The “029 pill” refers to a specific formulation of alprazolam, a benzodiazepine medication commonly used to treat anxiety and panic disorders. It is a round, peach or orange tablet imprinted with “029” on one side and a bisect score on the other, containing 0.5 mg of the active ingredient.
Identification and Appearance
This pill is produced by various generic manufacturers and matches the description of alprazolam 0.5 mg immediate-release tablets. The imprint “029” distinguishes it from other strengths like the 0.25 mg white “027” pill or 1 mg blue “031” pill. These tablets are scored for easy splitting and contain non-medicinal ingredients such as cornstarch, lactose, and magnesium stearate.
Medical Uses
Alprazolam, sold under brand names like Xanax, is FDA-approved for short-term treatment of generalized anxiety disorder (GAD) and panic disorder, with or without agoraphobia. It provides rapid relief from acute anxiety symptoms but is not intended for long-term use due to dependence risks. Off-label, it may help with chemotherapy-induced nausea, though evidence varies.
Mechanism of Action
Alprazolam acts as a positive allosteric modulator at GABA_A receptors in the brain, enhancing the inhibitory effects of the neurotransmitter GABA. This leads to neuronal hyperpolarization, reducing excitability and producing anxiolytic, sedative, muscle relaxant, and anticonvulsant effects. Its potency and quick onset (within 1-2 hours) make it effective for immediate symptom relief.
Dosage and Administration
For anxiety, typical starting doses are 0.25-0.5 mg taken 2-3 times daily, not exceeding 4 mg per day. Panic disorder may require higher initial doses up to 0.5 mg three times daily, titrated carefully. Tablets should be swallowed whole or split, with effects lasting 4-6 hours. Elderly patients or those with liver issues start at lower doses.
Common Side Effects
Frequent side effects include drowsiness (41%), light-headedness (21%), dizziness (19%), and dry mouth (15%). Less common issues involve gastrointestinal upset, hypotension, or rash. Dose-dependent effects peak early in treatment.
| Category | Side Effect | Frequency (Placebo-Controlled Trials) |
|---|---|---|
| Nervous System | Drowsiness | 41% |
| Light-headedness | 21% | |
| Dizziness | 19% | |
| Gastrointestinal | Dry mouth | 15% |
| Cardiovascular | Hypotension | 5% |
| Skin | Rash | 11% |
Serious Risks and Warnings
Alprazolam carries boxed warnings for risks of dependence, abuse, addiction, and withdrawal, especially with prolonged use. Abrupt discontinuation can cause seizures or severe rebound anxiety. It heightens respiratory depression when combined with opioids or alcohol. Contraindicated in acute narrow-angle glaucoma or hypersensitivity.
Rare severe reactions include mania, hepatic failure, Stevens-Johnson syndrome, or gynecomastia. Overdose symptoms involve extreme sedation, respiratory failure, and coma; flumazenil is an antidote.
Precautions and Interactions
Avoid in patients with substance abuse history, sleep apnea, or severe lung disease. Use caution in pregnancy (Category D) due to fetal risks and in breastfeeding. Major interactions occur with CYP3A inhibitors (e.g., ketoconazole, increasing levels) or inducers (e.g., rifampin).
| Patient Group | Recommendation |
|---|---|
| Elderly (≥65) | Start at 0.25 mg; monitor closely |
| Liver Impairment | Reduce dose; avoid chronic use |
| History of Addiction | Use lowest effective dose shortest duration |
| With Opioids | Contraindicated |
History and Regulation
Introduced as Xanax in the 1980s, alprazolam became one of the most prescribed benzodiazepines before Schedule IV controlled substance status in the US due to misuse potential. Generic versions like the 029 pill dominate today.