Benzodiazepines - Alprazolam (Xanax) - Outline

1. A brief history of the drug

1. The drug was developed by J.B. Hester

1. The drug was approved on 16^th October 1981
2. Alprazolam is in the class of triazolobenzodiazepine class

2. The purpose of Alprazolam was to treat mental-related disorders

1. One of the conditions treated is an anxiety disorder
2. The other issue that the medication treats is panic disorder

2. Psychopharmacology of the drug

1. Alprazolam is metabolized in humans by Cytochrome P450 3A4 (CYP3A4)

1. cytochrome P450 3A4 are metabolism enzymes comprised of more than 50 enzymes
2. The functions of the drugs involve detoxication, homeostasis, and cellular metabolism

2. The drug is eliminated through the urine

1. The drug’s average half-life is 11.2 hours
2. Xanax is fully eliminated from the body within 2-4 days

3. Current trends or issues

1. The popularity of Alprazolam (Xanax) increases each day due to its significant prescription

1. The drug is highly effective due to its unique psychodynamic properties
2. By 2013 there were 48 million prescriptions of the drug

2. When the drug is overused, it has a high level of addiction

1. Primary healthcare providers usually prescribe the medication longer than recommended
2. One of the symptoms of drug addiction involves developing risk-taking behaviors

4. Societal concerns or issues related to the topic

1. The drug has severe side effects, especially when abused

1. One of the side effects involves decreased sex drive
2. The other side effects involve the overproduction of saliva

2. When the drug is taken at high levels, it can lead to coma or death

1. Overuse of the drugs tends to cause brain damage
2. Heart palpations increase, and blood pressure decrease during addiction

5. Significance or relevance of the topic to the counseling profession

1. The topic enables counselors to understand how to address drug addiction

1. The treatment of Xanax addiction depends on the amount of drugs abused
2. The treatment is also determined by whether the user uses other substances

2. The counselor may address the issue or refer the client to the doctor

1. The first treatment involves pumping the stomach to remove unabsorbed drugs
2. Other IV fluids may be administered to the patient

6. Any future implications

1. The drug might cause significant harm to society if continued to be abused

1. The incidence of mental disorders due to addiction may increase in the society
2. The death caused by the drug might lead to under-population

2. More research should be conducted on how the medication addiction are addressed

1. More research may reduce the addiction to the drug
2. Inadequate research may contribute to a more severe impact on the society

Benzodiazepines - Alprazolam (Xanax)

Brief History of the Drug

Alprazolam is among the drugs used for the treatment of panic disorder and anxiety disorders. The drug is in the class of benzodiazepine due to its ability to bring sedative and calming effects to the user. The drug is usually availed in the market as Xanax, the brand name produced by Pfizer, Inc. Alprazolam was first patented in the 1970s after it was manufactured at Upjohn Company by J.B. Hester (Windisch et al., 2019). The Upjohn Company later became part of Pfizer, Inc. The Food and Drug Administration in the United States later approved the drug in 1981 to be used among individuals experiencing panic disorder and anxiety disorders.

Psychopharmacology of the Drug

The drug is usually taken orally. Alprazolam is available in different forms, including extended-release formulation, and as a tablet. The extended-release formulation increases the gradual availability of the drug to thus minimizing its administration frequency. The drug achieves its purpose by binding with gamma-aminobutyric acid A (GABA)_A, a special binding receptor within the central nervous system (Grau-López et al., 2018). The binding usually enhances the affinity of the receptor to the GABA, the inhibitory transmitter. The increased activity of GABA tends to minimize the neural impulses transmission in the brain. The neural impulses are related to panic and anxiety.

Alprazolam is administered through the mouth and experiences rapid absorption into the gastrointestinal tract. The drug attains its maximum concentration in about 1-2 (1.8) hours. Due to its high absorption level into the body, Alprazolam attains an oral bioavailability ranging between 84-91%. The extended formulation of the drug undergoes similar processes in the body, including absorption levels, bioavailability, and pharmacokinetics. However, the maximum time attained by the extended-release formulation of this drug to reach the maximum concentration is different from that of the Alprazolam tablets. In this case, the maximum time spent by the extended-release formulation to attain the maximum concentration is considered to be 10 hours, while that of the tablet is 1-2 hours (Squeglia et al., 2019). Besides, temporal dosing tends to alter the absorption, bioavailability, and Alprazolam pharmacokinetics, whereby the maximum concentration rises by 30% and the maximum time spent reduces by one hour when the medication is taken at night compared to when it is taken in the morning.

Besides, food usually affects the absorption of Alprazolam. For example, if the user takes meals rich in high-fat content two hours before or after taking the medication, the maximum concentration rises by 25%, while the maximum time taken increases or decreases by one-third. In this case, the maximum time taken decreases by one-third if the food-rich in fat content is taken within two hours of the drug administration. On the other hand, the maximum time taken increases by one-third if the food is taken within two hours after the drug administration.

The drug is metabolized by Cytochrome enzyme (CYP) to form a less metabolized form. However, this enzyme appears in more than 50 forms, including CYP2C9, CYP3A4, CYP3A5, and CYP3A7 (Chen et al., 2020). In most cases, the metabolism of the drug is mediated via CYP3As by hydroxyalzolam. The drug is then eliminated from the body through the urine. Much of the drug is removed from the body as an unmetabolized form. In this case, 10% of Alprazolam is eliminated from the body as either 4-hydroxy-alprazolam or hydroxyl-alprazolam. The half-life of Alprazolam usually ranges between 6.3-26.9 hours, with a mean of 11.2 hours.

Current Trends or Issues

Alprazolam is among the most prescribed medication among patients with panic attacks and anxiety disorder. For example, by 2013, there were approximately 48 million people prescribed the medication in the U.S. since its approval. Alprazolam is considered among the controlled drugs, especially in the U.S., due to its high level of misuse and dependence. The drug is only supposed to be prescribed by a pharmacist. However, despite the drug being among the controlled medications, most patients buy them over-the-counter without prescription by a physician. This has made several people develop an addiction to the medication due to its repeated use without control.

The addiction effect of the drug has made the medication have severe withdrawal effects. Alprazolam is considered to be the most toxic medication compared to other drugs under the class of benzodiazepines. Therefore, not all people with anxiety and panic disorders are advised to use it. Some individuals who are warned against Alprazolam are the people who are using various drugs and substances such as sedatives, opioids, alcohol, and those who experience suicidal ideation (Askari et al., 2020). Under these cases, the drug is said to have a serious life-threatening ability due to breathing issues. If Alprazolam is used with sedatives and opioids, it can make the user experience coma or sedations.

Moreover, an individual using Alprazolam is advised to avoid grapes and grapes juice due to their ability to increase the concentration of the medication. Grapes usually contribute to elevated concentration of the medication in the body leading to respiratory depression and prolonged sedation. The increased concentration of Alprazolam in the body when used with various drugs and substances has made the drug to be banned in various countries such as Australia. The effects of the drug when not prescribed by a physician have contributed to great debates where some people indicate that the medication should be banned in the U.S. while others support its use in the country. Several people have also died due to the misuse of the drug.

 

Societal Concerns or Issues Related to the Topic

There are several societal concerns that have emerged due to the use of Alprazolam. Some of the societal concerns are associated with the side effects brought about by the medication. Some of the side effects of the medication can be severe, while others are mild. Some mild include irritability, tiredness, headache, light-headedness, increased salivation, and nausea.  However, some serious side effects of the medication include loss of balance, speech problems, confusion, eyes or skin yellowing, severe skin rashes, seizures, and shortness of breath. Some side effects are brought about by Alprazolam overdose. Some impacts of Alprazolam overdose include loss of consciousness, coordination problems, confusion, and drowsiness.

The medication has also contributed to societal concerns due to their displacement. The misplacement of Alprazolam can not only affect other non-users such as the children but also the pets. When a child takes the medication accidentally, it can contribute to his or her death or comma due to its strong, unique properties that are said to be life-threatening. Therefore, Alprazolam should be placed in a safe place out of reach of children and pets. The unnecessary medications should be disposed of appropriately by burying them deep in the ground, burning, or flushing them in the toilet. Besides, the unnecessary medications can be returned to medical facilities through a medicine take-back program for safer disposal or recycling.

Moreover, the medication can significantly affect the user despite having been prescribed by a physician. This is because the drug works best under various conditions. For example, before Alprazolam is prescribed to an individual, the patient needs to inform the physician whether he or she is allergic to any benzodiazepine or other medications. Besides, the patient should inform the physician whether he or she is using ketoconazole or itraconazole since these substances may affect an individual's health condition if used together.

Significance or Relevance of Topic to the Counseling Profession

The topic of Alprazolam is critical to counseling professionals in different ways. First, the topic enables a counselor to understand the level of addiction that the drug causes to the user. Some patients may visit a counselor due to their addition of Alprazolam. If the counselor has adequate knowledge regarding the medication, he or she will understand how the patient used the medication and the content used. For example, the counselor can understand that the patient used the medication without a physician's prescription. Based on this argument, the counselor will understand how to guide the patient. For example, in a situation where a patient is addicted to Alprazolam, the counselor can advise him or her never to use the medication without a physician's prescription. However, if the counselor has inadequate knowledge regarding the medication, he or she would be unable to guide the patient appropriately.

The second aspect associated with the relevance of the medication is that the counseling professional can understand when to refer a patient to a physician. In this case, a counselor who has adequate knowledge regarding Alprazolam is aware that the drug is used to treat panic attacks and anxiety disorders. Therefore, if a counselor comes across a patient with any of these two conditions, the professional will understand that the most appropriate medication is Alprazolam. Therefore, the counselor can refer the patient to the appropriate physician, thus enabling him or her to improve in health condition.

Future Implications

Based on the current trends of Alprazolam and the concerns experienced in society, several aspects need to be improved in the future. First, the use of the drug needs to be controlled and monitored to reduce its increased abuse (Chye et al., 2019). The increased abuse of the medication contributes to the development of mental disorders or even death. Therefore, the medication needs to be controlled by restricting its sales over the counter.

Besides, more research needs to be conducted to indicate how the medication can be used to reduce its several addictive effects. Such effects can be reduced by minimizing the concentration of the medication. The lower the concentration, the lower the side effects experienced among the users. If more research is not conducted, the medication can cause significant harm to society, including increased suicides in various communities.