Individualized dosage. Lowest possible effective dose & duration should be used & the need for continued treatment reassessed frequently. Anxiety Initially 0.75 to 1.5 mg daily in divided doses. Usual dose range: 0.5 to 4 mg daily in divided doses. Panic disorders Initially 0.5-1 mg at bedtime or 0.5 mg 3 times daily. Usual dose range: Adjusted to patient's response. Dose increments should not exceed 1 mg at intervals of 3-4 days. Additional doses can be added until a 3 times or 4 times daily schedule is achieved. Max: 10 mg daily. Geriatric patients Initial & usual dose range: 0.5 to 0.75 mg daily in divided doses. May be gradually increased if needed & tolerated.
Patients w/ panic-related disorders. Episodes of hypomania & mania. Dosage must be gradually tapered to preclude sequelae of rapid w/drawal. May result in profound sedation, resp depression, coma & death in concomitant use w/ opioids. Depression w/ psychosis features, bipolar disorders or “endogenous” depression (eg, severely depressed in-patients). Risk of dependence increases w/ higher doses & long-term use & is further increased in patients w/ a history of alcoholism & drug abuse. Not recommended in patients whose primary diagnosis is schizophrenia. Caution against engaging in hazardous occupations or activities requiring complete mental alertness eg, operating machinery or driving a motor vehicle. Impaired renal or hepatic function. Increased risk of congenital abnormalities when administered to pregnant woman during the 1st trimester. Not recommended for use in pregnancy. Nursing should not be undertaken while using benzodiazepines. Childn <18 yr. Elderly or debilitated patients.
Benzodiazepines produce additive CNS depressant effects when co-administered w/ opioids, other psychotropic medications, anticonvulsants, antihistaminics, ethanol & other dugs which produce CNS depression. Co-administration w/ erythromycin. Dose adjustment or discontinuation of alprazolam when co-administered w/ HIV PIs (eg, ritonavir). Increased digoxin conc especially in elderly (>65 yr). Co-administration w/ ketoconazole, itraconazole, or other azole type antifungals is not recommended. Dose reduction is recommended when co-administered w/ nefazodone, fluvoxamine & cimetidine. Co-administration w/ fluoxetine, propoxyphene, OCs, diltiazem, or macrolide antibiotics eg, troleandomycin.
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