How to taper Alprazolam (Xanax) 2mg tid?

From the Guidelines

To taper off 2mg Xanax 3 times a day, it's recommended to gradually reduce the dose by 25% every 1-2 weeks [ 1 ].

Tapering Schedule

• Start by reducing the daily dose by 0.5mg to 1mg every 1-2 weeks, for example, from 6mg (2mg x 3) to 5.5mg or 5mg.
• Continue to taper down to 5mg, 4mg, 3mg, 2mg, 1mg, and finally 0.5mg before stopping completely.

Important Considerations

• The tapering process should be individualized and may take several weeks to months to complete, depending on the patient's response and tolerance [ 1 ].
• It's essential to work closely with a healthcare provider to monitor for withdrawal symptoms and adjust the tapering schedule as needed [ 1 ].
• Cognitive Behavioral Therapy (CBT) may be helpful in increasing tapering success rates, especially for patients struggling with benzodiazepine taper [ 1 ].
• In cases where patients are taking multiple central nervous system depressants, such as benzodiazepines and opioids, tapering decisions should be coordinated with prescribers of all medications to reduce the risk of respiratory depression [ 1 ].

From the FDA Drug Label

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 be decreased by no more than 0.5 mg every 3 days. Some patients may require an even slower dosage reduction.

It is suggested that the dose be reduced by no more than 0.5 mg every 3 days, with the understanding that some patients may benefit from an even more gradual discontinuation.

To taper Alprazolam (Xanax) 2mg tid, the daily dosage should be decreased by no more than 0.5 mg every 3 days. The patient should be closely supervised during this process, and the dosage reduction should be gradual. Some patients may require an even slower dosage reduction. If significant withdrawal symptoms develop, the previous dosing schedule should be reinstituted and, only after stabilization, should a less rapid schedule of discontinuation be attempted 2.

From the Research

Tapering Alprazolam (Xanax) 2mg tid

To taper Alprazolam (Xanax) 2mg tid, the following strategies can be considered:

• Gradual tapering over a period of time to minimize the risk of withdrawal symptoms 3
• Tapering at a rate of 0.5 mg three times a day, regardless of whether the patient is being tapered for low- or high-dose withdrawal 3
• Hyperbolic tapering, which involves reducing the dose by a fixed percentage (e.g. 10%) at regular intervals (e.g. every 3-6 months) 4, 5, 6
• Substitution with a long-acting benzodiazepine, such as chlordiazepoxide, and then tapering the substitute medication 7

Key Considerations

• The tapering schedule should be individualized based on the patient's tolerance and response to dose reductions 3, 6
• The use of guidelines and practice guidelines can support patients and prescribers in achieving effective drug discontinuation 6
• Further studies are needed to reduce the barriers associated with psychiatric drug discontinuation, particularly in obtaining flexible doses for the last steps of tapering 6

Tapering Strategies

• Linear tapering: reducing the dose by a fixed amount at regular intervals 6
• Hyperbolic tapering: reducing the dose by a fixed percentage at regular intervals 4, 5, 6
• Extended dosing: using a long-acting formulation to reduce the frequency of dosing 6
• Substitution: substituting the original medication with a different medication, such as a long-acting benzodiazepine, and then tapering the substitute medication 7