Treatment for Patients with Anxiety should be Initiated with a Dose of 0.25 mg to 0.5 mg Given 3 Times Daily. The Dose may be Increased to Achieve a Maximum Therapeutic Effect, at Intervals of 3 to 4 Days, to a Maximum Daily Dose of 4 mg Given in Divided Doses. But the Successful Treatment of Many Panic Disorder Patients has Required the Use of Alprazolam at Doses Greater Than 4 mg Daily. In Elderly Patients, in Patients with Advanced Liver Disease or in Patients with Debilitating Disease, the Usual Starting Dose is 0.25 mg, Given 2 or 3 Times Daily. This may be Gradually Increased if Needed and Tolerated.
The Elderly Patients may be Especially Sensitive to the Effects of Benzodiazepines. If Side Effects Occur at the Recommended Starting Dose, the Dose may be Lowered. In All Patients, Dosage should be Reduced Gradually when Discontinuing Therapy or when Decreasing the Daily Dosage. Although there are no Systematically Collected Data to Support a Specific Discontinuation Schedule, it is Suggested that the Daily Dosage may be Decreased by no More Than 0.5 mg Every 3 Days. Some Patients may Require an Even Slower Dosage Reduction. The Usual Maximum Dose should not Exceed 4 mg Daily.
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