Alprazolam Dosage Guide + Max Dose, Adjustments - Drugs.com (2025)

Medically reviewed by Drugs.com. Last updated on Oct 9, 2024.

Applies to the following strengths: 0.25 mg; 0.5 mg; 1 mg; 2 mg; 3 mg; 0.5 mg/5 mL; 1 mg/mL

Usual Adult Dose for Anxiety

Immediate-release tablets/orally disintegrating tablets (ODT): 0.25 to 0.5 mg orally administered 3 times a day

• Maximum dose: 4 mg/day

Comments:

• The lowest possible effective dose should be administered and the need for continued treatment reassessed frequently.
• Dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage.
• The daily dosage may be decreased by no more than 0.5 mg every 3 days; however, some patients may require an even slower dosage reduction.
• The dose may be increased at intervals of 3 to 4 days in increments of no more than 1 mg per day.
• The times of administration should be distributed as evenly as possible throughout the waking hours

Uses:

• Treatment of generalized anxiety disorder
• Management of anxiety disorder or APA DSM-III-R diagnosis of generalized anxiety disorder
• Short-term relief of symptoms of anxiety

Usual Adult Dose for Panic Disorder

Immediate-release tablets/ODTs: 0.5 mg orally administered 3 times a day

• Maximum dose: 10 mg/day

Extended-release tablets:

• Initial dose: 0.5 to 1 mg orally once a day
• Maintenance dose: 3 to 6 mg orally per day, preferably in the morning
• Maximum dose: 10 mg/day

Comments:

• The lowest possible effective dose should be administered and the need for continued treatment reassessed frequently.
• Dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage.
• The daily dosage may be decreased by no more than 0.5 mg every 3 days; however, some patients may require an even slower dosage reduction.
• The dose of extended-release tablets may be increased at intervals of 3 to 4 days in increments of no more than 1 mg per day.
• The times of administration should be distributed as evenly as possible throughout the waking hours

Use: Treatment of panic disorder, with or without agoraphobia

Usual Geriatric Dose for Anxiety

• If side effects develop, the dose may be lowered.
• The lowest possible effective dose should be administered and the need for continued treatment reassessed frequently.
• Dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage.

Uses:

• Treatment of generalized anxiety disorder
• Management of anxiety disorder
• Short-term relief of symptoms of anxiety

Usual Geriatric Dose for Panic Disorder

Elderly or debilitated patients:
Immediate-release tablets/ODTs:

• Initial dose: 0.25 mg orally administered 2 or 3 times a day

Extended-release tablets:

• Initial dose: 0.5 mg orally once a day

Comments:

• If side effects develop, the dose may be lowered.
• The lowest possible effective dose should be administered and the need for continued treatment reassessed frequently.
• Dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage.

Use: Treatment of panic disorder, with or without agoraphobia

Renal Dose Adjustments

• Impaired renal function: Use with caution

Liver Dose Adjustments

Immediate-release tablets/ODTs:

• Mild to moderate liver dysfunction: Use with caution
• Severe liver dysfunction: 0.25 mg orally 2 or 3 times a day

Extended-release tablets:

• Mild to moderate liver dysfunction: Use with caution
• Severe liver dysfunction: 0.5 mg orally once a day

Dose Adjustments

Patients with debilitating disease (e.g., severe pulmonary disease):
Immediate-release tablets/ODTs:

• Initial dose: 0.25 mg orally 2 or 3 times a day

Extended-release tablets:

• Initial dose: 0.5 mg orally once a day

Switching Between Immediate and Extended-release Formulations:

• Patients who are currently being treated with divided doses of immediate-release tablets, for example 3 to 4 times a day, may be switched to extended-release tablets at the same total daily dose taken once a day.

Dose Reduction:
Immediate-release tablets/ODTs:

• Extended-release tablets: Doses should be decreased gradually, with dose decreases of no more than 0.5 mg every 3 days.

Precautions

US BOXED WARNINGS:
RISK FROM CONCOMITANT USE WITH OPIOIDS:

• Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death.
• Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate.
• Limit dosages and durations to the minimum required.
• Follow patients for signs/symptoms of respiratory depression and sedation.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule IV

Dialysis

Data not available

Other Comments

Administration advice:

• Extended-release Tablets: Tablets should not be chewed, crushed, or broken.
• ODTs:
• Immediately upon opening the blister, using dry hands, remove the tablet and place it on top of the tongue.
• Tablet disintegration occurs rapidly in saliva so it can be easily swallowed with or without water.

Storage requirements:

• ODTs: Protect from light and moisture.
• Oral solution: Protect from light; discard 90 days after opening.
• Tablets: Protect from light.

General:

• This drug is not recommended for the primary treatment of depression and psychotic illness.

Monitoring:

• Genitourinary: Periodic urinalysis
• Hematologic: Periodic blood counts during long-term treatment (e.g., longer than 4 weeks)
• Hepatic: Periodic liver function tests during long-term treatment (e.g., longer than 4 weeks)
• Metabolic: Periodic blood chemistry analyses

Patient advice:

• This medicine may increase the risk of suicidal thoughts and behavior. Patients should be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Patients should report any behavior of concern to their healthcare provider as soon as possible.
• This drug may cause drowsiness and dizziness and reduce alertness. Patients should not drive a car or operate dangerous machinery until they know how this drug affects them.
• Patients should avoid drinking alcohol or taking other drugs that may cause sleepiness or dizziness while taking this drug until they talk to their healthcare provider.
• Patients should be told to contact their healthcare provider before increasing/decreasing the dose or discontinuing treatment.
• Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.

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See also:

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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