Pharm

Alprazolam

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Alprazolam, Xanax

  • See Also
  1. Benzodiazepine
  • Indications
  1. Generalized Anxiety Disorder
  2. Panic Disorder
  • Pharmacokinetics
  1. Half Life: 12-15 hours
    1. However, patients often need to re-dose at 6-8 hours
  2. Peak activity: 1 hour
  3. Onset of activity: 15-20 minutes
    1. Triazole ring is rapidly absorbed and crosses the blood brain barrier within 20 minutes
  • Dosing
  • Alprazolam Immediate Release
  1. Start: 0.25 to 0.5 mg orally 2 to 3 times daily
  2. Reduced Dose: 0.25 mg twice daily (elderly, severe liver disease)
  3. May titrate as needed every 3 to 4 days
  4. Maximum Daily Dose
    1. Generalized Anxiety Disorder: maximum 4 mg/day in divided doses
    2. Panic Disorder: maximum 10 mg/day in divided doses
  5. Stopping
    1. Taper dose by 0.5 mg every 3 days
  • Dosing
  • Alprazolam Extended Release (XR)
  1. Start: 0.5 mg to 1 mg orally once daily
  2. Typical: 3 to 6 mg orally once daily
  3. Maximum: 10 mg/day
  1. Valium = Dose x10
  2. Phenobarbital = Dose x30
  • Precautions
  1. Avoid if Chemical Dependency history
  2. Very difficult to wean due to addictive potential (compared with other Benzodiazepines)
    1. When using Alprazolam to wean, decrease total daily dose by 5% every 2-4 weeks
    2. Early withdrawal is common and appears similar to anxiety and panic
    3. Ideally, switch to Diazepam or Clonazepam to wean off Benzodiazepines (see Benzodiazepine Withdrawal)
  • Safety
  1. Pregnancy Category D
  2. Avoid in Lactation
  3. Schedule IV Controlled Substance
  4. No significant active metabolites
  • Drug Interactions
  1. Avoid Strong CYP3A4 Inhibitors (increase Alprazolam levels and duration)
    1. Ketoconazole
    2. Itraconazole
    3. Fluconazole
  2. Exercise caution with other CYP3A4 Inhibitors (increase Alprazolam levels and duration)
    1. Macrolides
    2. Estrogens (e.g. Oral Contraceptives)
    3. Tricyclic Antidepressants
    4. Cimetidine
    5. Paroxetine
    6. Sertraline
  • Resources
  1. Alprazolam (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=388e249d-b9b6-44c3-9f8f-880eced0239f
  • References
  1. (2019) Med Lett Drugs Ther 61(1578): 121-6
  2. (2020) Presc Lett, Resource #361206, Appropriate Use of Benzodiazepines
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 55
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  5. Swaminathan, Schoenberger and Nordt (2026) Alprazolam Dependence, EM:Rap, 7/27/2026