What are the green Xanax bars

AlprazolamDrug groupsBenzodiazepinesAlprazolam is an active ingredient from the group of benzodiazepines with anti-anxiety and calming properties. It is used to treat anxiety and panic disorders and against panic attacks. The most common adverse effects include drowsiness, fatigue, and dizziness. Regular use can lead to dependence. Withdrawal must be gradual to avoid withdrawal symptoms. Alprazolam is metabolized by CYP3A4. It can also be used as an intoxicant.

synonymous: AlprazolamumPhEur, Xanax, Niravam


Alprazolam is available in the form of tablets, prolonged release tablets and sublingual tablets (Xanax®, generics). It has been approved in Switzerland since 1980. "Xanax" is a palindrome and remains the same when read forwards and backwards.

Structure and properties

Alprazolam (C.17H13ClN4, Mr = 308.7 g / mol) is a white, crystalline powder that is practically insoluble in water. It is a 1,4-triazole benzodiazepine and differs from the classic benzodiazepines in that it has a triazole ring in the molecule.


Alprazolam (ATC N05BA12) has anti-anxiety, disinhibiting, dampening, antidepressant and sometimes euphoric properties. It crosses the blood-brain barrier and binds to the GABA in the brainA.-Receptor. It thereby strengthens the effect of the inhibitory neurotransmitter GABA in the central nervous system. The half-life is between 12 to 15 hours.

Mechanism of action of the benzodiazepines, click to enlarge. Illustration © PharmaWiki


For the treatment of anxiety and panic disorders.


According to the specialist information. The usual daily dose is 0.5 to 4 mg, divided into several doses. A daily dose of 6 mg should not be exceeded. There are also retarded drugs available that can be taken once or twice a day. Withdrawal after regular intake must be gradual, as withdrawal can lead to withdrawal symptoms.


Alprazolam, like other benzodiazepines, is misused because of its anxiety-relieving, disinhibiting, dampening and sometimes euphoric effects.

Many celebrities are said to have (over) used alprazolam. The actor Heath Ledger (Brokeback Mountain, The Dark Knight) died, according to the autopsy report, of a drug cocktail which, in addition to opioids, benzodiazepines and doxylamine, also contained alprazolam.

Michael Jackson is said to have consumed alprazolam in high doses and Whitney Houston also had the substance in her blood when she died.

The death of the rapper Lil Peep is attributed to an overdose of alprazolam and fentanyl. Various other opioids and intoxicants were found during his autopsy.

  • Hypersensitivity
  • Myasthenia gravis
  • Severe respiratory failure
  • Sleep apnea syndrome
  • Simultaneous administration of HIV protease inhibitors

The complete precautionary measures can be found in the medicinal product information sheet. Alprazolam can lead to dependence, especially if it is taken for a long time, in high doses and if there is a predisposition. If possible, it should be taken at short notice and only sporadically, and the need for treatment should be checked regularly.


Alprazolam is biotransformed by CYP3A4 to inactive hydroxy derivatives. CYP3A4 inhibitors such as azole antimycotics or marcolides can lead to an increase in the concentrations and a prolongation of the effect. For this reason, the simultaneous administration of HIV protease inhibitors is also contraindicated. Other relevant interactions must be taken into account.

unwanted effects
  • Drowsiness, tiredness, dizziness, drowsiness
  • Blurred vision, headache, depression, sleep disorders, nervousness, anxiety, tremor, weight changes, memory disorders, anterograde amnesia, incoordination
  • Gastrointestinal complaints
  • Allergic reaction
  • Dystonia, irritability, anorexia, fatigue, articulation difficulties, jaundice, muscle weakness, changes in libido, menstrual disorders, incontinence, urinary retention, liver dysfunction, hyperprolactinemia
  • Rare: Paradoxical reactions such as difficulty concentrating, confusion, hallucinations, undesirable behavioral reactions such as irritability and aggressive behavior

With abrupt discontinuation after regular intake, withdrawal symptoms occur. Alprazolam should therefore be gradually discontinued by gradually reducing the dose. Withdrawal symptoms include: tremors, restlessness, insomnia, anxiety, mental depression, headache, poor concentration, sweating, muscle and abdominal cramps, impaired perception. Rare: delirium, cerebral seizures.

see also


  • Medicinal product information (CH)
  • European Pharmacopoeia PhEur
  • Isbister G.K. et al. Alprazolam is relatively more toxic than other benzodiazepines in overdose. Br J Clin Pharmacol, 2004, 58 (1), 88-95 Pubmed
  • Media reports
  • Verster J.C., Volkerts E.R. Clinical pharmacology, clinical efficacy, and behavioral toxicity of alprazolam: a review of the literature. CNS Drug Rev, 2004, 10 (1), 45-76 Pubmed
  • Wismer T.A. Accidental ingestion of alprazolam in 415 dogs. Vet Hum Toxicol, 2002, 44 (1), 22-3 Pubmed

Conflicts of Interest: None / Independent. The author has no relationships with the manufacturers and is not involved in the sale of the products mentioned.

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This article was last changed on February 24th, 2020.
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