The Role of Extended-Release Benzodiazepines in the Treatment of Anxiety: A Risk-Benefit Evaluation With a Focus on Extended-Release Alprazolam
J Clin Psychiatry 2002;63(suppl 14):27-33
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Immediate-release (IR) benzodiazepines have a short duration of therapeutic effect and are generally
less effective for anxiety than selective serotonin reuptake inhibitors in reducing concomitant depressive
symptomatology. Common criticisms of benzodiazepines also include the patient’s tendency
to develop a tolerance to the anxiolytic effect and a dependence on the drug itself. The newer
extended-release (XR) benzodiazepine formulation was designed to increase efficacy, duration of
therapeutic effect, tolerance, compliance, and ease of discontinuation. The XR benzodiazepine alprazolam
has shown efficacy in panic disorder and generalized anxiety disorder comparable to the older
benzodiazepine formulations. Pharmacokinetic data show that the XR formulation has a longer therapeutic
effect compared with IR formulations, which reduces the potential for breakthrough anxiety
symptoms. Data also indicate that the XR formulation has less abuse liability than the IR formulation.
This article reviews the efficacy, safety, and discontinuation data from clinical trials of IR and XR
benzodiazepines in the treatment of anxiety disorders and provides guidelines to minimize the risk of
withdrawal syndrome during benzodiazepine discontinuation.