III. Pharmacokinetics

  1. Half Life: 12-15 hours

IV. 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

V. 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

VI. Dosing: Equivalent Dosing (for Benzodiazepine Withdrawal)

  1. Valium = Dose x10
  2. Phenobarbital = Dose x30

VII. Precautions

  1. Very difficult to wean due to addictive potential
  2. Avoid if Chemical Dependency history

VIII. Safety

  1. Pregnancy Category D
  2. Avoid in Lactation
  3. Schedule IV Controlled Substance
  4. No significant active metabolites

IX. 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

XI. 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

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xanax (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
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