What medications can be taken during a panic attack?

Medications for Panic Attacks

For immediate relief during a panic attack, benzodiazepines such as alprazolam or clonazepam are the most effective medications to take. 1, 2

First-Line Medications for Acute Panic Attacks

Benzodiazepines

Benzodiazepines provide rapid onset of action and are highly effective for managing acute panic symptoms:

• Alprazolam (Xanax):

  • FDA-approved specifically for panic disorder 1
  • Dosage: Start with 0.25-0.5 mg at onset of panic symptoms
  • Onset: Very rapid (15-30 minutes)
  • Duration: 4-6 hours

• Clonazepam (Klonopin):

  • FDA-approved for panic disorder 2
  • Dosage: 0.5-1 mg at onset of panic symptoms
  • Onset: Relatively quick (30-60 minutes)
  • Duration: Longer-acting (8-12 hours)

How to Use During a Panic Attack

1. Take the medication at the first sign of panic symptoms
2. Use the lowest effective dose
3. Sit or lie down in a quiet environment if possible
4. Practice slow, deep breathing while waiting for medication to take effect
5. Avoid driving or operating machinery after taking benzodiazepines

Important Considerations and Cautions

• Risk of dependence: Benzodiazepines should generally be used for short-term or intermittent use due to risk of dependence 3
• Tolerance: Some patients may develop tolerance with regular use 4
• Withdrawal: Abrupt discontinuation can lead to withdrawal symptoms; always taper under medical supervision 1
• Side effects: May cause drowsiness, dizziness, and impaired coordination 3
• Contraindications: Not recommended for patients with a history of substance abuse or certain respiratory conditions

Alternative Approaches

Non-Benzodiazepine Options

• SSRIs (like sertraline, fluoxetine): Not useful during acute attacks but effective for prevention when taken regularly 5
• Psychological first aid: Based on supportive principles for people in acute distress 6

Cognitive-Behavioral Techniques

• Cognitive-behavioral therapy (CBT) principles should be considered for treatment of people concerned about prior panic attacks 6
• These techniques can be learned and applied during an attack but require practice beforehand

Long-Term Management

For patients with recurrent panic attacks, a comprehensive treatment plan should include:

1. Preventive medication: SSRIs are first-line for prevention of recurrent panic attacks 5
2. Regular therapy: CBT with exposure techniques is highly effective 6
3. Reserve benzodiazepines: Use only for breakthrough panic attacks 3, 7

Common Pitfalls to Avoid

• Overreliance on benzodiazepines: Using them as the only treatment strategy can lead to dependence
• Inadequate dosing: Taking too little medication may not effectively abort the panic attack
• Delayed administration: Waiting too long after symptoms begin reduces effectiveness
• Abrupt discontinuation: Always taper benzodiazepines gradually under medical supervision

Benzodiazepines remain the most effective medication class for immediate relief during panic attacks, but their use should be balanced with appropriate long-term strategies to manage panic disorder and reduce reliance on medication.