What is Tiadylt (Alprazolam) used for?

What is Tiadylt (Alprazolam) Used For?

Alprazolam is FDA-approved for the management of anxiety disorders (generalized anxiety disorder) and panic disorder, with or without agoraphobia. 1

FDA-Approved Indications

Anxiety Disorders

• Alprazolam is indicated for generalized anxiety disorder (GAD), characterized by unrealistic or excessive anxiety and worry about multiple life circumstances lasting 6 months or longer. 1
• The drug is effective for short-term relief of anxiety symptoms, though anxiety associated with everyday stress does not require anxiolytic treatment. 1
• Anxiety associated with depression is also responsive to alprazolam treatment. 1

Panic Disorder

• Alprazolam is indicated for panic disorder, defined by recurrent unexpected panic attacks with at least 4 of 13 specific symptoms (palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, fear of losing control, etc.). 1
• Efficacy has been demonstrated in studies lasting 4-10 weeks for panic disorder, though patients have been treated for up to 8 months without apparent loss of benefit. 1

Off-Label and Procedural Uses

Procedural Anxiety

• The National Comprehensive Cancer Network recommends alprazolam 0.25-0.5 mg orally 30-60 minutes before procedures (such as MRI) for procedural anxiety. 2
• Alprazolam and lorazepam are used for anticipatory anxiety related to medical procedures, including anticipatory nausea/vomiting before chemotherapy, though prospective trials establishing effectiveness in this setting are lacking. 3

Depression

• Multiple studies demonstrate alprazolam compares favorably with tricyclic antidepressants for exogenous (reactive) depression, though it is not currently FDA-approved for this indication. 4, 5, 6
• Alprazolam may be particularly useful in patients with mixed anxiety/depression. 6

Dosing and Duration

• The FDA-approved daily dosage range is 0.5 to 4.0 mg for anxiety disorders. 1
• Typical starting doses are 0.25-0.5 mg for procedural anxiety. 2
• Systematic clinical studies supporting efficacy are limited to 4 months for anxiety disorder and 4-10 weeks for panic disorder. 1
• Physicians should periodically reassess the usefulness of continued treatment. 1

Critical Safety Considerations

Abuse and Dependence Risk

• The most concerning adverse effect is alprazolam's high potential for abuse and dependence, attributed to its unique pharmacokinetic properties (rapid onset, intermediate half-life of 12-15 hours). 4, 7
• Discontinuation is particularly difficult and associated with serious rebound and withdrawal symptoms, requiring gradual dose reduction. 8

When to Avoid Alprazolam

• The World Health Organization recommends Cognitive Behavioral Therapy (CBT) as preferred first-line treatment for panic attacks and anxiety, reserving alprazolam only for patients who have failed or cannot access CBT-based interventions. 8
• Severe respiratory insufficiency and sleep apnea are contraindications. 2
• Caution is warranted in patients with substance abuse history. 7

Common Pitfalls

• Drowsiness is the primary side effect, though less than diazepam at comparable doses. 4
• Alprazolam is approximately 1.5-3.5 times more potent than diazepam, requiring dose adjustments when switching between benzodiazepines. 3
• Drug interactions occur with cimetidine, fluoxetine, fluvoxamine, and propoxyphene, which significantly impair alprazolam clearance. 9
• Elderly patients and those with cirrhosis require dose reductions due to reduced clearance. 9