxical reactions. Some side effects are rare and some are common. --Carpetman2007 16:34, 12 August 2007 (UTC)

Memory Loss

I added the information about Memory Loss, with a reference to an Erowid Experience, this was the best that I could find. There has to be more information about this 'side effect' of Xanax, because it is real. If anyone can find better references, it'd be great. JavaDog 14:37, 15 September 2007 (UTC)

other trade names

in Brazil alprazolam is sold under the name of "Frontal" (as the main brand name), but there are generic forms of it, just named "alprazolam" —Preceding unsigned comment added by 201.24.137.52 (talk) 09:55, 9 October 2007 (UTC)

I have my own experience... me and a friend kept taking alcohool, lorazepam and xanax one night, i dont know how many we had, i had a small bottle with 5mg lorazepam pills and a box with 0.5mg xanax. We had 2 bottles of wine during the night.

Not only i cant rememeber anything from a certain point in the night, but i cant remember anything at all the next day (although i was in a semi-conscious state and was functionating, cause i know i went shoping for clothes, but cant remember buying them). And in the 2nd day after that night i had a period of about 1 hour experiencing double vision... My friend went to the hospital at the 2nd day. He spent 4 hours sleeping while waiting to be attended, after some tests they sent him home, though they wanted him to stay overnight to be observed he refused. —Preceding unsigned comment added by 89.152.211.72 (talk) 04:11, 6 November 2007 (UTC)

I know that Busebar is not a trade name for alprazolam. It is just anothe anti anxiety pill that greatly resembles a 2mg alprazolam pill. Insted of being a long white pill that can be split into fours like xanax is can only be split into thirds. —Preceding unsigned comment added by 72.154.39.178 (talk) 03:57, 5 June 2008 (UTC)

Fair use rationale for Image:XanaxHologramAd.png

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BetacommandBot (talk) 05:46, 30 November 2007 (UTC)

History of alprazolam

LevelTubes tried to delete a section of History because it was based on the book by David Healy "The Psychopharmacologists III", because "the claim that "patients" running to buy pfizer stock is unsubstantiated except in the anti-psychiatrist's "cited" book".

First of all, "Psychopharmacologists III" is a book of interviews, which was only edited by Healy, and I took the information on the history of alprazolam directly from the Sheehan's words so no possible bias by Healy could be introduced. The story is clearly attributed in Sheehan in the body of the Alprazolam article: "Sheehan describes that the first group of patients..." etc.

Secondly, David Healy is not "antipsychiatrist" he is a conventional psychiatrist (see David Healy (psychiatrist)), one-time secretary of the British Association for Psychopharmacology and currently professor of Psychological Medicine in Cardiff [3]. Regardless of his views on the SSRIs and suicide, he is certainly the leading expert on the history of psychopharmacology—he authored nine books in this area with two of them published by the prestigious Harvard University Press. Paul gene 18:14, 2 December 2007 (UTC)

I agree the deletion was unfair. Prof David Healy is not antipsychiatry at all. He is a very well respected doctor in the UK. Just because he raised the profile of SSRI's having dependence and withdrawal problems (and his views are now confirmed and contained in the patient information leaflets about withdrawal reactions when stopping SSRIs) does not make him antipsychiatry and for someone to suggest such a thing about Prof Healey is ridiculous. All that can be said about Prof Healey is that he is a stern supporter of more open research and less conflict of interest in medicine. He is pro-improving scientific openess in research in drugs and that is all. --Literaturegeek 21:26, 2 December 2007 (UTC)

Use of Cquote and RQquote templates in articles is discouraged

Template:Rquote is a is a variant of the {{Cquote}} quotation template. According to Template:Cquote, "this template should not be used for block quotes in article text." This point of view is supported by WP:MOS—"Block quotes are not enclosed in quotation marks (especially including decorative ones such as those provided by the {{cquote}} template, used only for "call-outs", which are generally not appropriate in Wikipedia articles). Use a pair of <blockquote>...</blockquote> HTML tags." Paul gene (talk) 11:24, 14 December 2007 (UTC)

-- Random Deletion ==

Deleted "xanax bars fuck you up mah nigga.. fuck wit em. they good" from the links section. —Preceding unsigned comment added by 24.147.170.95 (talk) 08:21, 26 December 2007 (UTC)

Half-Life discrepency between IR & XR in sources/improper reference

When examining the references for the half life in both the Xanax XR and IR, they cite the same figures "Using a specific assay methodology, the mean plasma elimination half-life of Alprazolam has been found to be about 11.2 hours (range: 6.3-26.9 hours) in healthy adults." The site is misleading by saying 'specific' methodology, however, since the numbers are the same its obvious its a study of the drug independently (IR package).

So we either need to correct the numbers or the references if there was another source used. —Preceding unsigned comment added by Jmoore2333 (talk • contribs) 19:33, 29 July 2008 (UTC)

GA nomination

I have removed this article from Wikipedia:Good article nominations, as it is not yet ready for a review. There are five "citation needed" tags and a cleanup banner. Before renominating the article, I recommend dealing with the tags and banners, ensuring that the article is fully sourced, expanding the lead section, and formatting the references, preferably with Template:Cite web (many are missing information — the should have at least a title, url, publisher, and accessdate). Best wishes, GaryColemanFan (talk) 21:55, 27 October 2008 (UTC)

I have just done quite a bit of work to the article. The tags have been dealt with and the banners are no longer needed and have been removed. I have sourced the unsourced sections of the article and I have expanded the lead section. All references are placed in the citation template format now.--Literaturegeek | T@1k? 21:53, 9 December 2008 (UTC)

Availability

I think we should remove the availibility section. Half of these named I never even heard of, and Google doesn't have alot of info. I believe this horrible section is what is keeping Alprazolam from being a good article. If you need to contact me on my talk page, please feel free.Cssiitcic (talk) 21:38, 31 October 2008 (UTC)

I changed it to english only brand names greatly shortening the section and added a web citation.--Literaturegeek | T@1k? 22:56, 31 October 2008 (UTC)

An image on this page may be deleted

This is an automated message regarding an image used on this page. The image File:Alprazolam2mgresize.jpg, found on Alprazolam, has been nominated for deletion because it does not meet Wikipedia image policy. Please see the image description page for more details. If this message was sent in error (that is, the image is not up for deletion, or was left on the wrong talk page), please contact this bot's operator. STBotI (talk) 17:20, 28 December 2008 (UTC)

Removed non-encyclopedic Michael Jackson specific section

It is unnecessary and non-encyclopedic to have a specific section regarding the use or misuse by a celebrity of a specific pharmaceutical. This is more properly placed in the celebrity/death of celebrity article with a wikilink to the pharmaceutical in question. -- Rydra Wong (talk) 10:13, 7 July 2009 (UTC)

Number of users

Could the article benefit from usage statistics in the United States and other countries? Number of people who are prescribed this drug, estimates of numbers using it without prescription. RomaC (talk) 02:14, 10 July 2009 (UTC)

Dissociative Disorders

It is also prescribed for these (in the absence of any specifically recommended drugs) that's what I take it for. —Preceding unsigned comment added by 173.180.218.83 (talk) 01:22, 28 January 2011 (UTC)

Dose Escalation

Dose escalation most certainly is characteristic of this drug 74.131.16.117 (talk) 10:01, 7 January 2009 (UTC)

I agree, I will delete the sentence.--Literaturegeek | T@1k? 20:56, 28 January 2009 (UTC)

Dose escalation is rare in those prescribed alprazolam for legitimate medical conditions. You can find abstracts on Pubmed which demonstrate that panic disorder patients on alprazolam for 10 years never escalated the dose. In fact, the article goes on to say that they tended to reduce the dose over the ten year period. Alprazolam also maintained its anxiolytic efficacy over the same time period. The vast majority of those who abuse alprazolam are persons with preexisting substance abuse disorders, including alcoholism (which includes those who indulge in "recreational use", which is simply a flowery name for abuse). Alprazolam does not make the average person euphoric. If someone experiences euphoria from taking alprazolam, then they are abusing the medication or taking it in conjunction with other illicit substances. I think the entire article is written by benzophobes who just want to bash alprazolam.

I've been on benzodiazepines including alprazolam for 20 years and have never increased the dose or experienced any "euphoria" or any habituation. 202.152.170.241 (talk) 10:46, 10 March 2009 (UTC)

I would like to note that I was prescribed alprazolam for a severe panic attack disorder and severe generalized anxiety disorder and most certainly escalated the dose too high. (Discussion of whether or not that was my fault is irrelevant, hah.) As it is known for, the drug has become ineffective and counterproductive as I became physically dependent on it. Although escalation may be rare, it is a very recognizable threat. Personally, in agreement with the article, I do not recommend this drug for long term use to anyone. This is what I would call a sledgehammer drug; it should be used when force that is otherwise excessive is necessary, and it is not by any means precise or gentle in its approach. This is serious drug, even for medical application, and should be approached with caution. Omnimmotus (talk) 19:58, 26 May 2009 (UTC)

I think the literature is consistent with the abuse of alprazolam among the population being treated for an anxiety disorder (not recreational use) being very uncommon, although every psychoactive drug produced is no doubt is abused by some populations (even Prozac, with its often nasty side effects). My personal experience and my eight year experience as a facilitator for an anxiety/depression support group is consistent with the post above ending in "I've been on benzodiazepines including alprazolam for 20 years and have never increased the dose or experienced any "euphoria" or any habituation." Individuals with anxiety orders seem to have an global aversion to any medication-the literature also documents that compliance with taking benzodiazepines for these patients is a continuing problem, especially problematic since the rate of suicide among some anxiety sufferers is higher than for the depressed. Dehughes (talk) 16:01, 23 May 2011 (UTC)

Withdrawal section

This is unbalanced. In the many years alprazolam has been used, many many people have stopped ordinary therapeutic doses (I don't mean abusive doses) with no problem. I think I can find a reference for this, but it is always more difficult to find references for what, for many years, was simply taken for granted (that there is very little withdrawal except when doses are very high) than it is to find references for recent claims (that it is much more dangerous than we ever thought). I'll work on a reference supporting the overall safety of cessation, but I do think that the sheer number of references exaggerating the difficulty is deceptive.Rose bartram (talk) 00:07, 15 March 2009 (UTC)

The majority of papers on benzodiazepine withdrawal conclude between 30% - 100% of people discontinuing benzodiazepines experience significant withdrawal problems upon discontinuation, even low dose dependence. If the lower bracket of 30% is accurate then 70% discontinue without problems but 30% is still very common and significant. I am not sure what your viewpoint is but if it is that withdrawal is uncommon and insignificant you are going to find it a very tough job finding a ref to back up your belief, even a clinical study never mind a review paper. If your suggestion is that we should shrink the size of the section a bit, that might be an idea. It did cross my mind that the section was a bit large.--Literaturegeek | T@1k? 00:43, 15 March 2009 (UTC)

I just deleted a paragraph to shorten the section down a bit. Looks better now.--Literaturegeek | T@1k? 00:53, 15 March 2009 (UTC)

Imputing a "viewpoint" that withdrawal is "uncommon and insignificant" looks to me like straw-man argumentation. I said only that the section seemed unbalanced. I am actually planning to use pharmacology texts, not articles, as books are a bit more resistant to hype. No, I am not trying to start an editing war. It's just that there are a lot of people whose benzodiazepine use is unhealthy and whose rationalizations are wrapped up in exaggerated beliefs about dependency and withdrawal. It is not NPOV to portray the situation as this article does.Rose bartram (talk) 12:25, 15 March 2009 (UTC)

I am sorry if you felt that I was misrepresenting you or using a straw man argument. Perhaps I misinterpreted your position. I actually think that some balance could be brought to that section. Not everyone gets severe withdrawal and some can discontinue with no withdrawal.--Literaturegeek | T@1k? 23:31, 15 March 2009 (UTC)

Re Litgeek's latest changes, I know when to give up on a hopeless situation. Stahl is well-respected, and you disregard him at your peril. Just because sloppy use of terms, such as using "withdrawal" as a synonym for "discontinuation," is widespread does not mean it is right. Also, there is a link to the "benzodiazepine withdrawal" article at the head of the section, so the added links seem more like advertising than Wikification.Rose bartram (talk) 11:29, 25 March 2009 (UTC)

uh, huh? Anti-depressants are well known and documented in the fact that they cause physical addiction and thus withdrawal. You have your terms backwards. Addiction is a term coined by pharm companies to suggest that you will psychologically crave a drug, while physical dependence is a term used to describe the physiological changes which take place when your body is exposed to a drug that can cause physical dependence. That is why they say anti-depressants aren't addictive, but will cause "discontinuation symptoms" (ie, physical withdrawal). In my opinion, it's all crap. If a drug causes you to crave that drug again, or if it causes your body to change its own physiology which results in physical withdrawal symptoms, than IMO it should be called addictive. Distinctions should be made between the "type" of addiction (physical or psychological), but it's still addiction in my book.24.251.185.162 (talk) 03:26, 4 July 2009 (UTC)

You seem to be getting agitated. Please remember, WP:CIVIL. I explained in the edit summary that withdrawal is the correct scientific terminology used for drugs of physical dependence. Discontinuation syndrome is used for drugs which have not proved to cause physical dependence eg antidepressants.

Why do I need to ignor Stahl at my peril? From the footnotes of this paper Dr. Stahl has been a consultant for, received honoraria from, or conducted clinical research supported by Abbott, Asahi Kasei, AstraZeneca, Bristol-Myers Squibb, Cephalon, Cypress Bioscience, Eli Lilly, GlaxoSmithKline, Organon, Otsuka, Pfizer, Pierre Fabre , and Wyeth. Also several other pharmaceutical companies according to another paper. So basically the World Health Organisation, British National Formulary and Committee on Safety of Medicines are sloppy but Stahl is well respected and should change the designation of scientific terminology. I disagree. The manufacturer of xanax, pfizer also call it withdrawal symptoms and withdrawal syndrome in their product information guide for prescribing doctors. Are they sloppy as well?--Literaturegeek | T@1k? 12:51, 25 March 2009 (UTC)

Schatzberg an author of the other book is a cofounder of a pharmaceutical firm and has been involved in controversy over alledged failure to disclose financial conflicts of interest. According to this paper, In the past 3 years, Dr Schatzberg has served as a consultant for Abbott Laboratories, Inc, Aventis, BrainCells, Bristol-Myers Squibb Co, Corcept Therapeutics, Eli Lilly & Co, Forest Pharmaceuticals, Inc, GlaxoSmithKline, Innapharma, Inc, Janssen Pharmaceutica Products, LP, Neuronetics, Inc, Organon Pharmaceuticals, Inc, Pfizer, Inc, Somaxon Pharmaceuticals, Somerset Pharmaceuticals, Inc, and Wyeth Pharmaceuticals. He has received grants from Bristol-Myers Squibb Co, Eli Lilly & Co, GlaxoSmithKline, Somerset Pharmaceuticals, Inc, and Wyeth Pharmaceuticals. He is also a founder of Corcept Therapeutics. More conflicts documented in this paper.[4] I haven't looked at the other authors but I am sure I would find another similar story. The only reason I am looking into this information is because you have wrongly accused me of using sloppy editing when I was sticking to respected scientific definitions.--Literaturegeek | T@1k? 13:06, 25 March 2009 (UTC)

This is somewhat of a minor point, but the idea of "rebound anxiety" seems to be a bit of a dated concept....recent thoughts by current experts (e.g. Shipko) tend to believe that when a tapering schedule is too aggressive (as was very common in the past when the drug was not believed to be particularly dependence-causing), it causes severe anxiety suddenly-which may be perceived as worse than the original anxiety state. Given the inherent subjective nature of determining "rebound anxiety", it would seem to be best omitted from a scientific point of view-if, for no other reason than it cannot be verified empirically. While this isn't the place to do it, I commend the editors/writers of this article for its balanced presentation, which is not the case, in my opinion, in many other Wikipedia benzodiazepine-related articles. 71.251.128.88 (talk) 23:07, 14 January 2011 (UTC) Dehughes (talk) 19:30, 23 May 2011 (UTC)

I might as well make two minor points: the statement "To some degree, these older benzodiazepines are self-tapering"-that is, the implication that shorter half-life benzos cause dependence more readily-has come into question in several studies of late. It has been suggested that longer half-life benzos simply delay the onset of withdrawal symptoms and this has been mistaken as a weaker dependence-inducing property. An additional complication is that there is such large biological variation as to how dependent an individual becomes; also, there have been studies (I can dig all this stuff out if anyone really cares)that suggest that a lot of benzo dependence is psychological, rather than physical, in nature-which would, of course, help explain the large differences in "dosing interval to dependence". We all recall the medical community was in agreement that what caused Valium to cause dependence was its long half life and hence the introduction of Xanax was heralded as a step in the right direction when it came to the issue of dependence; well, that turned out not to be true. I suspect (and I've read) that the "short half life causes more dependence" mantra is being questioned. Considering the history of dogmatic statements about benzos by the medical community, it's really hard to be on firm ground with any point of view. 71.251.128.88 (talk) 17:27, 15 January 2011 (UTC) Dehughes (talk) 19:30, 23 May 2011 (UTC)

Contradiction

I couldn't see where better to add this, so I'll just stick it here. There appears to be some contradiction between a statement in this article: "Alprazolam has a fast onset of symptom relief (within the first week); it is unlikely to produce dependency or abuse." and a statement on the article on diazapam (http://en.wikipedia.org/wiki/Diazepam) under the "Drug Misuse and addiction" section, which states: "The most commonly-abused benzodiazepine is, however, alprazolam."

so, which is correct? Is alprazolam highly addictive and abused, or not? —Preceding unsigned comment added by 118.92.182.91 (talk) 03:36, 23 February 2010 (UTC)

Both statements are correct I think, the source doesn't put the statement into context unfortunately. In context, this is what is being said, most patients do not abuse their medication and won't descend into addictive drug abuse. Such a statement would also be true for people receiving opiod painkillers for example. However, benzodiazepines a commonly abused drug on the street and in the USA alprazolam is the "favourite" benzo. Only a minority of people abuse prescription drugs, most people don't.--Literaturegeek | T@1k? 19:10, 23 February 2010 (UTC)

I think it is not sensible to say "Alprazolam has a fast onset of symptom relief (within the first week); it is unlikely to produce dependency or abuse.". Alprazolam IS effective for therapeutic uses but it must be acknowledged that it will cause at least some form of dependency even in therapeutical quantities. Dependency and withdrawal associated with it can very from simple rebound anxiety to convulsions, tremors and heavy dysphoria. I think people seeking information on alprazolam, whether it be Xanax or some other brand name, should be warned of the dependency potential of benzodiazepines. Which also applies to clonazepam and diazepam, for example. For example, see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1002418/ .

Halocandle (talk) 19:41, 8 March 2010 (UTC)

I agree that the wording is misleading especially to the lay reader. Dependence has many different meanings, in this context it is talking about abusive drug addiction. I have made some changes, for clarity and added in some more references and more text. Click on the history tab at the top of the article and the diff links of my edits and let me know if my edits have resolved your concerns. :) Your source is interesting but it is a bit old to be making scientific statements.--Literaturegeek | T@1k? 08:39, 9 March 2010 (UTC)

Looks better to me, thanks Literaturegeek. While googling around I found another credible source which specifically states that alprazolam, lorazepam and triazolam can be classified as the top three when it comes to abuse potential. ( http://www.benzo.org.uk/ashbzab.htm ) You're right with the assumption that not all patients develop dependency, but I think the issue should remain visible in the first blocks of text. Some people do rely on Wikipedia when it comes to information about drugs. Although it should be physician's responsibility to take care of his or her patient :) Halocandle (talk) 09:06, 9 March 2010 (UTC)

Great. The reference doesn't specifically say that, unless I am missing something. Can you copy and paste the relevant sentence(s) from the reference? It might be worth summarising some of the history section in the first paragraph. What do you think? If you want to feel free to make a stab at it.--Literaturegeek | T@1k? 22:58, 23 March 2010 (UTC)

What is "The primary uses of alprazolam are: anxiety disorders, panic disorders, and nausea due to chemotherapy" supposed to mean? 125.16.180.5 (talk) 10:38, 10 May 2011 (UTC)

FDA labeling

The label says "the longer term efficacy of Xanax XR has not been systematically evaluated. The physician who elects to use this drug for periods longer than 8 weeks should periodically reassess the usefulness of the drug for the individual patient"

It does not say it is approved for only short term use. It does not say "for up to 6-8 weeks". What it says is that their studies only lasted 8 weeks, so they have no systematic data for longer use. What it says is to reassess usefulness periodically after treatment of longer than 8 weeks. This is already cited in the body of the Wiki article. The source has been misrepresented in the article. 70.137.156.196 (talk) 23:43, 24 July 2011 (UTC)

The FDA approval is based on the studies. Because it has only been studied for 6 to 8 weeks, it is only approved for 6 to 8 weeks. It is NOT approved for long term use. Please do not change this again. It is indeed only approved for 6-8 weeks. Thank you. — Preceding unsigned comment added by Charleswallacecharleswallace (talk • contribs) 03:46, 25 July 2011 (UTC)

It says it is approved. The other claims are your synthesis. Read the label. It does not say "approved for only 6-8 weeks". Where does it say, what you claim? Cite that wording, not what you think it would imply. It has already been cited from the text word by word. Don't change that. 70.137.153.193 (talk) 04:49, 25 July 2011 (UTC)

(edit conflict) I agree with 70.137 here. We can't go beyond what the labels and other sources say. If it's approved only for a certain time-frame, we need a source that specifically supports both ends of the range as the approved length. Otherwise we're getting hypothetical if we say that an approval based on an 8-week study is limited to that length as the approved use. That latter seems to be CW's contention, and it's quite possibly true, but if so we should have a clearly stated direct cite of it. For example, if it's routinely prescribed longer off-label, some professionals would have likely discussed this somewhere in print, and that article would likely contain a statement like "although only approved for 8-week treatments, longer courses are sometimes used for...". Until then (and especially given the controversy we see here), the article should leave out the disputed statement and instead state only the specifically supported facts--no harm or hurry in saying nothing, and WP:V concerns about saying something that is disputed vs given sources. DMacks (talk) 04:53, 25 July 2011 (UTC)

This is what FDA label says (copy/paste)

INDICATIONS AND USAGE XANAX XR Tablets are indicated for the treatment of panic disorder, with or without agoraphobia. This claim is supported on the basis of two positive studies with XANAX XR conducted in patients whose diagnoses corresponded closely to the DSM-III-R/IV criteria for panic disorder (see CLINICAL STUDIES). Panic disorder (DSM-IV) is characterized by recurrent unexpected panic attacks, ie, a discrete period of intense fear or discomfort in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes: (1) palpitations, pounding heart, or accelerated heart rate; (2) sweating; (3) trembling or shaking; (4) sensations of shortness of breath or smothering; (5) feeling of choking; (6) chest pain or discomfort; (7) nausea or abdominal distress; (8) feeling dizzy, unsteady, lightheaded, or faint; (9) derealization (feelings of unreality) or depersonalization (being detached from oneself); (10) fear of losing control; (11) fear of dying; (12) paresthesias (numbness or tingling sensations); (13) chills or hot flushes. The longer-term efficacy of XANAX XR has not been systematically evaluated. Thus, the physician who elects to use this drug for periods longer than 8 weeks should periodically reassess the usefulness of the drug for the individual patient.

So it "is approved"! And "periodically reassess". So easy. Everything else is WP:SYN. We cannot change the wording of the "Is approved..." above. It doesn't say "for short term symptomatic relief", it doesn't say "up to 6-8 weeks". It says what to do when using for longer treatment. 70.137.153.193 (talk) 05:04, 25 July 2011 (UTC) 70.137.153.193 (talk) 05:04, 25 July 2011 (UTC)

The 6/1/2001 XANAX label says "Demonstrations of the effectiveness of XANAX by systematic clinical study are limited to 4 months duration for anxiety disorder and 4 to 10 weeks duration for panic disorder; however, patients with panic disorder have been treated on an open basis for up to 8 months without apparent loss of benefit. The physician should periodically reassess the usefulness of the drug for the individual patient." So even the previously stated timeframe of study is not up-to-date. And further, "Anxiety Disorders: XANAX Tablets (alprazolam) are indicated for the management of anxiety disorder (a condition corresponding most closely to the APA Diagnostic and Statistical Manual [DSM­ III-R] diagnosis of generalized anxiety disorder) or the short-term relief of symptoms of anxiety." separately from the panic-disorders section. So our article's statement about only being approved for panic disorders seems out-of-date. Part of the confusion might be that some studies looked specifically at the extended-release formulation, whereas our article is generally about the chemical itself rather than limited to certain formulations. Have to remember we're trying to provide useful information to a wide range of audiences instead of cloning PDR or other medical advice. DMacks (talk) 05:17, 25 July 2011 (UTC)

Note: should read "6/1/2011" (not 2001) in my comment. DMacks (talk) 20:23, 25 July 2011 (UTC)

Good if we have a newer version. First I had to make it fit to the reference they cited, that is only a formal issue of a linguistic nature regarding the semantics. It seems hard to convey what citing a reference means. Thank you for the newer source. 70.137.153.193 (talk) 05:29, 25 July 2011 (UTC)

Here link to Alprazolam label/indications

http://www.fda.gov/ohrms/dockets/dockets/06p0209/06P-0209-EC12-Attach-1.pdf 70.137.153.193 (talk) 06:02, 25 July 2011 (UTC)

I am a physician and it is a fact that it is only FDA approved for short term use. The FDA labeling is indicating that it is only approved for the 6-8 weeks, as the FDA approves for usage based on the clinical trials. It is indeed ONLY approved for which it has been studied. Please do not change it again. Thank you. — Preceding unsigned comment added by 174.130.244.69 (talk) 14:39, 25 July 2011 (UTC)

Per WP:V wikipedia policy, we cannot take your word for it. It's a bit concerning that a physician would not take a moment to read the label-link above to see multiple statements about trials longer than 8 weeks if clinical-trial duration is the basis for his analysis. DMacks (talk) 14:47, 25 July 2011 (UTC)

There you see why I am always afraid to see a physician :)) 70.137.153.193 (talk) 14:51, 25 July 2011 (UTC)

Look at his last revert of your revert. He didn't notice that either. I could probably show up carrying my head under my arm and he would prescribe Aspirin, when this head would start talking and complaining about headache. 70.137.153.193 (talk) 14:55, 25 July 2011 (UTC) 70.137.153.193 (talk) 16:05, 25 July 2011 (UTC)

I read up to 8 month on the label and in the study.TMCk (talk) 16:27, 25 July 2011 (UTC)

The study has been up to 8 months. The label approves use without this time limit, but advises to periodically check the usefulness for the individual patient. It does not say indicated for up to 8 months. 70.137.153.193 (talk) 17:27, 25 July 2011 (UTC)

Yes it does.TMCk (talk) 17:37, 25 July 2011 (UTC)
"Alprazolam is also indicated for the treatment of panicdisorders for up to 8 month"TMCk (talk) 17:41, 25 July 2011 (UTC)
It's on the package insert to be precise.TMCk (talk) 17:50, 25 July 2011 (UTC)

Sorry to be dense here, TMCk, but do you have a link to this insert? The label-link given by 70.137 above on page 4 section "INDICATIONS AND USAGE" says "Panic Disorder: XANAX is also indicated for the treatment of panic disorder, with or without agoraphobia." The later discussion notes lengths it has been studied, but does not note a limit to the indicated use or match your quote. My link before that also does not mention your statement. DMacks (talk) 20:23, 25 July 2011 (UTC)

My quote comes straight from the package label I have in front of me so no, I don't have a link, although in the link provided it says:"patients with panic disorder have been treated on an open basis for up to 8 months without apparent loss of benefit."TMCk (talk) 21:34, 25 July 2011 (UTC)

Interesting! I see from the FDA approval history that there have been several revisions to the label (and I do not know whether generics are different than name-brand). Is there a date on yours? The issue seems to turn on a clear and specific statement about indicated use (yours does, but others do not) vs analysis of specific trials that do not set an explicit limit on indication. DMacks (talk) 22:06, 25 July 2011 (UTC)

Well, my label is dated February 2000 (generic).TMCk (talk) 22:19, 25 July 2011 (UTC)

• This a great illustration of the problem with original research. Picking up the bottle in front of us and reading it is primary research and problems like this are an inevitable consequence. Can we find any reliable, secondary sources explaining the warnings and constraints? causa sui (talk) 22:33, 25 July 2011 (UTC)

Protected

I've fully protected this article for 1 week due to an ongoing edit war. Please use the talk page to reach consensus over article content instead of edit warring. Note that violators of the three revert rule may be blocked without warning. Regards, causa sui (talk) 17:07, 25 July 2011 (UTC)

There have already been multiple violations of the 3-revert rule.Jasper Deng (talk) 17:12, 25 July 2011 (UTC)

Please point them out, with diffs if possible. Since the article is now protected (and blocks are preventative, not punitive) it may be moot to block anyone now. But it will be helpful to have them recorded in case edit warring resumes when protection expires. causa sui (talk) 17:40, 25 July 2011 (UTC)

Here's a set by one IP: [5], [6], [7], [8]. Another set by another IP that is believed to be the same as the aforementioned one:[9], [10], [11], [12]. Also, another set by another IP, the other side of this dispute. However, I believe the IP might actually be enforcing consensus. The set is as follows: [13], [14], [15], [16]. These are just for starters.Jasper Deng (talk) 17:56, 25 July 2011 (UTC)

I'm party to this dispute but made this change unrelated to the dispute at hand (to which I am a party). Other admins feel free to revert and redo next week if this was inappropriate given the nature of the protection. DMacks (talk) 20:33, 25 July 2011 (UTC)

Thanks for coming forward. It looks like a change that is unlikely to be challenged, so I will not revert it. However, going forward it is important that you get consensus for every change, and let someone else do the editing. causa sui (talk) 20:59, 25 July 2011 (UTC)

•  Question: I'm bringing myself up to speed on the dispute. Is it fair to say that the dispute is exclusively over the FDA labeling? Specifically, the question seems to be whether the FDA labeling actually constrains use past 8 weeks (months?), or only advises caution. This is not an invitation to rehash arguments - only to clarify the scope of the dispute. Thanks, causa sui (talk) 21:19, 25 July 2011 (UTC)

Exactly this is now the question in the last cycle of reverts. Previously it was misrepresented sources which did not even say something related at other parts of the article. 70.137.153.193 (talk) 22:42, 25 July 2011 (UTC)

Well, what we have done is taking the labeling info from the FDA website, this is the authoritative source. And it does not limit the length of use, but advises to periodically check the usefulness for the individual patient.(in the indication panic disorder).

It also says it is indicated for anxiety disorder, which was previously not the case.

It also says it is for the temporary relief of symptoms of anxiety, which was prevoiusly not the case. It does not specify "temporary" in this case.

It also says it is effective in anxiety, caused by depression.

Here link for Xanax:

http://www.fda.gov/ohrms/dockets/dockets/06p0209/06P-0209-EC12-Attach-1.pdf 70.137.153.193 (talk) 23:05, 25 July 2011 (UTC)

This would be an example of "rehashing the argument". Please avoid arguing by making the same point over and over. Consider that if you've made the argument already, people are even less likely to be persuaded the second time around. What we need to find are alternative dispute resolution outlets, such as secondary sources that evaluate the FDA labels. causa sui (talk) 23:17, 25 July 2011 (UTC)

I believe the FDA site is the only authoritative source. It is an administrative order, which is continuously being kept up to date by the FDA. Insofar it is like the law. Insofar it also differs from other medical sources, in that it is not open to discussion, dispute or interpretation by secondary sources. 70.137.153.193 (talk) 23:24, 25 July 2011 (UTC)

To make it more clear, there may be and there are differing opinions in the medical community about the indications of alprazolam. But this does not change the FDA approval and labeling, and this is what is the issue at hand here. So if I read "Alprazolam is FDA approved and indicated for..." I expect to read the FDA approval, not something somebody else has concluded. Otherwise it would have to read "... is indicated in the opinion of somebody else with a citation of this somebody else. FDA approvals are not primary sources. They are administrative acts. 70.137.153.193 (talk) 06:27, 26 July 2011 (UTC)

70.137.153.193 (talk) 06:18, 26 July 2011 (UTC)

If I understand you correctly, this argument would represent a minority view on Wikipedia policies like no original research and citing sources. It may be necessary to get outside opinions via WP:3O or the dispute resolution noticeboard. Would you be willing to accept the judgment of the community of editors if a clear consensus resulted from such a discussion, regardless of the outcome? causa sui (talk) 18:53, 26 July 2011 (UTC)

No you do not understand this correctly. I want to cite sources, namely the FDA approval. I do not want original research in. I believe there is no dispute now as the disruptive IPs are gone/have not ever contributed to the discussion. 70.137.134.251 (talk) 19:26, 26 July 2011 (UTC)

Can you please answer the question that I asked above? causa sui (talk) 19:34, 26 July 2011 (UTC)

It is not a dispute and not a minority view. Please let the editors now cite what they want. 70.137.134.251 (talk) 19:39, 26 July 2011 (UTC)

You may turn out to be right. But there is only one way to find out. Will you respect the results of a third-party review by WP:3O or WP:DRN? causa sui (talk) 19:46, 26 July 2011 (UTC)

Sure, go ahead. 70.137.134.251 (talk) 19:49, 26 July 2011 (UTC)

Honestly, there are three IPs involved, and I am not the one who adds OR or challenges WP policy or adds unsourced changes or statements. Reminds a bit of the sketch with the cross eyed judge and the three accused men standing in front of him. Judge asks the first one: "whats your name?" The second one responds: "Myers." Judge look at the second one: "I didn't ask you!" - Says the third one: "I didn't say anything." 70.137.134.251 (talk) 01:02, 27 July 2011 (UTC)

You're probably right. We'll pick this up in the morning. causa sui (talk) 07:17, 27 July 2011 (UTC)

Causa, your initial {question} is right-on. I agree with 70.137 here, that since the content being disputed is one of a regulatory status (and stated as such), the regulations themselves seem like the proper source (the FDA's website of the approved label and the companies' labels themselves). Most (all) involved editors seem to agree on that idea. Thanks for stepping in to help mediate, I'd go along with your recommendation (including even removing the disputed timeframe wording, since it's only a minor point).

One concern is being up-to-date: the label wording has changed several times over the life of the drug, and the regulatory body adjusts its stance based on new clinical and other results (and public/political pressures). For example, the label used in 2000 might say one thing but a label from 2011 another. Another concern is reading beyond or interpreting what is said to fill in some blanks about what is not directly said. Some labels apparently make certain direct statements what to do (which we all trust was based on the FDA studying available data and reliable analyses of it), whereas others only include weaker statements what to do. Both labels include information about the data. Some IPs are claiming that the underlying data tells us what the regulation is, but I and others are disputing that link as being WP:SYNTH. If the label used to say "do A and B and the data was X and Y" but now the label says "do A and the data was X and Y" (or maybe even X&Y&Z), my position is that "the regulations say 'do B'" is no longer supportable without a contemporary WP:RS that says so. DMacks (talk) 13:24, 27 July 2011 (UTC)

I have given my position above already. following remarks: Over time the FDA label has been extended. Longer studies (up to 8mo)have been added, the anxiety disorder, the symptoms of anxiety (temporary) and anxiety caused by depression has been added, the time guidance after which to reevaluate the benefit for the individual patient has been dropped. The individual manufacturer is free to restrict the FDA label (e.g. for reasons of liability or even marketing, as in the case of Bupropion as Wellbutrin or Zyban) as he sees fit. Fact is, that the timeframe is not restricted and was not restricted. It is legaleeze and as such it says what it is indicated for and what not and how, and it is plain to see, the wording is intentionally unambiguous. FDA is free to approve as it sees fit, they have enough brainpower under the hood that we do not need to guess what they are finally allowed to approve and what not. 70.137.158.132 (talk) 14:25, 27 July 2011 (UTC) 70.137.141.96 (talk) 22:08, 27 July 2011 (UTC)

Third party

Okay, since I'm apparently having trouble keeping track of all the IPs starting with 70.xx.xx, hopefully this will simplify it.

Please sign below with a short (less than ten words) statement about whether you'll submit to the result of an outside review on WP:DRN. causa sui (talk) 16:51, 27 July 2011 (UTC)

• Yes. causa sui (talk) 16:51, 27 July 2011 (UTC)
• Yes. DMacks (talk) 16:53, 27 July 2011 (UTC)
• Yes. 70.137.x.x are all the same, its me. and I agree with DMacks. where is the dispute? 70.137.141.96 (talk) 21:36, 27 July 2011 (UTC)

good grief, please don't get confused by the IPs 70.137, my damn provider gives variable IP. I swear its all me. there is no whole stable of 70.127 editors hanging around in a dispute. I agree with DMacks. Why complicated? 70.137.141.96 (talk) 21:40, 27 July 2011 (UTC)

Okay, I'll post something up on DRN soon. You might want to consider registering a username to reduce the confusion. causa sui (talk) 22:50, 27 July 2011 (UTC)

Copyediting

{{editprotected}}

1. Use non-brand name: "Anxiety associated with depression is responsive to XANAX" → "Anxiety associated with depression is responsive to alprazolam"
2. Capitalization and punctuation: "In the UK Alprazolam" → "In the UK, alprazolam"

--Cybercobra (talk) 05:40, 26 July 2011 (UTC)

You are right, this comes from copyediting from the FDA label, which was for Xanax. sorry, please fix that. 70.137.153.193 (talk) 06:07, 26 July 2011 (UTC)

Done. Nyttend (talk) 03:21, 30 July 2011 (UTC)

DRN is live

This dispute has been listed on Wikipedia:Dispute_resolution_noticeboard#Alprazolam. All editors are invited to participate in the discussion. causa sui (talk) 19:53, 29 July 2011 (UTC)

Unsourced statements

I am moving the tagged unsourced statements here, This way they will not hold up the GA nomination and can be addressed later. The Sceptical Chymist (talk) 16:14, 14 February 2009 (UTC)

• However, long-term maintenance therapy on alprazolam is not unheard-of in the medical community, and, if a genuine therapeutic need exists, benefits must be weighed against risks.[citation needed]

• However, many physicians and practictioners prescribe a benzodiazepine (i.e. alprazolam, diazepam, etc.) in conjunction with an antidepressant not to augment such a medication, as may be done with methylphenidate, but to lessen the severity of common side effects associated with an antidepressant regiment (i.e. anxiety, insomnia, restlessness, etc.).[citation needed][dubious – discuss]

• Some off-label uses for Alprazolam are: Insomnia and Sedative for Minor Medical/Dental Procedures.[citation needed]

• Paradoxical side effects

Paradoxical side effects occasionally occur. Severe paradoxical effects such as seizures only rarely occur.[citation needed]

   * hyperactivity
   * nervousness
   * restlessness
   * sleeplessness
   * muscle twitching
   * tremor
   * seizure (convulsions)

• Patients from the aforementioned groups should be monitored very closely during therapy for signs of abuse and development of dependence because it may cause addiction. Discontinue therapy if any of these signs are noted, if a physical dependence has developed therapy will need to be discontinued gradually. Long-term therapy in these patients is not recommended, unless the net benefit to the patient outweighs the net risk.[citation needed]

I am adding another unsourced statement to the list: Zacmea (talk) 14:24, 7 August 2011 (UTC)

• It is unlikely to produce dependency or abuse.

This is not unsourced, but you don't or can't read the reference

Clinical pharmacology, clinical efficacy, and behavioral toxicity of alprazolam: a review of the literature. Verster JC, Volkerts ER. Source

Utrecht Institute for Pharmaceutical Sciences, Department of Psychopharmacology, University of Utrecht, P. O. Box 80082, 3508 TB, Utrecht, The Netherlands. j.c.verster@pharm.uu.nl. Abstract

Alprazolam is a benzodiazepine derivative that is currently used in the treatment of generalized anxiety, panic attacks with or without agoraphobia, and depression. Alprazolam has a fast onset of symptom relief (within the first week); it is unlikely to produce dependency or abuse. No tolerance to its therapeutic effect has been reported. At discontinuation of alprazolam treatment, withdrawal and rebound symptoms are common. Hence, alprazolam discontinuation must be tapered. An exhaustive review of the literature showed that alprazolam is significantly superior to placebo, and is at least equally effective in the relief of symptoms as tricyclic antidepressants (TCAs), such as imipramine. However, although alprazolam and imipramine are significantly more effective than placebo in the treatment of panic attacks, Selective Serotonin Reuptake Inhibitors (SSRIs) appear to be superior to either of the two drugs. Therefore, alprazolam is recommended as a second line treatment option, when SSRIs are not effective or well tolerated. In addition to its therapeutic effects, alprazolam produces adverse effects, such as drowsiness and sedation. Since alprazolam is widely used, many clinical studies investigated its cognitive and psychomotor effects. It is evident from these studies that alprazolam may impair performance in a variety of skills in healthy volunteers as well as in patients. Since the majority of alprazolam users are outpatients, this behavioral impairment limits the safe use of alprazolam in patients routinely engaged in potentially dangerous daily activities, such as driving a car.

PMID:

   14978513
   [PubMed - indexed for MEDLINE] 

70.137.137.134 (talk) 23:42, 7 August 2011 (UTC)

The Sceptical Chymist (talk) 16:14, 14 February 2009 (UTC)

Paradoxical side effects are referenced in the references above the side effects list. Perhaps the paradoxical side effects should not be in a subsection, but the paradoxical heading should be just in bold text, like this.

Paradoxical side effects

   * hyperactivity
   * nervousness
   * restlessness
   * sleeplessness
   * muscle twitching
   * tremor
   * seizure (convulsions)

Bolding instead of making it a subsection should stop making it look like uncited data.--Literaturegeek | T@1k? 17:35, 14 February 2009 (UTC)

I wonder if there is a specific reference that addresses the paradoxical side effects of alprazolam. Or may be one of the 5 references for the "Side effects" chapter has more information on the paradoxical side effects. It would be nice to have such reference(s) included and even repeated for the "Paradoxical side effects" part. The Sceptical Chymist (talk) 00:53, 15 February 2009 (UTC)

There is the option of individually sources each side effect. What I did was added back the paradoxical side effects for now, without the header. If we can individually source them then we could add back the paradoxical subsection header. I don't think the citations seperate paradoxical side effects from other side effects.--Literaturegeek | T@1k? 01:45, 15 February 2009 (UTC)

Agree with that. Good decision. The Sceptical Chymist (talk) 12:34, 15 February 2009 (UTC)

Almost every prescription drug handbook mentions the paradoxical side effects of benzodiazepines in its own section. They are rare and only happen in certain individuals. It is not known why it happens, but everyone's body chemistry is unique and for some people these medications can cause stimulation instead of sedation. A few psychiatrists believe this is due to disinhibition, but the majority of textbooks clearly point out the paradoxical syndrome. We should separate it from the list of primary side effects, at least with bold text. 202.152.170.241 (talk) 12:43, 10 March 2009 (UTC)

Recent edit by LiteratureGeek

I have reverted this, because it relies on sources, which seem not to reflect mainstream opinion. For mainstream opinion please refer to the Alprazolam FDA approval, on this discussion page above. There the trials have already been 8 months long. Of course it could well be that all, Upjohn and other pharm industry, have suppressed the unfavorable results, and that the FDA is plain corrupt. But as long as this is not mainstream opinion, this is not encyclopedic material, but conspiracy theory. We will not include dissenting fringe opinions in every article, as these exist from a pharm-critical community practically for all kinds of medications, be it antibiotics or anti-depressants or other psychoactives.

Of course there is always the fringe opinion that this would better be treated by Bachbluten, Homeopathy, Moxing, psychotherapy, hypnosis, or by preaching and praying, as in the Christian Scientists, or by water of Lourdes, or by megavitamins, sweating and the system of Elron Hubbard, as a side effect turning you into an "Operating Thetan" of the highest degree, who by definition is free of diseases and has an eternal life...

We cannot include this. As far as I can see the both cited references are not main stream textbooks, but claim forgery and pseudoscience by big-pharm and the FDA.

So to say, in the case of Guilford Press it is "Roswell Press" from the cognitive therapy corner, Mind over body, Mind over mood etc. etc.

Wiki is not the platform for a show down between pharm critical fringe and the mainstream opinion. Wiki is representing the mainstream opinion of medical science.

Otherwise I want also to read about "Jesus instead of Alprazolam", "The vitamin clearance rundown" and "Moxing with old cigar butts". Remembering the discussions we had over the like content added by "Thegoodson", now blocked, the latter would have to read "Moxing with old cigar butts at the KGB", of course while using li'l old grandmas old sleeping pills as a truth serum!

In addition these dissenting refs are quite dated from 1994, the time when there was a benzo scare and allegedly slobbering zombie armies were taking over Glasgows public transport system, after raiding their grandparents medicine cabinets. In the 2000s this has dissipated, and mainstream opinion is now that benzos are not the highly addictive "new heroin" but more akin to huffing gasoline from an old rag, after the liquor store owner has kicked you out.

In the past 15 years there have been new studies to support FDA approval, see above on this discussion page. But of course only in the US, not in the home land of the tooth fairy, where she obviously also pays for adult teeth. 70.137.134.93 (talk) 04:15, 5 August 2011 (UTC)

WP:MEDRS does not apply because it is part of the drug's history and the reference was in the 'history' section of the drug. The FDA approval was based on the 8 week long placebo controlled studies, not the uncontrolled 8 month long trials, as the FDA is evidence based. It is part of the history of the drug that the results of the placebo controlled showed tolerance developed to the drug and that Upjohn suppressed the negative findings. The source, Panic disorder a critical analysis is most definately a reliable source to make historical claims.

It is you who is POV pushing by removing this content, regarding results from controlled research, and only allowing a POV from uncontrolled research, thus it is you who is pushing out evidence based medical historical controversy and promoting psuedoscience. I really object to you casting asperations by trying to associate me with scientology and homeopathy and whatnot, when it is actually you who is removing results from placebo controlled research and only allowing a singular point of view from uncontrolled research; I am just saying have both points of view, per WP:NPOV. Additionally as you self-identified in the past as having worked for 35 years in the research and development of drugs for the pharmaceutical industry, it makes the name calling even more hypocritical. Not that I don't have my biases, I do some work with people with drug addictions so have my biases to. Surely we can however, just have mature conversations without all this name calling, eh? Can we drop the name calling and just discuss the references? I just want both points of view to be fairly represented per WP:NPOV, I don't see any reason for this controversy to be removed and only allow a singular point of view The source is a reliable secondary source for history of the drug. There is controversy with this drug and it should not be eliminated from the article.--Literaturegeek | T@1k? 11:25, 5 August 2011 (UTC)

Besides, not pharmaceutical industry. You made that up, conjectured it. Take a look here

http://www.fda.gov/ohrms/dockets/dockets/06p0209/06P-0209-EC12-Attach-1.pdf

Are there any scientific sources supporting the controversy, other than conspiracy theories from the pharm-critical corner? If really manipulation had taken place, there must have been an official challenge of the results and an FDA investigation? Otherwise I do not believe it belongs into the lead of the article. Or has this been in the homeland of the tooth fairy again? 70.137.134.93 (talk) 11:48, 5 August 2011 (UTC)

So the points:

1. Even if there have been allegations - what was the outcome?

2. It is questionable if mere allegation, open ended, belong into history. Allegations are always part of the deal.

3. Is this so notable, prominent and well supported, that it deserves a place in the lead?

4. It is immaterial, what else could be done against anxiety, e.g. other treatments or alternative methods. For the article it is tangential.

5. For the lead of the article it is not obvious that we balance mainstream results with material from non MEDRS sources. It does not say "history" there. So I want that out. For the history section I want alternate sources. Allegations about the effectiveness and safety and withdrawal symptoms are not history, but medical claims, so need MEDRS sources. Simply moving such medical claims to the history section to bypass MEDRS requirements is not a valid method, and it does not turn medical claims into historical notes. Either remove the medical claims sourced to your refs, or support them by MEDRS sources. 70.137.134.93 (talk) 12:02, 5 August 2011 (UTC)

I didn't make anything up, the only people who 'develop/manufacture' drugs are the pharmaceutical industry. The FDA only requires 4 week long studies of psychotropic drugs and Upjohn did not seek long-term approval, so you citing the FDA is irrelevant. The source is not a pharm critical source. :-) Read the book description. Not making medical claims, just documenting a controversy of a drug company suppressing unfavourable results which is part of the history and an important POV. I am sorry but you are POV pushing here.--Literaturegeek | T@1k? 12:57, 5 August 2011 (UTC)

You really made up that I worked in pharmaceutical drug R&D, it was simply R&D. I read your statements as medical claims, as such I think it needs MEDRS sources. See above points I listed. 70.137.134.93 (talk) 13:15, 5 August 2011 (UTC)

Also, reading the ref I am under the impression as if the effectiveness of pharmaceuticals (namely alprazolam and tricyclics) vs. behavioral and cognitive therapies is the issue in question and the discussion is mainly about this, comparing the positives and negatives of each. I believe this is off topic for the alprazolam article. Newer review articles like Verster et al. come to different conclusions. We cannot allow ourselves a synthesis from the ref. Concluding, find contemporary MEDRS sources to support, or leave it out. Please again, take a look at above list of points, can we discuss that? 70.137.134.93 (talk) 13:36, 5 August 2011 (UTC) 70.137.134.93 (talk) 23:07, 6 August 2011 (UTC)

Drug companies

I have suspicions that drug companies are targeting this article. I recommend editors keep this page on their watch list. There have been over a dozen "attacks" on the article in the past month or so with cited data or even entire sections deleted. 6 attacks by one ip address. They tend to get obsessed with removing anything which associates their product with illicit drug use or drug abuse. This has happened on other benzo pages recently, particularly Roche benzos. They try over and over again to remove any reference to say cross tolerance with barbiturates (which have a bad name). Only way to stop them is to just keep reverting their edits until they realise that they are wasting their time, which they are. I have contributed very little to this particular benzodiazepine article and the edits under attack are not edits that I made. Just letting the wiki community know. I can usually tell the difference between a genuine editor who has a POV or genuine opinion or suggestion and someone who has an agenda to protect their product, even via falsification or complete removal of sections and encylopedic cited data.--Literaturegeek (talk) 11:47, 9 May 2008 (UTC)

A lot of people use xanax to get really high. Although I know wikiwatch should let you know what's going on, the attacks are most likely the result of someone getting high on xanax, maybe splash in some alcohol there, and some antipsychotic medications and a clearer image of the potential attacker might become clear. I know drug companies want to control information, but the number of people they have doing that versus the number of people who abuse xanax is a winning statistic in favor of drugged out behind the keyboard. —Preceding unsigned comment added by 76.89.223.250 ([[User talk:76.89.223.250|talk]]) 08:01, 11 June 2009 (UTC)

... seriously? You must be from Roche or one of the other sleazy pharmaceutical companies if you're actually insinuating that people are getting high on xanax and then editing wiki articles about xanax. I've been prescribed xanax at doses people take to get "high", and I can tell you right now that editing a wiki article isn't my first (or second or third) priority. When you get so high on xanax that you could lose control of your actions, you're destined to do one of two things. Either you're going to do something incredibly stupid and wake up in jail, or you're going to pass out wherever you are, but you certainly aren't going to be making drug-induced wiki edits. Give me a break.

As Literaturegeek and others have stated, this page seems to be subject to attacks undermining its creditability, specifically reworking or deleting sections that mention negative effects of the drug or its potential for abuse. The result of one such attack is that the second paragraph of the article's introduction is self-contradictory: it states that Alprazolam is unlikely to produce dependance or abuse, but also that it is one of the most abused drugs in the US, and describes the need for gradual reductions in dose due to physical dependancy. Because the statement that Alprazolam "is unlikely to produce dependency or abuse" is not cited and contradicts information throughout the rest of the article, I am moving the unsupported, ill-placed, contradictory sentence to promote clarity & creditability in the article. Zacmea (talk) 14:25, 7 August 2011 (UTC)

User Zacmea, don't you read the references? Since when is it unsourced, it is exactly what the ref says! Here:

Clinical pharmacology, clinical efficacy, and behavioral toxicity of alprazolam: a review of the literature. Verster JC, Volkerts ER. Source

Utrecht Institute for Pharmaceutical Sciences, Department of Psychopharmacology, University of Utrecht, P. O. Box 80082, 3508 TB, Utrecht, The Netherlands. j.c.verster@pharm.uu.nl. Abstract

Alprazolam is a benzodiazepine derivative that is currently used in the treatment of generalized anxiety, panic attacks with or without agoraphobia, and depression. Alprazolam has a fast onset of symptom relief (within the first week); it is unlikely to produce dependency or abuse. No tolerance to its therapeutic effect has been reported. At discontinuation of alprazolam treatment, withdrawal and rebound symptoms are common. Hence, alprazolam discontinuation must be tapered. An exhaustive review of the literature showed that alprazolam is significantly superior to placebo, and is at least equally effective in the relief of symptoms as tricyclic antidepressants (TCAs), such as imipramine. However, although alprazolam and imipramine are significantly more effective than placebo in the treatment of panic attacks, Selective Serotonin Reuptake Inhibitors (SSRIs) appear to be superior to either of the two drugs. Therefore, alprazolam is recommended as a second line treatment option, when SSRIs are not effective or well tolerated. In addition to its therapeutic effects, alprazolam produces adverse effects, such as drowsiness and sedation. Since alprazolam is widely used, many clinical studies investigated its cognitive and psychomotor effects. It is evident from these studies that alprazolam may impair performance in a variety of skills in healthy volunteers as well as in patients. Since the majority of alprazolam users are outpatients, this behavioral impairment limits the safe use of alprazolam in patients routinely engaged in potentially dangerous daily activities, such as driving a car.

PMID:

   14978513
   [PubMed - indexed for MEDLINE]

70.137.137.134 (talk) 23:19, 7 August 2011 (UTC)

To whomever is hiding behind IP 70.137.137.134, please 1) create a username if you intend to make large changes or communicate with people. Having only an IP address makes it impossible to communicate back with you (which is, sadly, probably what you wanted), and 2)while I don't mean to be as rude to you as you were to me, your own English skills make me doubt how well you can assess the creditability of sources; however, your source is self-contradictory, stating in one breath that alprazolam is unlikely to produce dependance, but that withdrawal symptoms are common. Withdrawal happens only once physical dependance has been established; otherwise it is called a side effect instead. As for contradicting the rest of the article, yes, the paragraph was contradictory, as it said that alprazolam has no potential for abuse, but also that it is the most abused benzodiazepine in the US (a statement which is supported by more credible sources that do not contradict themselves.)

A source that is not credible is not a source.

Neither your source nor your own argument stand up to very basic logic, and both contradict statements found elsewhere in the article. As well, you hide behind anonymity. I'm sorry, but I cannot accept that you are correct.

Zacmea (talk) 16:23, 8 August 2011 (UTC)

User Zacmea, credibility does not depend on what appears credible to you. Basic logic is not defined as what appears logical to you. Stop this kind of edits. It is what the ref says, and what it says it is. The ref is valid and you cannot delete it, it meets WP:MEDRS criteria as a reliable source. Thank you. Please append edits at the end of discussion page, such that we don't intersperse edits in other topics. 70.137.146.135 (talk) 17:59, 8 August 2011 (UTC)