Talk:Alprazolam/GA1

GA Review
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Will not start a formal review but just have some concerns about the number of lists in this article. Might be better to change some of it to prose.-- Doc James (talk · contribs · email) 20:12, 29 January 2009 (UTC)
 * I think that sometimes lists are easier to understand than prose writing. It's more streamlined.--Cssiitcic (talk) 20:49, 2 February 2009 (UTC)

After looking at the article, I have noticed that it is constantly edited by individuals who do not have an account. Some things in the article are totally false and many 'references' are either from an unreliable source or they're completely misinterpreted. It is my opinion that at least 3 out of every 4 of those anonymous editors are drug abusers. Alprazolam is by far the most prescribed benzodiazepine in the U.S, and one of the most commonly prescribed drugs, as a result, it has become a somewhat popular drug of abuse in the United States. Outside the US, however, it's abuse is limited, if not non-existent. Benzodiazepines with a higher abuse potential and much more toxic profiles, especially temazepam and nimetazepam are the two worlds most abused benzodiazepines, followed by nitrazepam, flunitrazepam, diazepam, triazolam, and midazolam. In the alprazolam article, it states that it is the most addictive benzodiazepine and it produces euphoria (which is false, FDA studies showed that 0.000% of human subjects reported euphoria as a side effect during trials), and they list it as the most toxic, etc. The article needs clean up. VeronicaPR (talk) 6:25, 7 February 2009 (UTC)
 * Should we semi-protect the page from the unregistered editors? We can attempt cleanup, but I think the page needs to be semi protected first, so the unregistered editors don't mess the page up over and over.Cssiitcic (talk) 20:43, 7 February 2009 (UTC)
 * If the article is not stable (not due to vandalism), then it cannot become GA, see criterion 5 at Good_article_criteria. Xasodfuih (talk) 14:55, 13 February 2009 (UTC)
 * I would regard this article as "stable", which according to the quoted guideline means that "it does not change significantly from day-to-day because of an ongoing edit war or content dispute." (see Good_article_criteria) The Sceptical Chymist (talk) 16:04, 14 February 2009 (UTC)

Alprazolam is widely abused in other countries. An example is Australia, where it is I believe either the 1st or 2nd most abused benzodiazepine. In the UK its abuse is almost nonexistent because it is not available on the National Health System. It is available via private prescription but its use in the UK would be less than 1%, perhaps less than 0.1% of benzos. 2 mg of alprazolam is equivalent to 40 mg of diazepam, making it a very potent benzodiazepine. Alprazolam is one of the most dangerous benzos in overdose and is one of the worst for causing withdrawal seizures. I do not know about euphoria incidence but this would likely increase if the drug was abused in higher than therapeutic doses.-- Literature geek |  T@1k?  22:01, 7 February 2009 (UTC)

I deleted this paragraph which seemed to be original research.

"Long term daily use of high or even low doses may totally eliminate the euphoric properties of the drug due to drug tolerance, leaving the user the desire to take it to only delay withdrawal symptoms or because of a "placebo" euphoric effect that is actually not due to the drug itself but due to psychological conditioning."-- Literature geek |  T@1k?  14:36, 8 February 2009 (UTC)

Alprazolam can certainly be dangerous in overdose, but then again every benzodiazepine is dangerous in overdose. Poison Control Centers in the United States note that despite being by far the #1 most commonly prescribed benzodiazepine, it has a lower rate of emergency related visits, overdose incidents, and deaths than benzodiazepines that are much less frequently prescribed (ie. temazepam, for example had the highest rate of emergency related visits and overdose deaths from 2003-2005, despite being only the 5th most prescribed benzodiazepine). Similarly, triazolam had a higher overdose rate, and triazolam is rarely prescribed in the U.S. This is also true of lorazepam, and I believe clonazepam also has a higher overdose rate, but I am not certain on the clonazepam. Alprazolam may have a higher over tally, but the rate at which overdose occurs is peanuts compared to triazolam and temazepam. So, clearly, it's completely false for the article to state that alprazolam is the "most toxic". However, it's true that alprazolam causes a very bad physical dependence, not unlike other short to medium acting benzodiazepines. Psychological dependence on the other hand is a different issue. It's desirability as a drug of abuse was ranked slightly lower than lorazepam according to Darke, Hall, and Ross, and it was significantly surpassed by diazepam, temazepam, nitrazepam, nimetazepam, and several others in overall 'liking'. VeronicaPR (talk) 05:40, 9 February 2009 (UTC)

Hi Veronica, I do agree that really there is not a big degree of differences between the various benzos. I think if one was to take an equivalent dose of diazepam in overdose that there would really be little difference between the two benzos in overdose symptomatology and severity. This study from New Zealand suggests alprazolam is more dangerous in overdose than other benzodiazepines. This study suggests that alprazolam is more difficult to confirm in tests than other benzodiazepines. Could this explain the discrepancy, I dunno? I can't explain the poison control statistics. Do you have a link as I would be interested in reading their statistics? This study shows that alprazolam is the most common drug overdose seen in emergency room visits in the USA. Are you sure that temazepam has such a high overdose rate in the USA? I could imagine it in a country where it is more commonly prescribed eg the UK or perhaps australia. Also the volume of temazepam dispensed in the USA must be very low with ambien, lunesta etc taking the majority of the hypnotic market over there. It shows that it is seen twice as often as the next most common overdosed prescription benzo which is clonazepam in the USA. I am not aware of any head to head comparison with nitrazepam, nimetazepam, temazepam comparing abuse potential. I just checked pubmed and could not locate any such studies. There has been a lot of misinfo put into wikipedia regarding temazepam and other benzodiazepines which has caused a lot of headache for me and other editors in trying to either defend articles from being gutted or having to read through tonnes of references to validate or invalidate the data. I wonder if your views on the benzos have been shaped by the misinfo put into wikipedia articles (not by me) by some editors? Maybe you assumed their summary of citations was accurate? Lorazepam is a very potent benzodiazepine which is why it is preferred for status epilepticus but also has very severe problems of physical dependence, withdrawal and abuse potential. With that said I do think that temazepam, nitrazepam, lorazpam and alprazolam are worse than say oxazepam, chlordiazepoxide, diazepam etc partly due to potency and pharmacokinetics as well as toxicity and abuse potential.-- Literature geek |  T@1k?  18:11, 9 February 2009 (UTC)
 * In response to this discussion, I added the following to the "Misuse section": "Alprazolam, together with lorazepam and diazepam, have the highest abuse liability among the benzodiazepine medications.[42]" The Sceptical Chymist (talk) 15:56, 14 February 2009 (UTC)

I think the statement that alprazolam has the highest abuse liability is misleading because it is stating it as fact, as if that applies to every country in the world. Perhaps it is most abused in the United States, but this wikipedia article is for the entire world to read and must reflect the reality in the world, not just the United States. It would be ok to say, "Alprazolam, together with lorazepam and diazepam, have the highest abuse liability among the benzodiazepine medications in the United States" and source that, but leaving out the countries' name makes the reader think it applies to the entire world, which is untrue. There are many countries where alprazolam is not even available. 202.152.170.241 (talk) 12:53, 10 March 2009 (UTC)

Listitis. This article has bit too many lists, some of which use, ugh, bold text! At least for the brand names you could put them in a box like the article on paracetamol does. Xasodfuih (talk) 12:44, 13 February 2009 (UTC)

I have fixed this issue.-- Literature geek |  T@1k?  00:44, 14 February 2009 (UTC)

History. I find the writing style there quite convoluted and confusing. If you have access to the source (The Psychopharmacologists) I strongly suggest you rewrite that section. Xasodfuih (talk) 14:23, 13 February 2009 (UTC)
 * Please specify what you want clarified.The Sceptical Chymist (talk) 00:32, 14 February 2009 (UTC)
 * This the worst part: "Sheehan describes that the first group of patients treated by alprazolam was so impressed by its action that they knew outright—this drug was going to be a hit. A few of those patients actually pooled their money and purchased stock in Upjohn. Several months later, when alprazolam was approved by the FDA, they sold out and made a profit." I trust I don't need to explain why it's confusing. The rest of that section isn't much better. Xasodfuih (talk) 03:02, 14 February 2009 (UTC)
 * Yes, you do have to describe what confuses you in this excerpt, if you want to make the article better. Do you have any concrete suggestions on how to improve this and other parts of the History section? How would you re-write the paragraph in question? The Sceptical Chymist (talk) 15:16, 14 February 2009 (UTC)

That very part I deleted, but someone reverted me. A few patients from a clinical trial or whatever investing their money isn't notable which was why I deleted it before. I can't make recommendations though on this review as I have contributed quite a bit to the article, just saying that I did try deleting it. I also thought it was a bit promotional and unencylopedic content. I am not opposed to deleting that sentence again.-- Literature geek |  T@1k?  17:26, 14 February 2009 (UTC)
 * To me the History part does not look more convoluted than Penicillin. It makes the article more interesting, though. Are there other examples of patients liking the drug so much that they invest in it? Not that I know of. The fact is certainly notable. As for being promotional, the fact that the first patients in the trials really really liked alprazolam is a double-edged sword. It clearly suggested the future abuse potential.The Sceptical Chymist (talk) 23:49, 14 February 2009 (UTC)

Yea but the penicillin article is a B class article, not a good article. Fair points. I guess though it is the reviewers though ultimately about what is a pass and a fail.-- Literature geek |  T@1k?  02:27, 15 February 2009 (UTC)
 * Before reviewing the article, the reviewer should read WP:Reviewing good articles guideline, which recommends: "When reviewing an article, keep in mind that nominators want guidance on improving an article which is not yet up to standard, and appreciate especially specific comments on how to bring the article up to standard. Reviewing is a serious responsibility, and the most dedicated reviewers spend considerable time on each article." The Sceptical Chymist (talk) 12:46, 15 February 2009 (UTC)

Side effects. Given the very long list of side effects given, these should individually sourced; it's not reasonable to give 5 sources, and expect reviewers/readers to cross-check all of them. Xasodfuih (talk) 14:28, 13 February 2009 (UTC)
 * That is incorrect. WP guidelines, e.g. WP:MEDMOS, WP:RS recommend using reviews. So it is very reasonable to give 5 sources for any number of side effects. The Sceptical Chymist (talk) 15:32, 14 February 2009 (UTC)
 * You didn't understand my objection. The difficulty is cross-checking. Reference them (the side effects) individually from whichever review they appear in. See for instance how this is done for the list of medications that can produce serotonin syndrome. Xasodfuih (talk) 16:41, 15 February 2009 (UTC)

I got a bit sidetracked this weekend (by the serotonin syndrome review and Libby Zion expansion), and didn't manage to review this more in depth. I'll try to do it over the week, but no promise I'll be done before the next week end. Xasodfuih (talk) 00:44, 16 February 2009 (UTC)
 * Lists- Can someone please tell me what's so wrong with lists? I don't get it? Don't you agree that some lists are nice?Cssiitcic (talk) 19:45, 17 February 2009 (UTC)
 * Someone else take over this. I'm removing myself as official reviewer for this due to lack of time. Xasodfuih (talk) 06:07, 25 February 2009 (UTC)