What is the recommended tapering schedule for discontinuing 0.25 mg of Xanax (alprazolam)?

Tapering Off Xanax (Alprazolam) 0.25 mg

For a patient taking 0.25 mg of Xanax (alprazolam), the recommended tapering schedule is to reduce the dose by no more than 0.5 mg every 3 days, with an even more gradual approach often being beneficial. 1

Recommended Tapering Schedule for 0.25 mg Xanax

For a low dose of 0.25 mg, the following specific approach is recommended:

1. Initial Phase (Weeks 1-2):

   • Reduce to 0.125 mg daily (half tablet) for 1-2 weeks
   • Monitor for withdrawal symptoms before proceeding

2. Intermediate Phase (Weeks 3-4):

   • Take 0.125 mg every other day for 1-2 weeks
   • This represents a 75% reduction from the original dose

3. Final Phase (Weeks 5-6):

   • Take 0.125 mg every 3 days for 1-2 weeks before complete discontinuation
   • This gradual approach minimizes withdrawal symptoms

The FDA label for alprazolam specifically warns against abrupt discontinuation and recommends that "reduction of dose must be undertaken under close supervision and must be gradual" 1. The label suggests that "some patients may benefit from an even more gradual discontinuation" than the standard recommendation of reducing by 0.5 mg every 3 days 1.

Managing Withdrawal Symptoms

Common withdrawal symptoms to monitor for include:

• Anxiety and irritability
• Insomnia
• Tremor
• Diaphoresis (excessive sweating)
• Agitation
• Hypertension and tachycardia 2

If significant withdrawal symptoms develop during tapering, the previous dosing schedule should be reinstated temporarily before attempting a slower taper 1. This is crucial as withdrawal symptoms can be mistaken for recurrence of underlying anxiety disorders.

Adjunctive Approaches

To increase the likelihood of successful tapering:

• Cognitive Behavioral Therapy (CBT) significantly increases tapering success rates and should be offered alongside medication taper 2
• Non-pharmacological approaches that can help manage withdrawal symptoms:
  • Regular exercise
  • Sleep hygiene practices
  • Stress management techniques 2

Special Considerations

• Elderly patients should undergo an even more gradual tapering schedule (5% reduction every 2 weeks) 2
• Patients with hepatic impairment should have a more gradual tapering schedule with closer monitoring 2
• Patients with a history of seizure disorders require closer monitoring and possibly a slower tapering schedule 2

Important Cautions

• Avoid abrupt discontinuation as it can lead to withdrawal syndrome which may include seizures in severe cases 1
• Some patients may prove resistant to all discontinuation regimens and may require an extremely slow taper 1
• Studies have shown that hyperbolically reducing doses (making smaller reductions as the dose gets lower) may be more effective in minimizing withdrawal symptoms 3

Remember that even at a low dose of 0.25 mg, withdrawal symptoms can still occur, particularly if the medication has been taken for an extended period. The tapering process should always be supervised by a healthcare provider who can adjust the schedule based on individual response.