Review of Alprazolam in Forensic Toxicology

Purpose: Alprazolam (Xanax®) is one of the most popular Benzodiazepines (BEZs) prescribed as a medication worldwide. It has been used for the treatment of anxiety and panic disorder since 1976. It is prescribed in doses up to 4 mg/day for generalized anxiety. While doses of 6–9 mg/day are used for phobic and panic disorders, the alprazolam may be subject to abuse because of its sedative and euphoric effects. Its abuse potential stems from its unique pharmacokinetic properties, i.e., its rapid onset and short duration of action. Alprazolam is often abused in combination with other substances including alcohol, methadone, oxycodone, and cocaine. A comprehensive survey of some of the largest scientific publishing databases such as PubMed, Medline and Science Direct was carried out to collate information on alprazolam. The outcome is a comprehensive overview that focuses on the more basic information needed by forensic toxicologists to help them analyze and interpret alprazolam data in ante and post-mortem biological specimens. It includes a detailed discussion of drug concentrations found in alprazolam-positive case reports, considering factors such as post-mortem redistribution, drug interactions and stability. The review also covers the pharmacology, and methods of analysis of alprazolam in biological fluids.