CURRENT Diagnosis &Treatment: Family Medicine, 5e >Anxiety Disorders

Jeannette E. South-Paul, Samuel C. Matheny, Evelyn L. Lewis+

Table 57–3.Pharmacotherapy for anxiety disorders.

Drug Name Usual Dosage Range FDA-Approved Indications Comments

XR dosed once daily

Reduce doses for elderly or patients with hepatic

disease

Benzodiazepines a Short-term relief of anxiety

0.5–4 mg (3–6, ≤10 mg daily for panic) divided Physical dependence can occur with relatively
into 3 doses short-term use
Alprazolam b (Xanax, Xanax XR, Niravam) Panic disorder

Abrupt discontinuation can result in rebound

anxiety or withdrawal symptoms

Rapid-dissolve tablet available

Reduce doses for elderly or patients with hepatic

disease
Clorazepate b (Tranxene) 15–60 mg in divided doses Short-term relief of anxiety
Physical dependence can occur with relatively
short-term use

Long duration of effect results in smoother

control
Clonazepam b (Klonopin) 0.25–0.5 mg twice daily (max dose 4 mg/d) Panic disorder

Rapid-dissolve tablet available

Reduce doses for elderly or patients with hepatic

Anxiety disorders disease
Diazepam b (Valium) 2–10 mg 2–4 times daily (max dose 40 mg/d)
Short-term relief of anxiety Physical and psychological dependence can
occur with continuous use

Effective when given orally or by IM/IV injection

Short-term relief of anxiety
Lorazepam b (Ativan) 2–6 mg in divided doses
Preferred in patients with hepatic insufficiency
Anxiety associated with depression
because of no active metabolites

Selective Serotonin Reuptake Inhibitors (SSRIs)

No significant additional benefit if dose increased
10 mg once daily GAD
to 20 mg
Escitalopram (Lexapro)

GAD

Panic disorder Doses should be taken in the morning

Fluoxetine b (Prozac) 10–60 mg once daily
OCD Start with low dose and titrate to effective dose

PMDD
 Panic disorder

Social anxiety disorder

Start with low dose and titrate to effective dose

Paroxetine b (Paxil, Paxil CR)
GAD
Abrupt discontinuation can result in rebound
10–60 mg (12.5–62.5 mg CR) once daily
anxiety or withdrawal symptoms
PTSD

CR formulation has lower gastric intolerance

OCD

PMDD

Panic disorder

Social anxiety disorder

Start with low dose and titrate to effective dose

Sertraline (Zoloft) 25–200 mg once daily OCD

Abrupt discontinuation can result in rebound
anxiety or withdrawal symptoms
PTSD

Pediatric OCD

Initiate with 37.5 mg daily and titrate up to

effective dose
Miscellaneous GAD
75–225 mg in 2–3 divided doses XR formulation dosed once daily
Venlafaxine (Effexor, Effexor XR) Social anxiety disorder
Taper dose on discontinuation to avoid rebound
or withdrawal symptoms

Not for situational anxiety; therapeutic benefit

may not be achieved for ≤1 month

Buspirone b (BuSpar) 10–60 mg in divided doses GAD No risk of physical or psychological dependence

Avoid in patients with severe renal or hepatic

impairment

aAll benzodiazepines are Schedule IV controlled substances.

bGeneric formulations are available.

CR, controlled release; FDA, US Food and Drug Administration; GAD, generalized anxiety disorder; IM, intramuscular; IV, intravenous; OCD, obsessive-compulsive disorder; PMDD, premenstrual dysphoric
disorder; PTSD, posttraumatic stress disorder; XR, extended release.

Date of download: 12/27/22 from AccessMedicine: accessmedicine.mhmedical.com, Copyright © McGraw Hill. All rights reserved.