Tranquilizers (benzodiazepines) are one of the main classes of psychotropic drugs and have been used in clinical medicine for over 50 years. Farmapram is a typical representative of benzodiazepine anxiolytics – to a different extent it has all properties of drugs of this group.
About 30 different benzodiazepine drugs (anxiolytics and hypnotics) are currently used. In spite of the fact that in 1983 WHO recognized the ability of benzodiazepines to cause drug dependence, nevertheless they are still widely used not only in psychiatry, but also in other fields of medicine, and in a number of cases they are irreplaceable. Development of antidepressants with pronounced anxiolytic action (especially selective serotonin reuptake inhibitors), anxiolytics and hypnotics of non-benzodiazepine structure contributed to some displacement of benzodiazepines from treatment practice, but due to specific action mechanism that ensures high and rapidly developing psychotropic activity and good tolerability, they invariably occupy their niche in therapy of neurotic level mental disorders.
The spectrum of action of benzodiazepines is traditionally divided into several main effects: anxiolytic (anti-anxiety), sedative, hypnotic, muscle relaxant, anticonvulsant and amnesic. Currently, their anxiolytic and soporific effects are the most important for clinical practice, while the others are hardly used or are considered as side effects. The main one, however, is the anxiolytic action. Alprazolam belongs to high-potency benzodiazepines, that is, a pronounced anxiolytic effect develops when using low doses of the drug. This is explained by the fact that alprazolam has a higher affinity for specific benzodiazepine receptors.
There are other properties that distinguish alprazolam from other representatives of this group: medium duration of action, less pronounced sedation and behavioral toxicity. These features allow alprazolam to be widely used, including in outpatient practice. In addition, the ability of alprazolam to attenuate manifestations of depression is used in the therapy of psychiatric disorders. It is believed that alprazolam is the only benzodiazepine tranquilizer with antidepressant activity.
The range of clinical effects of alprazolam, like other benzodiazepines, is based on modulation of GABAA receptors, followed by secondary neurochemical and hormonal rearrangements. It is discussed that stimulation of GABA-receptors leads to changes in the activity of the monoaminergic system. At the same time, a weakening of the activity of the hypothalamic-pituitary-adrenal system is described. Prolonged use of benzodiazepines, including alprazolam, leads to decreased sensitivity of GABA receptors. This is the basis for the development of the addictive phenomenon. However, it is believed that tolerance is not formed to all effects of benzodiazepines. It is unconditional with regard to the hypnotic, myorelaxant and anticonvulsant effects, and is disputed with regard to the anxiolytic effect. Indeed, many patients take alprazolam for prolonged periods of time to alleviate anxiety without diminishing the effectiveness of treatment.