What is an appropriate starting dose for alprazolam?

1.

Elsevier ClinicalKey Drug Monograph

Content last updated: March 4, 2024.

Indications And Dosage Immediate-release formulations: Initially, 0.25 mg PO 2 to 3 times daily for adults. If side effects occur at this recommended starting dose, decrease dosage. May increase gradually if needed and tolerated. Extended-release formulations: Initially, 0.5 mg PO once daily for adults. May increase gradually if needed and tolerated.

Indications And Dosage Oral dosage (immediate-release tablets, orally disintegrating tablets or oral solution) Adults: 0.5 mg PO 3 times per day, initially. In debilitated adults, a lower initial dose of 0.25 mg PO 2 or 3 times daily is recommended. If clinically indicated, may increase gradually as tolerated, by no more than 1 mg/day at intervals of 3 to 4 days. Many patients require more than 4 mg/day total. Mean effective total dosage during clinical trials: 5 to 6 mg/day, although some required up to 10 mg/day. It is advisable to slowly titrate to higher doses and divide the doses throughout the waking hours on a 3 to 4 times per day schedule. If discontinuation becomes necessary, the manufacturer suggests that the daily dose be decreased by no more than 0.5 mg every 3 days. Some patients may require a more gradual and individualized taper. Geriatric Adults: 0.25 mg PO 2 or 3 times daily, initially. Lower initial doses may be appropriate for some patients. May increase gradually as tolerated, at intervals of 3 to 4 days. During clinical trials in younger adults, the mean effective total dosage was 5 to 6 mg/day. Geriatric adults are more sensitive to the effects of benzodiazepines; use the lowest effective dose. If discontinuation becomes necessary, decrease the daily dose by no more than 0.5 mg every 3 days. Some patients may require a more gradual and individualized taper. Oral dosage (extended-release tablets, e.g., Xanax XR) Adults: 0.5 to 1 mg PO once daily, initially. Use the lower initial dose in debilitated adults. Increase by no more than 1 mg/day at intervals of every 3 to 4 days, as needed and tolerated. Mean effective dosage range: 3 to 6 mg PO once daily. Up to 10 mg/day has been required in occasional patients. Use the lowest effective dose. To switch from immediate-release alprazolam, calculate the total daily dose and administer once daily using the XR formulation.

Indications And Dosage Oral dosage (immediate-release) Adults: 0.25 to 0.5 mg PO 3 times per day, initially. Use the lower dose for debilitated adults. If clinically indicated, increase as tolerated at intervals of 3 to 4 days. Use the lowest effective dose. Max: 4 mg/day in divided doses. If discontinuation becomes necessary, the manufacturer suggests that the daily dose be decreased by no more than 0.5 mg every 3 days. Some patients may require a more gradual and individualized taper. Geriatric Adults: 0.25 mg PO 2 or 3 times daily is the initial and usual recommended dose range. Some older adults may need a lower initial dosage. If clinically indicated, may increase dose gradually if tolerated. Use the lowest effective dose. Geriatric adults are more sensitive to the benzodiazepines. Adult Max: 4 mg/day in divided doses. If discontinuation becomes necessary, the manufacturer suggests that the daily dose be decreased by no more than 0.5 mg every 3 days. Some patients may require a more gradual and individualized taper.

2.

Food and Drug Administration (DailyMed).

Publish date: May 2, 2021.

Dosage And Administration 2 DOSAGE AND ADMINISTRATION • Recommended starting oral dosage is 0.5 mg to 1 mg once daily (preferably in the morning). Depending on the response, the dose may be increased at intervals of 3 to 4 days in increments of no more than 1 mg daily. ( 2.1 ) • Recommended total daily dosage is 3 mg to 6 mg daily. ( 2.1 ) • Swallow tablets whole; do not divide, crush, or chew. ( 2.1 ) • When tapering, decrease dosage by no more than 0.5 mg every 3 days. Some patients may require an even slower dosage reduction. ( 2.2, 5.2 ) • See the Full Prescribing Information for the recommended dosage in geriatric patients, patients with hepatic impairment, and with use with ritonavir. ( 2.3, 2.4, 2.5 ) 2.1 Recommended Dosage Administer Alprazolam XR (alprazolam) orally once daily, preferably in the morning. Swallow tablets whole; do not divide, crush, or chew. The recommended starting oral dosage for Alprazolam XR (alprazolam) is 0.5 mg to 1 mg once daily. Depending on the response, the dosage may be adjusted at intervals of every 3 to 4 days in increments of no more than 1 mg daily. The recommended dosage range is 3 mg to 6 mg once daily. Controlled trials of Alprazolam XR (alprazolam) for the treatment of panic disorder included dosages in the range of 1 mg to 10 mg per day. Most patients showed a response in the dosage range of 3 mg to 6 mg per day. Occasional patients required as much as 10 mg per day. The longer-term efficacy of Alprazolam XR (alprazolam) has not been systematically evaluated. If Alprazolam XR (alprazolam) is used for periods longer than 8 weeks, the healthcare provider should periodically reassess the usefulness of the drug for the individual patient.

3.

Food and Drug Administration (DailyMed).

Publish date: January 3, 2023.

Dosage And Administration 2 DOSAGE AND ADMINISTRATION • Recommended starting oral dosage is 0.5 mg to 1 mg once daily (preferably in the morning). Depending on the response, the dose may be increased at intervals of 3 to 4 days in increments of no more than 1 mg daily. ( 2.1 ) • Recommended total daily dosage is 3 mg to 6 mg daily. ( 2.1 ) • Swallow tablets whole; do not divide, crush, or chew. ( 2.1 ) • When tapering, decrease dosage by no more than 0.5 mg every 3 days. Some patients may require an even slower dosage reduction. ( 2.2, 5.2 ) • See the Full Prescribing Information for the recommended dosage in geriatric patients, patients with hepatic impairment, and with use with ritonavir. ( 2.3, 2.4, 2.5 ) 2.1 Recommended Dosage Administer Xanax XR (alprazolam) orally once daily, preferably in the morning. Swallow tablets whole; do not divide, crush, or chew. The recommended starting oral dosage for Xanax XR (alprazolam) is 0.5 mg to 1 mg once daily. Depending on the response, the dosage may be adjusted at intervals of every 3 to 4 days in increments of no more than 1 mg daily. The recommended dosage range is 3 mg to 6 mg once daily. Controlled trials of Xanax XR (alprazolam) for the treatment of panic disorder included dosages in the range of 1 mg to 10 mg per day. Most patients showed a response in the dosage range of 3 mg to 6 mg per day. Occasional patients required as much as 10 mg per day. The longer-term efficacy of Xanax XR (alprazolam) has not been systematically evaluated. If Xanax XR (alprazolam) is used for periods longer than 8 weeks, the healthcare provider should periodically reassess the usefulness of the drug for the individual patient.

4.

Food and Drug Administration (DailyMed).

Publish date: February 4, 2023.

Description The inactive ingredients are lactose monohydrate, hypromellose, and magnesium stearate. In addition, the 1 mg tablets also contain D&C yellow #10 aluminum lake. The 2 mg tablets also contain FD&C Yellow #6 aluminum lake, and the 3 mg tablets also contain D&C Yellow #10 aluminum lake, and FD&C Blue #2 aluminum lake. Product meets USP Dissolution Test 2. 1