II. Indications
III. Pharmacokinetics
- Half Life: 12-15 hours
- However, patients often need to re-dose at 6-8 hours
- Peak activity: 1 hour
- Onset of activity: 15-20 minutes
- Triazole ring is rapidly absorbed and crosses the blood brain barrier within 20 minutes
IV. Dosing: Alprazolam Immediate Release
- Start: 0.25 to 0.5 mg orally 2 to 3 times daily
- Reduced Dose: 0.25 mg twice daily (elderly, severe liver disease)
- May titrate as needed every 3 to 4 days
- Maximum Daily Dose
- Generalized Anxiety Disorder: maximum 4 mg/day in divided doses
- Panic Disorder: maximum 10 mg/day in divided doses
- Stopping
- Taper dose by 0.5 mg every 3 days
V. Dosing: Alprazolam Extended Release (XR)
- Start: 0.5 mg to 1 mg orally once daily
- Typical: 3 to 6 mg orally once daily
- Maximum: 10 mg/day
VI. Dosing: Equivalent Dosing (for Benzodiazepine Withdrawal)
- Valium = Dose x10
- Phenobarbital = Dose x30
VII. Precautions
- Avoid if Chemical Dependency history
- Very difficult to wean due to addictive potential (compared with other Benzodiazepines)
- When using Alprazolam to wean, decrease total daily dose by 5% every 2-4 weeks
- Early withdrawal is common and appears similar to anxiety and panic
- Ideally, switch to Diazepam or Clonazepam to wean off Benzodiazepines (see Benzodiazepine Withdrawal)
VIII. Safety
- Pregnancy Category D
- Avoid in Lactation
- Schedule IV Controlled Substance
- No significant active metabolites
IX. Drug Interactions
X. Resources
XI. References
- (2019) Med Lett Drugs Ther 61(1578): 121-6
- (2020) Presc Lett, Resource #361206, Appropriate Use of Benzodiazepines
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 55
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Swaminathan, Schoenberger and Nordt (2026) Alprazolam Dependence, EM:Rap, 7/27/2026