Tolerancia farmacológica y falta de respuesta terapéutica tras el uso prolongado de alprazolam: reporte de un caso clínico

Abstract

Prolonged use of benzodiazepines, especially alprazolam, has been associated with the development of pharmacological tolerance, dependence, and decreased therapeutic response, constituting a relevant clinical problem due to its physical, psychological, and social repercussions. This study presents a descriptive and retrospective case report of a 56-year-old female patient with a history of anxiety and chronic insomnia under long-term treatment with alprazolam. The methodology included a comprehensive nursing assessment, review of the patient's medical records, follow-up of the patient's progress, and comparison of the clinical findings with available scientific evidence. During the clinical course, a progressive loss of therapeutic efficacy was observed, manifested by an increase in anxiety symptoms, the need to increase the dose to achieve the same clinical effect, and the appearance of signs consistent with drug dependence. Sleep disturbances, daytime sleepiness, difficulty concentrating, mild withdrawal symptoms, and impaired work performance were also identified. The care plan focused on symptom management, monitoring for adverse effects, and education on the safe use of the medication. The patient's clinical progression demonstrated that prolonged use of alprazolam can promote the development of tolerance and dependence, compromising therapeutic efficacy and quality of life, which highlights the importance of early detection, continuous nursing follow-up, and the implementation of multidisciplinary strategies to promote the rational use of benzodiazepines and prevent complications associated with their prolonged use. Keywords: Alprazolam, Benzodiazepines, Drug tolerance, Substance-related disorders, Anxiety disorder