Acute Anxiety Benzodiazepines

Alprazolam (Xanax)

  • 0.125 mg up to 4 time/day PRN
  • Effective immediately, short ½ life

Clonazepam 

  • 0.5-2 mg once or twice daily PRN 

Lorazepam

  • 0.5–2 mg every 6-8 hours PRN

  • Benzodiazepines: bind to GABA receptors in brain & enhance GABA-mediated inhibitory effect on CNS
  • Unique to Alprazolam 🡪 antidepressant effect

  • Acute & self-limited stress

  • *

  • Sedation (subsides after few days)
  • Addiction & dependence 
  • Rebound anxiety 🡪 Do not stop abruptly, taper dosage to avoid withdrawal symptoms

CYP3A4 inhibitors 

  • ↑ Alprazolam levels

  • Alprazolam favored over other benzodiazepines due to short ½ life 🡪 less SE & interactions
  • For all, use maximum for 3-4 weeks (risk of addiction)