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The British Journal of Psychiatry 165: 79-86 (1994)
© 1994 The Royal College of Psychiatrists

Safety and side-effects of alprazolam. Controlled study in agoraphobia with panic disorder

GH O'Sullivan, H Noshirvani, M Basoglu, IM Marks, R Swinson, K Kuch and M Kirby
Institute of Psychiatry, London.

BACKGROUND. The widespread use of benzodiazepines has led to increasing recognition of their unwanted effects. The efficacy of alprazolam and placebo in panic disorder with agoraphobia, and the side-effect and adverse effect profiles of both drug groups were measured. METHOD. In London and Toronto 154 patients who met DSM-III criteria for panic disorder with agoraphobia were randomised to alprazolam or placebo. Subjects in each drug group also received either exposure or relaxation. Treatment was from weeks 0 to 8 and was then tapered from weeks 8 to 16. RESULTS. Mean alprazolam dose was 5 mg daily. Compared with placebo subjects, alprazolam patients developed more adverse reactions (21% v. 0%) of depression, enuresis, disinhibition and aggression; and more side-effects, particularly sedation, irritability, impaired memory, weight loss and ataxia. Side-effects tended to diminish during treatment but remained significant at week 8. Despite this, the drop-out rate was low. CONCLUSIONS. Alprazolam caused side- effects and adverse effects during treatment but many patients were willing to accept these.


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