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People don’t know what they’re taking, or prescribing for that matter. Alprazolam is 20 times more potent than diazepam, works twice as fast and lasts half as long. That’s some serious addiction potential right there.

Never prescribe alprazolam to the benzodiazepine-naïve. Best even to avoid it in those taking other, longer acting, benzodiazepines. In general, only prescribe alprazolam for those already dependent patients who will have an acute severe withdrawal, including the risk of seizures, without it. These patients will otherwise often go to extraordinary, and often unwholesome, lengths to get their hands on some — such is the nature of this addiction.

Achieving drug withdrawal from benzodiazepines takes time. We need to be patient and supportive, according to Prof Ashton. Better still, maintain a high threshold for prescribing these drugs. If and when you do, prescribe only the shortest course possible. All benzodiazepines are recommended for short-term use only (2-4 weeks maximum).

Annotation

• Indications for use of flumazenil (Anexate), the benzodiazepine antidote, are quite specific — see http://cdn.lifeinthefastlane.com/wp-content/uploads/2009/11/antidotes.pdf

Reference

• benzo.org.uk

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• Nervine settled everybody’s nerves by sedating everyone – Scientopia