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alprazolam
generic
Black Box Warnings .
Risks from Concomitant Opioid Use
concomitant benzodiazepine use w/ opioids may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options; limit to minimum required dosage and duration; monitor pts for s/sx of resp. depression and sedation
Addiction, Abuse, and Misuse
benzodiazepines expose users to risk of abuse, misuse, and addiction, can lead to overdose or death; commonly involves concomitant use w/ other meds, alcohol, and/or illicit substances, which is assoc. w/ incr. frequency of serious adverse outcomes; assess risk for abuse, misuse, and addiction before prescribing and throughout tx
Dependence and Withdrawal Reactions
cont. benzodiazepine use may lead to clinically significant physical dependence; risk of dependence and withdrawal incr. w/ longer tx duration and higher daily dose; use gradual taper to D/C after cont. use as abrupt D/C or rapid dose reduction may cause acute withdrawal reactions, potentially life-threatening
Adult Dosing .
Dosage forms: TAB: 0.25 mg, 0.5 mg, 1 mg, 2 mg; ER TAB: 0.5 mg, 1 mg, 2 mg, 3 mg; ODT: 0.25 mg, 0.5 mg, 1 mg, 2 mg; SOL: 1 mg per mL
generalized anxiety disorder, acute tx
- [0.25-0.5 mg PO tid]
- Start: 0.25 mg PO tid, may incr. dose q3-4 days; Max: 4 mg/day; Info: start 0.25 mg PO bid-tid in elderly or debilitated pts; taper dose by no more than 0.5 mg/day q3 days to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
panic disorder
- [immediate-release form]
- Dose: 1-2 mg PO tid; Start: 0.25 mg PO tid-qid, may incr. by up to 1 mg/day q3-4 days; Max: 10 mg/day; Info: start 0.25 mg PO bid-tid in elderly or debilitated pts; may divide dose more freq. if interdose sx emerge; doses >6 mg/day rarely more effective; taper dose by no more than 0.5 mg/day q3 days to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
- [extended-release form]
- Dose: 3-6 mg ER PO qd; Start: 0.5-1 mg ER PO qd, may incr. by up to 1 mg/day q3-4 days; Max: 10 mg/day; Info: start 0.5 mg ER PO qd in elderly or debilitated pts; doses >6 mg/day rarely more effective; do not cut/crush/chew ER tab; taper dose by no more than 0.5 mg/day q3 days to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
essential tremor (off-label)
- [0.25-1 mg PO tid]
- Start: 0.25 mg PO tid, may incr. dose q3-4 days; Info: taper dose by no more than 0.5 mg/day q3 days to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
renal dosing
- [see below]
- renal impairment: no adjustment
- HD: no adjustment; no supplement; PD: not defined
hepatic dosing
- [immediate-release form]
- hepatic impairment: start 0.25 mg bid-tid; Info: titrate gradually
- [extended-release form]
- hepatic impairment: start 0.5 mg ER qd; Info: titrate gradually
Peds Dosing .
- Dosage forms: TAB: 0.25 mg, 0.5 mg, 1 mg, 2 mg; ODT: 0.25 mg, 0.5 mg, 1 mg, 2 mg; SOL: 1 mg per mL
anxiety, short-term tx (off-label)
- [7 yo and older]
- Dose: 0.125-0.25 mg PO tid; Start: 0.125 mg PO tid, may incr. by 0.125 mg/dose q3-4 days; Max: 3.5 mg/day; Info: for adjunct tx; taper dose by no more than 0.5 mg/day q3 days to D/C; search 'benzodiazepine' for epocrates Benzodiazepine Deprescribing Advice decision tool
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: consider adult renal dosing for guidance
hepatic dosing
- [not defined]
- hepatic impairment: consider adult hepatic dosing for guidance