Trankimazin: Spanish brand name for alprazolam
Trankimazin is the Spanish brand name for alprazolam, a short to medium-acting benzodiazepine from the class of triazolobenzodiazepines. In Spain and several Latin American countries alprazolam is available under the brand names Trankimazin or Trankimazin Retard. Internationally the substance is mainly known as Xanax (USA, Canada, UK) and Tafil (in some Latin American countries). In Germany alprazolam is available as Tafil and in numerous generic preparations.
Alprazolam was approved in 1981 and is one of the most prescribed benzodiazepines worldwide, mainly for panic disorder and acute anxiety. Due to high addiction potential and pronounced withdrawal problems, use has become more restrictive in recent years.
Mechanism of action
Like all benzodiazepines, alprazolam binds allosterically to the GABA A receptor and enhances the action of the inhibitory neurotransmitter GABA. The opening frequency of the chloride channel rises, the neuron is hyperpolarised and its excitability reduced. Clinical effects include:
- Anxiolysis, especially in limbic structures
- Sedation via cortical and thalamic pathways
- Anticonvulsant effect
- Muscle relaxation at spinal level
- Anterograde amnesia
Compared with other benzodiazepines, alprazolam has particularly high binding affinity at benzodiazepine sites with a focus on anxiolysis. Mean half-life is 9 to 16 hours. Characteristic are rapid onset and a comparatively short duration of action, hence multiple daily dosing.
Indications
- Panic disorder with or without agoraphobia: classic indication, rapid symptom relief in the acute phase
- Generalised anxiety disorder: short-term therapy; long-term treatment with SSRIs, SNRIs, pregabalin or buspirone preferred
- Acute stress and agitation states: not for long-term therapy
- Off-label uses: premedicative anxiolysis before procedures, support in alcohol withdrawal symptoms (rare and controlled)
Alprazolam is not suitable as monotherapy for depression and is not optimised for long-term use.
Dosing and administration
Generalised anxiety disorder: 0.25 to 0.5 mg three times daily, stepwise titration. Maximum dose 4 mg per day.
Panic disorder: 0.5 to 1 mg four times daily, stepwise titration. Maximum dose 6 to 10 mg per day.
Trankimazin Retard: once daily 0.5 to 6 mg, depending on indication.
Take with water, regardless of meals. Titrate in small steps every 3 to 4 days; reduce very slowly over weeks to months.
Therapy goal: as short therapy as possible, lowest effective dose. Common recommendations suggest a maximum duration of 8 to 12 weeks including the tapering phase.
Side effects
Very common: sedation, fatigue, dizziness, concentration problems, slowed reaction, muscle weakness, anterograde amnesia.
Common: dry mouth, nausea, constipation or diarrhoea, headache, slurred speech, double vision.
Uncommon: paradoxical reactions with agitation, aggression, nightmares (especially in older patients and children), hypotension, visual disturbance, rash.
Rare: severe allergic reactions, respiratory depression especially with other CNS depressants, seizures after abrupt discontinuation, dystonias.
Tolerance and dependence:
- Tolerance to sedative effects usually develops within weeks
- Dependence can develop after as little as 4 to 6 weeks of regular use
- Abrupt discontinuation or too rapid tapering risks withdrawal symptoms up to seizures
- Compared with many other benzodiazepines, alprazolam has a particularly pronounced discontinuation syndrome, often beginning as a rebound with increased anxiety
Interactions
- Other CNS depressants (alcohol, opioids, antipsychotics, sedating antihistamines): additive sedation, respiratory depression, particularly dangerous combined with opioids
- Strong CYP3A4 inhibitors (itraconazole, ketoconazole, HIV protease inhibitors, erythromycin, grapefruit juice): markedly raised levels, increased sedation
- Strong CYP3A4 inducers (rifampicin, carbamazepine, phenytoin, St John's wort): reduced efficacy
- Cimetidine and ranitidine: moderate level increase
- Levodopa: attenuated antiparkinson effect
- SSRIs, SNRIs: additive sedation possible, often clinically tolerable
Special considerations
Pregnancy: not recommended, especially not in the first trimester. In the third trimester risk of floppy infant syndrome and neonatal withdrawal.
Breastfeeding: passage into milk, avoid use if possible.
Children and adolescents: not approved, paradoxical reactions more common.
Older patients: increased sensitivity, fall and fracture risk, cognitive impairment. The PRISCUS list classifies benzodiazepines as potentially inappropriate.
Addiction history: in alcohol or drug dependence, avoid use if possible.
Driving: markedly impaired, especially at therapy start and dose increase.
Tapering: with prolonged use, reduce very slowly, often over several months. Switching to longer-acting diazepam can facilitate tapering.
Patient communication: realistic expectations, discuss therapy duration and exit strategy from the start, include alternative therapies (psychotherapy, SSRI).
Related substances
- Bromazepam, medium-acting benzodiazepine
- Zolpidem, short-acting hypnotic
- Buspirone, non-addictive anxiolytic
- Pregabalin, alternative therapy in anxiety disorder
- Paroxetine, SSRI in panic disorder
Frequently asked questions
What is Trankimazin?
Trankimazin is the Spanish brand name for alprazolam, a benzodiazepine of the triazolobenzodiazepine class. In Germany the same substance is called Tafil or available as a generic.
How quickly does alprazolam cause dependence?
Tolerance and dependence can develop after as little as 4 to 6 weeks of regular use. Among benzodiazepines, alprazolam is considered particularly fast and strongly addictive, especially at higher doses or with multiple daily intake.
How is alprazolam tapered?
Very slowly, often over weeks to months. A common approach is stepwise reduction by 5 to 10 % of the current dose every 1 to 2 weeks, or switching to longer-acting diazepam in equivalent dose followed by slow tapering. Support from an experienced doctor is sensible.
What alternatives exist?
For panic disorder, SSRIs and SNRIs are first-line, often combined with cognitive behavioural therapy. Buspirone is a non-addictive option for generalised anxiety disorder. Pregabalin is also effective in generalised anxiety. Mindfulness-based and psychotherapeutic approaches show good efficacy.
Sources
- EMA European Medicines Agency
- BfArM Federal Institute for Drugs and Medical Devices
- AWMF anxiety disorders guideline
- Gelbe Liste alprazolam monograph
Legal notice and disclaimer
The information on this page is provided for general information purposes only and does not constitute medical advice, diagnosis or treatment recommendation. It does not replace the advice of a licensed physician or pharmacist. Medicines should only be used after a doctor's prescription or pharmacy supply. All information is based on summaries of product characteristics and accepted scientific sources at the time of writing; the current SmPC of the manufacturer is always decisive. Sanoliste accepts no liability for completeness, timeliness or accuracy. In a medical emergency, dial the emergency number 112.