What anxiolytic (anxiety) medication can be taken as needed?

From the Guidelines

Benzodiazepines, such as lorazepam or alprazolam, are the most commonly prescribed anxiety medications that can be taken as needed, but their use should be informed by side-effect profiles, interactions, response, patient age, and preference, as suggested by the ASCO guideline update 1. When considering anxiety medications that can be taken as needed, it's essential to weigh the benefits and risks of each option.

• Benzodiazepines, like lorazepam (Ativan) or alprazolam (Xanax), are often prescribed for short-term anxiety relief, with dosages ranging from 0.5-2mg per dose for lorazepam and 0.25-1mg per dose for alprazolam.
• These medications typically take effect within 30-60 minutes and can provide relief for several hours.
• However, their use should be carefully monitored due to the risks of dependence, tolerance, and withdrawal, as well as potential side effects like drowsiness, dizziness, and impaired coordination 1.
• Non-benzodiazepine options, such as hydroxyzine (Vistaril), may be considered for patients who require anxiety relief with less addiction potential.
• Ultimately, the choice of medication should be made in consultation with a healthcare provider, taking into account the patient's specific symptoms, medical history, and other medications they may be taking, as recommended by the ASCO guideline update 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Dosage should be individualized for maximum beneficial effect. The lowest possible effective dose should be employed and the need for continued treatment reassessed frequently. In all patients, dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage.

Alprazolam can be taken as needed for anxiety, but the dosage should be individualized for maximum beneficial effect and the lowest possible effective dose should be employed.

• The dose may be increased to achieve a maximum therapeutic effect, at intervals of 3 to 4 days, to a maximum daily dose of 4 mg, given in divided doses.
• It is essential to reassess the need for continued treatment frequently and reduce the dosage gradually when discontinuing therapy or decreasing the daily dosage 2.

From the Research

Anxiety Medications

Anxiety medications can be taken as needed, but it's essential to consider the type of medication and its potential effects.

• Benzodiazepines, such as alprazolam, can be taken as needed for anxiety, but they can be habit-forming and are generally recommended for short-term use 3, 4.
• Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used to treat anxiety disorders, but they are typically taken daily and may take several weeks to become effective 3, 5, 6.
• Buspirone, an azapirone, can be taken as needed, but it may not be as effective as other medications for severe anxiety 5.

Efficacy of Medications

The efficacy of medications for anxiety disorders can vary depending on the specific condition and individual response.

• Benzodiazepines have been shown to be effective in reducing anxiety symptoms, especially in the short-term 4.
• SSRIs and SNRIs have been found to be effective in treating anxiety disorders, with comparable efficacy to benzodiazepines in some studies 3, 5, 4.
• The choice of medication should be based on individual factors, such as medical history, co-morbidities, and prior treatment response 5, 6.

Considerations for Treatment

When considering treatment for anxiety, it's essential to weigh the potential benefits and risks of each medication.

• Benzodiazepines can be effective, but they carry a risk of dependence and withdrawal symptoms 3, 4.
• SSRIs and SNRIs can be effective, but they may have side effects, such as nausea, headache, and sexual dysfunction 3, 5, 6.
• A stepwise approach to treatment, considering patient-specific factors, can help guide medication selection and sequencing 6.