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Q. What is the best method to taper Alprazolam dosage?

Answered by
Dr. Seikhoo Bishnoi
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 04, 2018

Hello doctor,

I am a 60 year old female in not too bad health. I have been on 0.25 mg of Xanax in the morning, and 0.50 mg of Xanax at bedtime, since the last three months. Now it is time to come off it. Also, I take 50 mg Pristiq in the morning. My doctor wants to change my Xanax schedule to 0.25 mg in the morning, 0.25 mg in the late afternoon and 0.25 mg at bedtime as a preparation of tapering. Is this a sound idea? I thought it would be easier to leave it as is, and taper that way. Also, they want to do a 25 % taper, and I thought 10% was the maximum that can be done. Any input will be appreciated. Also, should it be decreased every week or every two weeks?

#

Hello,

Welcome to icliniq.com.

I have read your query, and understand that you are looking to taper Xanax.

  • Xanax is Alprazolam and is a benzodiazepine drug. Dose tapering after prolonged use should be done in a gradual manner. For my patients, I reduce the dose by 20 to 25 % every two weeks. Doses can be stopped completely at around six to eight weeks. Slow dose reduction in this manner will not result in withdrawal.

For further queries consult a psychiatrist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

Thank you doctor,

However, you did not answer the second part of my query. Do you agree with my physician's plan of changing the dosage from 0.25 mg in the morning, and 0.50 mg at night to 0.25 mg thrice a day? I wish to set myself up for success, and my physician is not as knowledgeable as yourself.

#

Hello,

Welcome back to icliniq.com.

I am sorry I did not address that. Let me clarify.

  • If there is a plan to taper the doses, then I do not see much of a benefit in changing the dosing schedule to 0.25 mg three times a day.
  • If we consider the pharmacokinetics of Xanax, its elimination half-life is around 10 to 11 hours. Even after regular intake, the effects tend to wean off about five hours after the last dose. So, if with the twice-a-day dose, your anxiety is under control, then I think that starting an afternoon dose is not a good idea because there is no requirement of the drug at that time.
  • Instead, I would suggest reducing the evening dose to 0.25 mg, while keeping the morning strength unchanged at 0.25 mg. If you suffer any issues on reducing the evening dose, then you can take half of the 0.25 mg tablet on an SOS basis in the evening. This is a relatively easier tapering method. Also, since you are on 0.75 mg dose per day, I do not think reducing the doses would cause many difficulties.

I hope this helps. Take care.

For more information consult a psychiatrist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

Hello doctor,

Thank you for replying. I was having issues at 4 PM, but I do not wish for an increase in dosage. However, are you saying that with 0.75 mg of Xanax per day, I should have minimal withdrawal symptoms?

#

Hello,

Welcome back to icliniq.com.

Yes, you have understood me correctly.

  • 0.75 mg dose of Xanax is not a high dose, and you will have only mild withdrawal symptoms. You might experience mild sleep issues and a slight increase in restlessness, but these symptoms will be tolerable.
  • Ensure you avoid coffee, tea or carbonated drinks in evening.
  • If you have worsening of anxiety or restlessness in the afternoon, but do not wish to add an afternoon dose, then I suggest you still reduce the evening dose, and take half of the 0.25 mg tablet in addition to the normal dose, on an SOS basis. You can stop the morning dose after two weeks.

Stay calm and relaxed. You will not have a lot of withdrawal symptoms. Take care.

For more information consult a psychiatrist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist


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