Benzodiazepine · Anxiolytic/Sedative
Also known as Xanax, Alprax, Anxit, Restyl, Trizolam
KDIGO 2024 + manufacturer label
661 branded formulations and 153 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Alprazolam is a triazolobenzodiazepine that acts as a positive allosteric modulator at the GABA-A receptor complex. It binds to the benzodiazepine recognition site (at the interface of alpha and gamma subunits), enhancing GABA's affinity for its receptor and increasing the frequency of chloride channel opening. This results in neuronal hyperpolarization, reduced excitability, and anxiolytic, sedative, hypnotic, muscle relaxant, and anticonvulsant effects. The triazole ring incorporation confers higher potency and more rapid onset compared to classical 1,4-benzodiazepines like diazepam.
FDA PLLR: Avoid during pregnancy, especially first trimester. Risk of congenital malformations (oral clefts), neonatal withdrawal syndrome (floppy infant syndrome, irritability, tremor, seizures), and long-term neurodevelopmental effects.
Excreted in breast milk (infant plasma ~10% of maternal). May cause infant drowsiness, poor feeding, weight loss. Avoid breastfeeding if possible. If essential, monitor infant closely.
FDA black box warning: combined CNS depression at GABA-A and mu-opioid receptors causes profound respiratory depression, coma, and death.
Avoid concurrent use. If absolutely necessary in supervised settings, lowest doses, shortest duration, monitor respiratory rate and oxygen saturation. Naloxone availability.
Source: Kimi deep-research + Cla
Profoundly increased alprazolam plasma concentrations, leading to severe and prolonged sedation, respiratory depression, and psychomotor impairment.
Concomitant use is contraindicated due to the risk of severe and potentially life-threatening adverse effects. Use an alternative benzodiazepine not metabolized by CYP3A4 or an alternative antiretroviral.
Source: DDInter
CYP3A4 inhibitors block alprazolam metabolism, dramatically increasing plasma levels, sedation, respiratory depression, and risk of overdose.
Contraindicated with ketoconazole/itraconazole per FDA label. With other strong inhibitors, reduce alprazolam dose by 50% or more, monitor closely. Avoid grapefruit juice.
Source: Kimi deep-research + Cla
Increased plasma levels of alprazolam.
Source: Harrison 22e · p1742
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Typically fatal if combined in overdose.
Use with extreme caution; avoid if possible.
Source: G&G 14e
Additive CNS depression — enhanced sedation, impaired coordination, respiratory depression, memory blackouts, overdose risk.
Absolute alcohol avoidance during alprazolam therapy. Mandatory patient education. Document counseling.
Source: Kimi deep-research + Cla
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: DDInter
Drug interaction classified as: synergy
Source: DDInter
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-18 · House clinical team·Cockpit curated: 2026-05-18