I am unable to sleep without Alprazolam. What to do?

Q. I have been taking Alprazolam since 5 years. I am unable to sleep without the medicine. Please help.

Answered by
Dr. Nidhi Jain
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 24, 2015 and last reviewed on: Sep 16, 2019

Hello doctor,

  • I am taking Alprazolam 3mg since 5 years.
  • I am also taking Carbamazepine 30mg since 3 years.
  • Now I am unable to sleep without the medicine.

Please help.



Welcome to icliniq.com.

  • You have been taking such a high dose of tablet Alprazolam 3mg since 5 years (long duration) and now you are dependent on it.
  • My treatment plan is to shift you to tablet Valium, a long acting benzodiazepine (in place of Alprazolam) and then gradually taper off tablet Valium.
  • So, stop the tablet Alprazolam and start with tablet Valium (Diazepam) 20mg per day.
  • Decrease the dose by 2.5 mg in every 15 days, which means 20mg for 15 days, then 17.5mg for the next 15 days and then 15 mg for the following 15 days and so on. Continue this method till zero dose.
  • Continue tablet Carbamazepine as it is.
  • If you encounter problem with sleep in this regimen, the dosage has to be altered.

Consult a psychiatrist online for further follow up --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

Thank you doctor,

  • For how long can I take Carbamazepine? 
  • Is this dose enough for chronic psychosis?


Welcome to icliniq.com.

  • Tablet Carbamazepine is an antiepileptic as well as a mood stabilizer.
  • It is effective for mood disorders like mania, bipolar disorder and epilepsy.
  • For psychosis antipsychotics are effective and not mood stabilizers.
  • Even for mood disorders Carbamazepine 30mg dose is not sufficient.
  • It is effective in at least 10mg/kg body weight dose which means, a minimum of 600mg for 60kg body weight.

I can suggest if you should continue or stop Carbamazepine, after knowing your illness in detail. I would like to know the answers for the following:

  • For how long have you had the symptoms?
  • How severe are the symptoms?
  • How was the response to this medication?
  • Is there any family history of the same symptoms?
  • How are you now?
  • Do you have any mood fluctuation now?
  • For how long have you been symptom free?

Revert back with the answers to a psychiatrist online for further follow up --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

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