What are as-needed (prn) medications for anxiety?

From the Guidelines

For anxiety that requires as-needed medication, physician-prescribed anxiolytics with choice informed by side-effect profiles, interactions, response, patient age, and preference, as recommended by the most recent guideline update 1, are the preferred option. When considering as-needed medication for anxiety, it's essential to weigh the benefits and risks of different options.

• Benzodiazepines like lorazepam (Ativan) 0.5-1mg, alprazolam (Xanax) 0.25-0.5mg, or diazepam (Valium) 2-5mg taken orally when anxiety symptoms become overwhelming are commonly prescribed.
• These medications typically work within 30-60 minutes and should be limited to short-term use (ideally less than 2-4 weeks of regular use) due to risks of dependence and tolerance.
• Take only when necessary and wait at least 4-6 hours between doses, with a maximum of 2-3 doses per day.
• Side effects may include drowsiness, dizziness, and impaired coordination, so avoid driving or operating machinery after taking them.
• For longer-term anxiety management, consider non-benzodiazepine options like buspirone or certain antidepressants that can be taken regularly, as recommended by the guideline update 1.
• It's crucial to discuss any anxiety medication with your healthcare provider to determine the most appropriate option for your specific situation, taking into account factors such as side-effect profiles, interactions, response, patient age, and preference, as emphasized in the guideline update 1.

From the FDA Drug Label

For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested: Alprazolam tablets are indicated for the management of anxiety disorder (a condition corresponding most closely to the APA Diagnostic and Statistical Manual [DSM-III-R] diagnosis of generalized anxiety disorder) or the short-term relief of symptoms of anxiety

The alprazolam and hydroxyzine can be used as needed for anxiety.

• Alprazolam is indicated for the management of anxiety disorder or the short-term relief of symptoms of anxiety.
• Hydroxyzine is used for symptomatic relief of anxiety and tension associated with psychoneurosis. 2 3

From the Research

As Needed Medication for Anxiety

• The use of as needed medication for anxiety is a common practice, with various options available, including benzodiazepines, buspirone, and hydroxyzine 4, 5, 6.
• Hydroxyzine, an antihistamine medication, has been shown to be effective in alleviating the acute symptoms of generalized anxiety disorder (GAD), with some evidence suggesting it is more effective than placebo 4.
• However, the use of hydroxyzine as a first-line treatment for GAD is not recommended due to the high risk of bias in the included studies and the small number of studies and sample size 4.
• Other medications, such as selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines, are also commonly used to treat anxiety disorders, including GAD and panic disorder 5, 6.
• Cognitive behavioral therapy (CBT) is also an effective treatment for anxiety disorders, and combining CBT with medication, such as SSRIs, can produce greater improvement than either treatment alone 7.
• The choice of medication and treatment approach should be individualized, taking into account the patient's specific needs and circumstances, including comorbid conditions and potential side effects 5, 6, 8.

Treatment Options

• Benzodiazepines, such as alprazolam, can be effective in treating anxiety disorders, but may have side effects, such as sedation and cognitive impairment, particularly in elderly patients 8.
• Buspirone, a non-benzodiazepine anxiolytic, may be a useful alternative for patients who experience side effects with benzodiazepines or have a history of substance abuse 6, 8.
• Hydroxyzine, as mentioned earlier, may be effective in alleviating the acute symptoms of GAD, but its use as a first-line treatment is not recommended due to the limited evidence and high risk of bias 4.
• SSRIs, such as fluoxetine, are commonly used to treat anxiety disorders, including GAD and panic disorder, and may be combined with CBT for greater effectiveness 5, 6, 7.