Alprazolam Dosage

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Usual Adult Dose for:

Usual Geriatric Dose for:

Additional dosage information:

Usual Adult Dose for Anxiety

Immediate-release tablets, orally disintegrating tablets, oral concentrate:
Initial dose: 0.25 to 0.5 mg orally 3 times a day
This dose may be gradually increased every 3 to 4 days if needed and tolerated.
Maintenance dose: May increase up to maximum daily dose of 4 mg in divided doses

Usual Adult Dose for Panic Disorder

Immediate-release tablets, orally disintegrating tablets:
Initial dose: 0.5 mg orally 3 times a day
This dose may be gradually increased every 3 to 4 days if needed and tolerated.
Maintenance dose: 1 to 10 mg per day in divided doses
Mean dose employed: 5 to 6 mg per day in divided doses

Extended-release tablets:
Initial dose: 0.5 to 1 mg once a day
The daily dose may be gradually increased by no more than 1 mg every 3 to 4 days if needed and tolerated.
Maintenance dose: 1 to 10 mg once a day
Mean dose employed: 3 to 6 mg once a day

Usual Adult Dose for Depression

Immediate-release tablets, orally disintegrating tablets, oral concentrate:
Initial dose: 0.5 mg orally 3 times a day
The daily dose may be gradually increased by no more than 1 mg every 3 to 4 days.
Average Dose: Studies on the use of alprazolam for the treatment of depression have reported an average effective dose of 3 mg orally daily in divided doses
Maximum Dose: Studies on the use of alprazolam for the treatment of depression have reported to have used 4.5 mg orally daily in divided doses as a maximum.

Usual Geriatric Dose for Anxiety

Immediate-release tablets, orally disintegrating tablets, oral concentrate:
Initial dose: 0.25 mg orally 2 to 3 times a day in elderly or debilitated patients
This dose may be gradually increased if needed and tolerated.

Because of increased sensitivity to benzodiazepines in elderly patients, alprazolam at daily doses greater than 2 mg meets the Beers criteria as a medication that is potentially inappropriate for use in older adults. Smaller doses may be effective as well as safer. Total daily doses should rarely exceed suggested maximums.

Usual Geriatric Dose for Depression

Immediate-release tablets, orally disintegrating tablets, oral concentrate:
Initial dose: 0.25 mg orally 2 to 3 times a day in elderly or debilitated patients
This dose may be gradually increased if needed and tolerated.

Because of increased sensitivity to benzodiazepines in elderly patients, alprazolam at daily doses greater than 2 mg meets the Beers criteria as a medication that is potentially inappropriate for use in older adults. Smaller doses may be effective as well as safer. Total daily doses should rarely exceed suggested maximums.

Usual Geriatric Dose for Panic Disorder

Immediate-release tablets, orally disintegrating tablets:
Initial dose: 0.25 mg orally 2 to 3 times a day in elderly or debilitated patients
This dose may be gradually increased if needed and tolerated.

Extended-release tablets:
Initial dose: 0.5 mg once a day preferably in the morning
This dose may be gradually increased if needed and tolerated.

Because of increased sensitivity to benzodiazepines in elderly patients, alprazolam at daily doses greater than 2 mg meets the Beers criteria as a medication that is potentially inappropriate for use in older adults. Smaller doses may be effective as well as safer. Total daily doses should rarely exceed suggested maximums.

Renal Dose Adjustments

Caution is advised in patients with renal dysfunction

Liver Dose Adjustments

Immediate-release tablets, orally disintegrating tablets, oral concentration:
Initial dose: 0.25 mg orally 2 to 3 times a day in elderly or debilitated patients
This dose may be gradually increased if needed and tolerated.

Extended-release tablets (panic disorder):
Initial dose: 0.5 mg once a day preferably in the morning
This dose may be gradually increased if needed and tolerated.

Precautions

The lowest possible effective dose should be employed and the need for continued treatment reassessed frequently. The risk of dependence may increase with dose and duration of treatment. The elderly may be especially sensitive to the effects of benzodiazepines.

Alprazolam should be used with caution in patients with renal or hepatic impairment.

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Alprazolam is not dialyzable.

Other Comments

In all patients, dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage. It is suggested that the daily dosage be decreased by no more than 0.5 mg every 3 days. Some patients may require an even slower dosage reduction.

A patient may be switched from divided doses of alprazolam tablets, for example 3 to 4 times a day, to alprazolam extended-release tablets at the same total daily dose taken once a day. If, after switching, the therapeutic response is inadequate the dose may be titrated following the guidelines outlined above for extended-release tablets.

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