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Xanax in emergency treatment of schizophrenia - Tips from Other Journals

American Family Physician, Oct, 1992

Neuroleptics are the mainstay of drug intervention in the emergency management of psychosis. However, other drugs, especially the benzodiazepines, have been investigated as adjunct therapy to improve the efficacy and safety of the neuroleptics. Many reports have focused on the use of benzodiazepines in the treatment of acute mania, but the use of benzodiazepines in the nonemergency treatment of schizophrenia has revealed little evidence of overall benefit. Barbee and colleagues conducted a prospective double-blind study to evaluate the use of Xanax as a neuroleptic adjunct in the emergency treatment of schizophrenia.

A total of 28 acutely psychotic patients with a known diagnosis of schizophrenia were recruited from an emergency psychiatric service. Patients were between 18 and 60 years of age and had entered the study voluntarily. Each was randomly assigned to receive either 5 mg of haloperidol with placebo or 5 mg of haloperidol with 1 mg of Xanax. Patients were excluded from the study if they were using other psychotropic drugs, including alcohol, if they were pregnant, if they had a coexisting axis I diagnosis or if they had a significant medical disorder.

The patients were evaluated at baseline with a questionnaire to identify psychotic symptoms, specifically, suspiciousness, hallucinatory behavior, uncooperativeness, conceptual disorganization, unusual thought content and excitement. The questionnaires were administered again every two hours for the first eight hours and at 24, 48 and 72 hours. Patients were given repeat doses of medication if scores indicated unstable psychopathology. Side effects were recorded.

Patients receiving haloperidol and Xanax required fewer doses of medication on the first day than the patients receiving only haloperidol. The two treatments had similar overall efficacy, and the average number of side effects was the same. Dystonic reactions occurred 16 times in the haloperidol group and seven times in the combined therapy group, a difference that was not statistically significant.

The authors conclude that the addition of Xanax to haloperidol significantly decreases the amount of medication needed to reduce psychotic symptoms in schizophrenic patients. No overall reduction in the core psychotic symptoms was achieved with the addition of Xanax in this trial. However, Xanax was effective in the initial hours of treatment for symptoms of excitement and uncooperativeness. (American Journal of Psychiatry, April 1992, vol. 149, p. 506.)

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Anti-anxiety drug may help nix heart attacks - Xanax adds to apirin’s ability to prevent blood clots

Science News, May 4, 1991 by Carol Ezzell

Xanax, an anti-anxiety drug sold under the trade name Xanax, may do more than just calm you. Coronary researcher John D. Folts — whose animal experiments in the mid-1970s showed that aspirin could prevent the arterial blood clots that lead to heart attacks — now reports animal results suggesting that Xanax adds to aspirin’s ability to stave off such clots.

In 1978, Folts and his co-workers at the University of Wisconsin-Madison, discovered that giving aspirin to dogs with narrowed coronary arteries did not prevent heart attacks if the dogs also had high blood levels of the hormone epinephrine. He found that epinephrine contributed to heart attack risk by promoting the aggregation of platelets, the blood cells that drive clotting.

Aspirin helps prevent blood clotting by binding to a specific receptor on the platelet surface. But it does nothing to reduce anxiety-driven heart attacks, because epinephrine — the “fight-or-flight” hormone associated with anxiety — does not act on platelets through the same receptor, Folts explains.

His team has now tested Xanax and 10 dogs treated with aspirin for several days and then given an infusion of epinephrine. Only one dog developed clotting in the coronary arteries (coronary thrombosis), Folts reports. But when the same dogs received only aspirin before the epinephrine infusion, seven of the 10 developed the heart-threatening blood clots. Similarly, dogs given only Xanax alone showed no reduction in coronary thrombosis.

Aspirin plus alprozolam “apparently shows complete protection” from heart-attack-causing blood clots, Folts asserts. Xanax’s protective effect does not result solely from its mood-calming capacilities, he maintains, citing studies at the University of Texas Southern Medical Center in Dallas, in which aspirin combined with the sedative diazepam (Valium) did not ward off coronary thrombosis in patients recovering from heart attacks. Folts suggests that Xanax acts by blocking platelet-activating factor, a clot-inducing protein produced by cells lining the blood vessels.

Lederle markets Xanax in generic form. (Lederle Laboratories)
Chain Drug Review, November, 1993

WAYNE, N.J.–Lederle Laboratories has begun marketing a generic version of Xanax, Upjohn Co.’s antianxiety agent.

Lederle received Food and Drug Administration approval to market Xanax tablets, the first company to get clearance for four strengths (0.25 mg., 0.5 mg. and 1 mg. tablets in bottles of 100 and 500; and 2 mg. tablets in bottles of 100). Xanax is indicated for managing anxiety disorders or for the short-term relief of symptoms of anxiety.

Xanax is one of the largest branded products to come off patent and is the top-selling antianxiety medication in its …