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

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

alprazolam (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ALPRAZOLAM 0.25 MG TABLET Generic $0.02 each
ALPRAZOLAM 0.5 MG TABLET Generic $0.02 each
ALPRAZOLAM 1 MG TABLET Generic $0.02 each
ALPRAZOLAM 2 MG TABLET Generic $0.05 each
ALPRAZOLAM ER 0.5 MG TABLET Generic $0.16 each
ALPRAZOLAM ER 1 MG TABLET Generic $0.18 each
ALPRAZOLAM ER 2 MG TABLET Generic $0.33 each
ALPRAZOLAM ER 3 MG TABLET Generic $0.27 each
ALPRAZOLAM ODT 0.25 MG TAB Generic $0.87 each
ALPRAZOLAM ODT 0.5 MG TAB Generic $1.11 each
ALPRAZOLAM XR 0.5 MG TABLET Generic $0.16 each
ALPRAZOLAM XR 1 MG TABLET Generic $0.18 each
ALPRAZOLAM XR 2 MG TABLET Generic $0.33 each
ALPRAZOLAM XR 3 MG TABLET Generic $0.27 each
xanax (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
XANAX 0.25 MG TABLET Generic $0.02 each
XANAX 0.5 MG TABLET Generic $0.02 each
XANAX 1 MG TABLET Generic $0.02 each
XANAX 2 MG TABLET Generic $0.05 each

Ontology: Alprazolam (C0002333)

Definition (CHV) a drug used to treat anxiety disorders and panic attacks
Definition (CHV) a drug used to treat anxiety disorders and panic attacks
Definition (NCI_NCI-GLOSS) A drug used to treat anxiety disorders and panic attacks. It is being studied in the treatment of nausea and vomiting caused by some cancer treatments. It is a type of benzodiazepine.
Definition (NCI) A triazolobenzodiazepine agent with anxiolytic, sedative-hypnotic and anticonvulsant activities. Alprazolam binds to a specific site distinct from the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) binding site on the benzodiazepine-GABA-A-chloride ionophore receptor complex located in the limbic, thalamic and hypothalamic regions of the central nervous system (CNS). This binding causes an allosteric modification of the receptor and enhances the affinity of GABA to the receptor leading to an increase in the frequency of chloride-channel opening events. This leads to an increase in chloride ion conductance, neuronal hyperpolarization, inhibition of the action potential and leads to a decrease in neuronal excitability.
Definition (MSH) A triazolobenzodiazepine compound with antianxiety and sedative-hypnotic actions, that is efficacious in the treatment of PANIC DISORDERS, with or without AGORAPHOBIA, and in generalized ANXIETY DISORDERS. (From AMA Drug Evaluations Annual, 1994, p238)
Definition (CSP) 8-chloro-1-methyl-6-phenyl-s-triazolo benzodiazepine, has both antidepressant and anxiolytic properties; possible efficacy in alcohol withdrawal therapy; abuse can lead to habituation or addiction.
Definition (PDQ) A triazolobenzodiazepine agent with anxiolytic, sedative-hypnotic and anticonvulsant activities. Alprazolam binds to a specific site distinct from the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) binding site on the benzodiazepine-GABA-A-chloride ionophore receptor complex located in the limbic, thalamic and hypothalamic regions of the central nervous system (CNS). This binding causes an allosteric modification of the receptor and enhances the affinity of GABA to the receptor leading to an increase in the frequency of chloride-channel opening events. This leads to an increase in chloride ion conductance, neuronal hyperpolarization, inhibition of the action potential and leads to a decrease in neuronal excitability. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39659&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39659&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C227" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D000525
SnomedCT 391741005, 111127002, 386983007
LNC LP14981-2, MTHU002286
English Alprazolam, Alprazolan, 4H-(1,2,4)Triazolo(4,3-a)(1,4)benzodiazepine, 8-chloro-1-methyl-6-phenyl-, alprazolam, alprazolam (medication), ALPRAZOLAM, Alprazolam [Chemical/Ingredient], alprazolan, ALPRAZolam, Alprazolam - chemical, Alprazolam - chemical (substance), Alprazolam (product), Alprazolam (substance)
Swedish Alprazolam
Czech alprazolam
Finnish Alpratsolaami
Italian Alprazolan, Alprazolam
Russian AL'PRAZOLAM, АЛЬПРАЗОЛАМ
Japanese アルプラゾラム
Polish Alprazolam
Spanish alprazolam (producto), alprazolam (sustancia), alprazolam, Alprazolam, Alprazolan
French Alprazolam
German Alprazolam, Alprazolan
Portuguese Alprazolam, Alprazolan

Ontology: Xanax (C0699034)

Definition (CHV) a kind of anxiety treatment drug
Definition (CHV) a kind of anxiety treatment drug
Definition (CHV) a kind of anxiety treatment drug
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D000525
English Pfizer Brand of Alprazolam, Alprazolam Pfizer Brand, tafil, xanax, trankimazin, Tafil, Trankimazin, Xanax