What are the guidelines for tapering off Xanax (alprazolam) when reducing the dosage from 90 tablets to 80 tablets?

Tapering Xanax from 90 to 80 Tablets

Reduce your total daily alprazolam dose by 25% (approximately 0.25 mg if taking 1 mg daily) every 1-2 weeks, which translates to decreasing by roughly 10 tablets over 1-2 weeks from your 90-tablet monthly supply. 1

Understanding the Reduction

• If you're currently taking 90 tablets per month (approximately 3 tablets daily of 1 mg each = 3 mg/day), reducing to 80 tablets means decreasing to approximately 2.67 mg/day 1
• This represents about an 11% reduction in total monthly dose, which aligns with the recommended 10-25% reduction every 2-4 weeks for benzodiazepine tapering 2
• The CDC recommends reducing by 10-25% of the total daily dose every 2-4 weeks, with slower tapers being better tolerated for patients on long-term therapy 2

Specific Tapering Schedule

For a patient taking 3 mg daily (90 tablets/month), the reduction should follow this pattern:

• Week 1-2: Reduce by 0.25-0.5 mg daily (targeting 2.5-2.75 mg/day total) 1
• Distribute the reduction across doses throughout the day rather than eliminating one entire dose 1
• Monitor closely for withdrawal symptoms at each step before proceeding 1

Critical Monitoring Requirements

Schedule follow-up appointments at least monthly during the taper, or more frequently if you're taking ≥50 MME equivalent or have risk factors 3

• Watch for withdrawal symptoms including: anxiety, insomnia, tremors, sweating, tachycardia (occurs in 12.2% of patients), muscle cramps, and sensory disturbances 1, 4
• If withdrawal symptoms become significant, pause the taper temporarily and resume at a slower rate 2
• The FDA warns that abrupt discontinuation can cause serious withdrawal including seizures 4

Common Withdrawal Symptoms to Expect

• Mild to moderate withdrawal syndrome occurs in 35% of alprazolam-treated patients during taper 5
• Most common symptoms include: anxiety (19.2%), insomnia (29.5%), light-headedness (19.3%), fatigue (18.4%), and irritability (10.5%) 4
• Rebound panic attacks occur in 27% of patients, typically appearing toward the end of taper 5
• Withdrawal symptoms are typically transient and subside within 1-2 weeks after stabilization 5

Adjunctive Support During Taper

Maximize non-pharmacological interventions to manage anxiety during the reduction:

• Cognitive-behavioral therapy (CBT) during taper significantly increases success rates, with weekly 90-120 minute sessions demonstrating effectiveness 1
• Consider relaxation techniques and regular physical activity 1, 2
• Pharmacological adjuncts like buspirone for anxiety/insomnia may be considered 1

Critical Pitfalls to Avoid

• Never discontinue alprazolam abruptly—the FDA specifically warns this can cause seizures, delirium, and rarely death 4, 2
• Avoid concurrent use of other CNS depressants (alcohol, opioids, other sedatives) during the taper period 1
• Do not reduce faster than 0.5 mg every 3 days as recommended by the FDA label 4
• Some patients may require an even slower taper than the standard protocol, particularly those on higher doses or longer duration of therapy 4

Special Considerations for Your Dose Level

• Withdrawal symptoms, including seizures, have been reported even with brief therapy at doses of 0.75-4 mg/day 4
• The risk of withdrawal seizures increases at doses above 4 mg/day 4
• For patients on benzodiazepines ≥1 year, tapers of 10% per month or slower are better tolerated 2
• Standardized tapering schedules achieve discontinuation in approximately 45% of patients at 12 months, with most experiencing stable or improved anxiety after successful taper 1