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In general, some patients receiving recommended (or higher) doses of Xanax for relatively brief periods of time (1 week to 4 months), withdrawal seizures have been reported upon rapid decrease of dosage. Thus, the dosage of Xanax should be reduced gradually.
If Alprazolam is to be combined with other psychotropic drugs or anticonvulsant drugs, careful consideration should be given to the pharmacology of the drugs to be employed, particularly with compounds which might increase the action of benzodiazepines.
Certain clinical adverse events, some life-threatening, are a direct consequence of physical dependence to Alprazolam. These include a spectrum of withdrawal symptoms, the most important is seizure even after relatively short-term use at doses of <4 mg/day and for long period (> 12 weeks). However, in a controlled post-marketing discontinuation study of panic disorder patientswho received Xanax tablets, the duration of treatment (3 months compared to 6 months) had no effect on the ability of patients to taper to zero dose, in contrast to patients treated with doses of Xanax tablets > 4 mg/day who had more difficulty tapering to zero dose than those treated with < 4 mg/day.
Relapse of return of illness was defined as a return of symptoms characteristic of panic disorder (primarily panic attacks) to levels approximately equal to those seen at baseline before active treatment was initiated. Rebound pertains to a return of symptoms of panic disorder to a level substantially greater in frequency or more severe in intensity than seen at baseline. Symptoms of withdrawal were identified as those which were generally not characteristic of panic disorder and which occurred for the first time more frequently during discontinuation than at baseline.
The rate of rebound, withdrawal and relapse in patients with panic disorder who received Xanax XR tablets has not been systematically studied.