Xanax Dosage Guide – Drugs.com

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Generic name: ALPRAZOLAM 0.25mg
Dosage form: tablet
Drug class: Benzodiazepines

Medically reviewed by Drugs.com. Last updated on Jan 18, 2023.

Dosage in Generalized Anxiety Disorder

The recommended starting oral dosage of XANAX for the acute treatment of patients with GAD is 0.25 mg to 0.5 mg administered three times daily. Depending upon the response, the dosage may be adjusted at intervals of every 3 to 4 days. The maximum recommended dosage is 4 mg daily (in divided doses).

Use the lowest possible effective dose and frequently assess the need for continued treatment [see Warnings and Precautions (5.2)].

Dosage in Panic Disorder

The recommended starting oral dosage of XANAX for the treatment of PD is 0.5 mg three times daily. Depending on the response, the dosage may be increased at intervals of every 3 to 4 days in increments of no more than 1 mg per day.

Controlled trials of XANAX in the treatment of panic disorder included dosages in the range of 1 mg to 10 mg daily. The mean dosage was approximately 5 mg to 6 mg daily. Occasional patients required as much as 10 mg per day.

For patients receiving doses greater than 4 mg per day, periodic reassessment and consideration of dosage reduction is advised. In a controlled postmarketing dose-response study, patients treated with doses of XANAX greater than 4 mg per day for 3 months were able to taper to 50% of their total maintenance dose without apparent loss of clinical benefit.

The necessary duration of treatment for PD in patients responding to XANAX is unknown. After a period of extended freedom from panic attacks, a carefully supervised tapered discontinuation may be attempted, but there is evidence that this may often be difficult to accomplish without recurrence of symptoms and/or the manifestation of withdrawal phenomena [see Dosage and Administration (2.3)].

Discontinuation or Dosage Reduction of XANAX

To reduce the risk of withdrawal reactions, use a gradual taper to discontinue XANAX or reduce the dosage. If a patient develops withdrawal reactions, consider pausing the taper or increasing the dosage to the previous tapered dosage level. Subsequently decrease the dosage more slowly [see Warnings and Precautions (5.3), Drug Abuse and Dependence (9.3)].

Reduced the dosage by no more than 0.5 mg every 3 days. Some patients may benefit from an even more gradual discontinuation. Some patients may prove resistant to all discontinuation regimens.

In a controlled postmarketing discontinuation study of panic disorder patients which compared the recommended taper schedule with a slower taper schedule, no difference was observed between the groups in the proportion of patients who tapered to zero dose; however, the slower schedule was associated with a reduction in symptoms associated with a withdrawal syndrome.

Dosage Recommendations in Geriatric Patients

In geriatric patients, the recommended starting oral dosage of XANAX is 0.25 mg, given 2 or 3 times daily. This may be gradually increased if needed and tolerated. Geriatric patients may be especially sensitive to the effects of benzodiazepines. If adverse reactions occur at the recommended starting dosage, the dosage may be reduced [see Use in Specific Populations (8.5), Clinical Pharmacology (12.3)].

Dosage Recommendations in Patients with Hepatic Impairment

In patients with hepatic impairment, the recommended starting oral dosage of XANAX is 0.25 mg, given 2 or 3 times daily. This may be gradually increased if needed and tolerated. If adverse reactions occur at the recommended starting dose, the dosage may be reduced [see Use in Specific Populations (8.6), Clinical Pharmacology (12.3)].

Dosage Modifications for Drug Interactions

XANAX should be reduced to half of the recommended dosage when a patient is started on ritonavir and XANAX together, or when ritonavir administered to a patient treated with XANAX. Increase the XANAX dosage to the target dose after 10 to 14 days of dosing ritonavir and XANAX together. It is not necessary to reduce XANAX dose in patients who have been taking ritonavir for more than 10 to 14 days.

XANAX is contraindicated with concomitant use of all strong CYP3A inhibitors, except ritonavir [see Contraindications (4), Warnings and Precautions (5.5)].

Frequently asked questions

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Medical Disclaimer

How long does Xanax last for / stay in your system?

Medically reviewed by Carmen Pope, BPharm. Last updated on Jan 28, 2023.

Xanax (alprazolam) is a medication used to treat anxiety and panic disorders. One dose of Xanax can last anywhere from 31 hours to 134.5 hours (5.6 days) in the body, depending on factors related to the individual who took it. However, the calming, relaxing, and sedative effects of Xanax usually wear off within about eight to twelve hours.

Xanax is taken by mouth and quickly absorbed into the bloodstream. Effects should be noticed within an hour and the medicine reaches peak concentrations in the body after one to two hours. People who take Xanax regularly can build up a tolerance to it and effects, such as a feeling of calm or sedation, may take longer to develop or not be felt as strongly as before.

Xanax is usually prescribed three times a day because its effects in the body (calming, sedation, relaxing) tend to wear off within eight hours for most people. However, one dose of Xanax remains detectable in the body for two to five days – the exact length of time depends on several factors specific to the individual who took the dose.

What factors determine the half-life of Xanax?

Factors that determine how long a dose of Xanax will persist in the body for include:

• A person’s age: Xanax lasts for longer in elderly people. The average half-life in the elderly is 16.3 hours, compared to 11.2 hours in younger, healthy adults
• Weight: Xanax lasts for longer in heavier people, because obesity makes it harder for your body to break down Xanax. The average half-life in people who are overweight/obese is 21.8 hours, compared to 11.2 hours in young, healthy adults
• Ethnicity: Xanax lasts for longer in Asian people. The average half-life in Asian people is 14 hours, compared to 11.2 hours in Caucasians
• Metabolism: People who exercise a lot or who have a faster metabolism clear Xanax faster than those who don’t exercise or do any physical activity. The half-life of Xanax is shorter in these people
• Liver function: Xanax lasts for longer in people with poor liver function. The average half-life in people with alcoholic liver disease is 19.7 hours, compared to 11.2 hours in young, healthy adults
• Length of time taking Xanax: If you take Xanax regularly, then you will have a higher concentration in your bloodstream and it will take longer to fully eliminate it all. But because you have built up a tolerance to the drug, you may not necessarily feel its effects for longer
• Interacting medications: Xanax lasts longer when it is taken with drugs that inhibit CYP3A4 (eg, erythromycin, ketoconazole, nefazodone, oral contraceptives), one of its metabolizing pathways. Other drugs (such as carbamazepine, St John’s wort), may decrease the half-life of Xanax
• Smoking: The half-life of Xanax may be reduced by up to 50% in smokers compared to nonsmokers. This means that smokers metabolize Xanax more quickly than nonsmokers
• Alcohol: Alcohol can increase the effects and half-life of Xanax, and can lead to dangerous side effects which could be fatal.

How long does Xanax stay in your system?

Studies have shown that the half-life of Xanax ranges from 6.3 to 26.9 hours. It is important to realize that half-life is a figure that is an estimate of the time it takes for the concentration or amount in the body of that drug to be reduced by exactly one half (50%). After four to five half-lives, 97% of a drug has cleared from the body, and the drug is no longer considered to be having any effect. However, this does not mean that it won’t be detectable by a drug test, as this depends on how specific and sensitive the drug test is.

If we use the average half-life of Xanax, which is 11.2 hours, then the following is estimated for a 1mg dose of Xanax:

• 11.2 hours after administration, 0. 5mg remains
• 22.4 hours minutes after administration, 0.25mg remains
• 33.6 hours after administration, 0.125mg remains
• 44.8 hours after administration, 0.063mg remains
• 56 hours after administration, 0.0315mg remains.

In theory, we can see that after 56 hours (2.3 days), almost all the original Xanax dose (slightly less than 97%) has been eliminated in people whose Xanax half life is 11.2 hours. However, in some people, the half-life of Xanax is 26.9 hours. In these people, it will take approximately 134.5 hours (5.6 days) for almost 97% of a dose of Xanax to be eliminated.

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Medical Disclaimer

SERS method for detecting counterfeit products

Author: Victor Section: Raman spectroscopy (Raman spectroscopy)

DEK082016

Emergence of counterfeit prescription drugs y, has become a real problem for the pharmaceutical industry. Currently counterfeit medicines are fraudulently labeled as genuine and sold as such.

These medicines usually do not contain active pharmaceutical ingredients (APIs) and instead contain highly potent hazardous substances [1, 2]. Such preparations are often very similar to real medicines (see Fig. 1).

Several cases of overdose of counterfeit Xanax containing the potent opioid fentanyl have recently been reported in the United States [3]. Due to the prevalence of such counterfeit drugs, it is necessary to develop a methodology that will quickly identify counterfeit drugs.

Since the concentration of APIs in tablets is very low, conventional Raman spectroscopy will not work, as it will not be possible to determine these substances from the tablet surface due to insufficient sensitivity to very low concentrations.

This article describes the development of the SERS method (enhanced surface Raman spectroscopy) for the determination of low doses of the active substance alprazolam (<0. 2%) in Xanax tablets using a handheld Raman spectrometer. If the characteristic peaks of alprazolam are not detected when using the SERS method, then the Xanax tablet is considered a fake.

This work demonstrates the potential of the SERS method to rapidly detect the presence of alprazolam in a tablet in order to identify counterfeit products.

Xanax is a pharmaceutical preparation containing alprazolam as an API (see Fig. 1b). It is used to treat panic disorders. Typically, a Xanax tablet may contain 0.25 mg, 0.5 mg, 1 mg, or 2 mg of alprazolam. Other components such as cellulose, corn starch, sodium docusate, lactose, magnesium stearate, silicon dioxide and sodium benzoate are excipients or inactive components [4].

Fentanyl – is synthetic drug (see Fig. 1c). Considered the strongest pain reliever on the pharmaceutical market (50 to 100 times more powerful than morphine [5]), fentanyl is prescribed by doctors to treat severe pain or as part of anesthesia to help relieve pain after surgery or other medical procedures. Increasingly, fentanyl is produced illegally and sold on the streets under the guise of heroin or Xanax and is fatal due to overdose. Due to the high activity of fentanyl, substances containing this drug are most often found on the street in the form of salts of acetyl fentanyl or fentanyl citrate.

Fig. 1. Real (left) and fake (right) Xanax tablets containing alprazolam (b) and fentanyl (c) as API.

Experiment

The TacticID-GP handheld Raman spectrometer from BWTek with a laser excitation wavelength of 785 nm and a special TacPac adapter for SERS measurements were used in the experiment (see figure below).

Fig. 2. TacticID-GP handheld Raman spectrometer with TacPac adapter.

The samples tested in this experiment were Xanax tablets containing alprazolam 0.25 mg, purchased from a pharmacy, and tablets containing fentanyl, provided by the Nashua Police Department’s Impoundment Division, Hillsborough County, New Hampshire, USA.

Approximately a quarter of Xanax tablets (≈ 30 mg) were placed in a plastic vial. After that, 0.5 ml of acetone was added to the same tube. Then the tube was shaken until the tablets were completely dissolved in acetone and the mixture looked like a cloud-like substance. Next, special paper SERS substrates were placed in this substance for some time for better interaction with it (about 30 seconds). These substrates were placed in a special TacPac adapter and analyzed using TacticID-GP. To increase the accuracy and reproducibility of measurements, each SERS substrate was analyzed at three different points. The signal accumulation time was in the range of 15–30 seconds.

Results

Direct measurement of Xanax

Figure 3 shows the Raman spectra obtained by direct contact of the instrument with the surface of a Xanax tablet (a) and a lactose tablet (b). Observed characteristic peaks at 356 cm ^-1 , 436 cm ^-1 , 476 cm ^-1 , 1088 cm ^-1 , 1120 cm ^-1 and 1264 cm 90 057 -1 coincided for both spectra. No peaks characteristic of alprazolam were observed.

Measurement in direct contact with the surface of a Xanax tablet using TacticID-GP produced a correlation result for the spectrum of lactose with an HQI quality of fit of 86.7 (the maximum HQI value can be as high as 100). This showed that the measurement by this method cannot provide reliable information about the content of alprazolam in Xanax.

Fig. Fig. 3. Raman spectra of Xanax (blue, (a)) and lactose (red, (b)) tablets in direct surface measurements.

Detection of alprazolam in xanax

Figure 4 shows the Raman spectrum of pure alprazolam (a) and the SERS spectrum of xanax (b). Observed characteristic peaks at 688 cm ^-1 , 1000 cm ^-1 , 1132 cm ^-1 , 1160 cm ^-1 , 1312 cm ^-1 and 1380 cm ^-1 , 1484 cm ^{– 1} , 1568 cm ^-1 and 1592 cm ^-1 for the SERS spectrum correspond to the peaks of the spectrum of pure alprazolam. Figure 5 shows Raman SERS spectra of Xanax tablet excipients. Due to the poor solubility of the components in acetone, their SERS spectra lack the characteristic peaks observed in the SERS spectrum of Xanax.

Although the mass fraction of alprazolam is < 0.2%, analysis by the SERS method can significantly improve the Raman signal of this API, although the component of excipients is represented by a higher concentration. This remark demonstrates the high selectivity of the method for the determination of API and its suitability for the determination of low concentrations of substances.

Fig. Fig. 4. Raman spectrum of pure alprazolam (red, (a)) and SERS spectrum of xanax (blue, (b)).

Fig. 5. Raman SERS spectra of Xanax tablet excipients.

Fentanyl detection

The SERS method was also used to detect fentanyl in Xanax tablets. Figure 6 shows the SERS spectra of fentanyl and alprazolam. Two characteristic peaks at 1000 cm ^-1 and at 1029 cm ^-1 are common to the SERS spectra of both fentanyl and alprazolam. However, the spectrum of alprazolam also has characteristic peaks at 688 cm ^-1 , 1484 cm ^-1 , 1568 cm ^-1 and 1592 cm ^-1 , which are not observed in the spectrum of fentanyl. With proper spectral analysis, these spectra can be distinguished from each other, despite the fact that both substances have several common characteristic peaks. In order to identify counterfeits, you can be guided by the following rule: if the SERS spectrum of the analyzed Xanax tablet does not have all the characteristic peaks of alprazolam, then it can be considered a fake.

Fig. Fig. 6. SERS spectra of fentanyl (a) and alprazolam (b).

Xanax Identification

To compare the spectra, a coefficient correlation algorithm was used to determine the unknown spectrum from a reference spectrum from the library. The correlation coefficient HQI (quality of fit index) for the unknown spectra with respect to the reference library spectrum was calculated from the least squares scalar product of the average value at the center of the unknown and library spectra using the following formula:

,

where A is the reference spectrum from the library,

B is the currently unknown, currently measured spectrum

The HQI value can be in the range 0 – 100 (100 corresponds to a complete match between the reference and measured spectra). The table below shows the results of measurements of the studied components and their HQI agreement with the library spectra (the spectrum of each component was obtained with an average of 3):

Table 1: Measurement results of

Conclusion

In this experiment, the SERS method Raman spectroscopy was developed and validated to detect low concentrations of alprazolam in Xanax tablets. The method showed high sensitivity and selectivity in the determination of alprazolam despite its low concentration. The portable TacticID-GP Raman spectrometer used during the experiment proved to be suitable for determining the differences between the SERS spectra of alprazolam and other components of Xanax. In order to identify counterfeits, you can be guided by the following rule: if the SERS spectrum of the analyzed Xanax tablet does not have all the characteristic peaks of alprazolam, then the tablet can be considered a fake.

This spectrometer is also capable of detecting the SERS spectrum of fentanyl, allowing it to be recorded when it is used instead of alprazolam. The sample preparation procedure for analysis is very simple and can be easily performed by the end user (even those who have no theoretical and/or practical knowledge of SERS Raman spectroscopy).

The ability to quickly detect the presence of alprazolam or other hazardous substances in Xanax tablets is an essential tool for law enforcement and the pharmaceutical industry to combat the proliferation of counterfeit products. Thus, it can be concluded that 9The 0029 TacticID-GP handheld Raman spectrometer is the ideal tool for this and similar applications.

Links

1. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/CounterfeitMedicine/
2. https://addictionresource.com/drugs/the-dangers-of-fentanyl/
3. https://www.dea.gov/docs/Counterfeit Prescription Pills.pdf
4. https://www.xanax.com/
5. https://www.drugabuse.gov/drugs-abuse/fentanyl

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