From the FDA Drug Label
Alprazolam tablets are indicated for the management of anxiety disorder ... characterized by unrealistic or excessive anxiety and worry ... At least 6 of the following 18 symptoms are often present in these patients: ... Autonomic Hyperactivity (shortness of breath or smothering sensations; palpitations or accelerated heart rate; sweating, or cold clammy hands; ... Panic disorder (DSM-IV) is characterized by recurrent unexpected panic attacks, i.e., 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;
Alprazolam can decrease sympathetic tone in patients with anxiety or panic disorder by reducing symptoms of autonomic hyperactivity, such as:
- Palpitations or accelerated heart rate
- Sweating
- Shortness of breath or smothering sensations This is based on the drug's indication for the management of anxiety disorder and panic disorder, as well as its effectiveness in reducing symptoms of these conditions 1, 1.
From the Research
Alprazolam (Xanax) can decrease sympathetic tone in patients with anxiety or panic disorder by enhancing the effects of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain, which leads to central nervous system depression. This mechanism helps reduce excessive sympathetic nervous system activity that occurs during anxiety and panic states, as seen in studies such as 2, where alprazolam was found to be effective in reducing panic attacks and anxiety in patients with panic disorder and agoraphobia. When patients experience anxiety or panic, their sympathetic nervous system becomes overactive, producing physical symptoms like increased heart rate, elevated blood pressure, rapid breathing, and sweating. Alprazolam typically begins working within 30-60 minutes of administration, with effects lasting 4-6 hours for immediate-release formulations.
Some key points to consider when using alprazolam for anxiety or panic disorder include:
- Common dosing starts at 0.25-0.5 mg three times daily, with adjustments made based on individual response, as noted in 3.
- Alprazolam should be used cautiously due to its potential for dependence and withdrawal symptoms, as highlighted in 4 and 5.
- It's generally recommended for short-term use (2-4 weeks) rather than as a long-term solution, with alternative approaches for managing sympathetic overactivity including cognitive behavioral therapy, relaxation techniques, and longer-acting, less dependency-forming medications like SSRIs for chronic anxiety management, as suggested in 5.
Overall, while alprazolam can be effective in reducing sympathetic tone in patients with anxiety or panic disorder, its use should be carefully considered and monitored due to the potential risks and side effects associated with its use.