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half-life. Preparations with high lipid solubility, such as diazepam and alprazolam, are absorbed rapidly from the GI tract and distribute rapidly to the brain by passive diffusion along a concentration gradient, resulting in a rapid onset of action. However, as the concentration of the medication increases in the brain and decreases in the bloodstream, the concentration gradient reverses itself, and these medications leave the brain rapidly, resulting in fast cessation of drug effect.

Alprazolam seems to be particularly associated with an immediate and severe withdrawal syndrome and should be tapered gradually.

The dosage range of carbamazepine used to facilitate withdrawal is 400 to 500 mg a day. Some clinicians report particular difficulty in tapering and discontinuing alprazolam, especially in persons who have been receiving high dosages for long periods. There have been reports of successful discontinuation of alprazolam by switching to clonazepam, which is then gradually withdrawn.

The manufacturer of nefazodone recommends that the dosage of triazolam be lowered by 75 percent and the dosage of alprazolam be lowered by 50 percent when given concomitantly with nefazodone.

The plasma concentrations of triazolam and alprazolam are increased to potentially toxic concentrations by nefazodone (Serzone) and fluvoxamine (Luvox).

Alprazolam is available in an extended-release form, which reduces the frequency of dosing.

Contamos con los primeros estudios longitudinales sobre las consecuencias de abusar de estos fármacos para dormir. Las benzodiacepinas —alprazolam, loracepam, diazepam y sus derivados— entran en el organismo e inducen el sueño, cada una con su mecanismo de acción, pero sostenidas en el tiempo generan a la larga tolerancia, abuso, y dependencia. La retirada es, en la mayor parte de los casos, un problema.

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Between July 2008* and the raid, the doctors of South Florida Pain and American Pain wrote 66,871 prescriptions for various medications. Ninety-six percent of the prescriptions were for oxycodone or alprazolam. More than 80 percent of the patients were from out of state.* The five American Pain doctors under investigation wrote prescriptions for fourteen million oxycodone pills. Executive Pain’s six doctors wrote for almost four million oxycodone pills. Boshers was the biggest writer, personally responsible for prescribing 3,601,860 oxycodone 30-milligram pills. Altogether, doctors targeted at both clinics had prescribed enough oxycodone to have given every man, woman, and child in Florida a pill. Then

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