From the Guidelines
To taper off Xanax 0.25mg once daily, a recommended schedule involves reducing the dose by approximately 10-25% every 1-2 weeks, with the goal of minimizing withdrawal symptoms and ensuring patient safety, as supported by the most recent and highest quality study 1. When considering tapering Xanax, it's essential to prioritize a gradual reduction in dose to avoid rebound anxiety, insomnia, irritability, and in severe cases, seizures.
- A typical tapering schedule might involve taking 0.25mg every other day for 1-2 weeks, then 0.25mg every third day for 1-2 weeks, before discontinuing completely.
- Alternatively, the dose could be reduced to 0.125mg daily for 1-2 weeks, then 0.125mg every other day for 1-2 weeks, before stopping. The exact schedule should be individualized based on how well the person tolerates the taper, and it's crucial to work with a healthcare provider when tapering benzodiazepines like Xanax, as they can help adjust the taper rate or temporarily hold at a dose until symptoms improve, as suggested by 1 and 1. Key considerations during the tapering process include:
- Monitoring for withdrawal symptoms, such as anxiety, insomnia, and irritability
- Adjusting the taper rate as needed to minimize discomfort and ensure patient safety
- Considering alternative therapies, such as cognitive-behavioral therapy (CBT) or other non-benzodiazepine medications, to manage anxiety and other symptoms that may arise during the tapering process, as recommended by 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.
To taper off Xanax 0.25mg once daily, it is recommended to decrease the daily dosage by no more than 0.5 mg every 3 days. However, since the current dose is already low (0.25mg), a more gradual reduction may be necessary. The dosage reduction should be undertaken under close supervision. 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.
- Key points:
- Reduce dosage by no more than 0.5 mg every 3 days
- May require an even slower dosage reduction
- Reduction of dose must be undertaken under close supervision
- If significant withdrawal symptoms develop, reinstitute the previous dosing schedule and attempt a less rapid discontinuation schedule after stabilization.
From the Research
Tapering Off Xanax
There are no research papers provided that directly address the recommended tapering schedule for Xanax (alprazolam) 0.25mg once daily.
- The studies provided focus on:
- Combining selective serotonin reuptake inhibitors and cognitive behavioral therapy in youth with depression and anxiety 3
- Comparative efficacy and acceptability of first-line drugs for the acute treatment of generalized anxiety disorder in adults 4
- Emotion-based brain mechanisms and predictors for SSRI and CBT treatment of anxiety and depression 5
- Equivalent efficacy and decreased rate of overcorrection in patients with syndrome of inappropriate secretion of antidiuretic hormone given very low-dose tolvaptan 6
- Neonatal outcomes for women at risk of preterm delivery given half dose versus full dose of antenatal betamethasone 7
- None of these studies provide information on tapering off Xanax (alprazolam) 0.25mg once daily.
- Therefore, there is no evidence from the provided studies to assist in answering this question.