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The MHRA reminds healthcare professionals that benzodiazepines and benzodiazepine-like drugs co-prescribed with opioids can produce additive CNS depressant effects, thereby increasing the risk of sedation, respiratory depression, coma, and death. Healthcare professionals are advised to only co-prescribe if there is no alternative and, if necessary, the lowest possible doses should be given for the shortest duration. Patients should be closely monitored for signs of respiratory depression at initiation of treatment and when there is any change in prescribing, such as dose adjustments or new interactions. If methadone is co-prescribed with a benzodiazepine or benzodiazepine-like drug, the respiratory depressant effect of methadone may be delayed; patients should be monitored for at least 2 weeks after initiation or changes in prescribing. Acute pulmonary insufficiency; marked neuromuscular respiratory weakness; not for use alone to treat chronic psychosis; not for use alone to treat depression or anxiety associated with depression ; obsessional states; phobic states; sleep apnoea syndrome; unstable myasthenia gravis. Avoid prolonged use and abrupt withdrawal thereafter ; debilitated patients reduce dose ; elderly reduce dose ; history of alcohol dependence or abuse; history of drug dependence or abuse; myasthenia gravis; personality disorder within the fearful group—dependent, avoidant, obsessive-compulsive may increase risk of dependence; respiratory disease.

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Alprazolam was invented at the Upjohn Company 11 and patented in and approved for medical use in the United States in Alprazolam is mostly used in management of anxiety disorders, panic disorders, and nausea due to chemotherapy. Alprazolam is effective in the relief of moderate to severe anxiety and panic attacks. However, people with panic disorder have been treated on an open basis for up to eight months without apparent loss of benefit. Alprazolam is recommended by the World Federation of Societies of Biological Psychiatry WFSBP for treatment-resistant cases of panic disorder where there is no history of tolerance or dependence. Anxiety associated with depression is responsive to alprazolam.

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