March 24, 2017
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Alprazolam

Brand Name: Niravam, Xanax, Xanax XR

Generic Name: alprazolam

Drug Class: Antianxiety Agents; Anxiolytics, Benzodiazepines

What Is Alprazolam and How Does It Work?

Alprazolam tablets are indicated for the management of anxiety disorder (a condition corresponding most closely to the APA Diagnostic and Statistical Manual [DSM-III-R] diagnosis of generalized anxiety disorder) or the short-term relief of symptoms of anxiety. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic. Alprazolam tablets are also indicated for the treatment of panic disorder, with or without agoraphobia.

Alprazolam is available under the following different brand names: Xanax, Niravam, and Xanax XR.

Dosages of Alprazolam Should Be Given As Follows:

Adult Dosage Forms & Strengths

Tablet: Schedule IV

  • 0.25 mg
  • 0.5 mg
  • 1 mg
  • 2 mg

Tablet, extended-release: Schedule IV

  • 0.5 mg
  • 1 mg
  • 2 mg
  • 3 mg

Tablet, orally disintegrating: Schedule IV

  • 0.25 mg
  • 0.5 mg
  • 1 mg
  • 2 mg

Oral solution: Schedule IV

  • 1 mg/mL

Dosage Considerations

Anxiety

  • 0.25-0.5 mg orally once every 6-8 hours; titrate to effect once ever 3-4 days; not to exceed 4 mg/day

Panic Disorder

Immediate-release

  • 0.5 mg orally once every 8 hours; may increase once every 3-4 days by 1 mg or less/day
  • Average dose: 5-6 mg/day orally
  • May require up to 10 mg/day orally divided once every 8 hours

Extended-release

  • 0.5-1 mg orally once/day; may increase once every 3-4 days by 1 mg or less/day
  • Average dose: 3-6 mg orally once/day

Anxiety Associated With Depression

  • Immediate-release: Decrease initial dose to 0.25 mg orally once every 8-12 hours; may gradually increase if needed and as tolerated
  • Extended-release: 0.5 mg orally once/day; may increase dose as needed and tolerated

Premenstrual Syndrome (Off-label)

  • 0.25 mg orally once every 6-12 hours; initiate treatment on day 16-18 of menses (not to exceed 3-4 mg/day); taper dose over 2-3 days once menses occurs

Dosing Modifications

Renal impairment

  • Use caution; not studied

Advanced hepatic impairment

  • Immediate-release: Decrease initial dose to 0.25 mg orally once every 8-12 hours; may gradually increase if needed and as tolerated
  • Extended-release: 0.5 mg orally once/day; may increase dose as needed and tolerated

Not recommended for use in patients 18 years and younger.

Geriatric Dose Panic Disorder

Immediate-release:

  • Decrease initial dose to 0.25 mg orally once every 8-12 hours; may gradually increase if necessary and as tolerated; may increase every 3-4 days by 1 mg or less/day to 5-6 mg/day average dose

Extended-release:

  • Start at 0.5 mg orally once/day; may gradually increase if necessary and as tolerated; may increase once every 3-4 days by 1 mg or less/day to 3-6 mg/day

Geriatric Dose Anxiety Associated With Depression

Decrease initial dose to 0.25 mg orally once every 8-12 hours; may gradually increase if needed and as tolerated; may increase every 3-4 days by 1 mg or less/day to 1-4 mg/day

Maintenance

  • 1-4 mg/day orally divided once every 8 hours

Geriatric Dosing Considerations

Use smallest effective dose to avoid ataxia and over-sedation

Elderly especially sensitive to benzodiazepine effects; higher plasma levels exhibited because of reduced clearance

Mean half-life: 16.3 hours in healthy elderly individuals (range: 9-26.9 hour), compared with 11 hours in healthy adults (range: 6.3-15.8 hour)

Medically Reviewed by a Doctor on 3/9/2017



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