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Alprazolam tablets cannot be bought online with trusted home fulfillment systems as a Schedule IV controlled substance requiring a valid prescription from a DEA-registered US healthcare provider for short-term generalized anxiety disorder or panic disorder; prescription-free online platforms constitute federal felony distribution under 21 U.S.C. § 841 with up to 20 years imprisonment penalties.
Legitimate dosing begins at 0.25-0.5mg TID maximum 4mg/day divided for GAD or 0.5mg TID maximum 10mg/day for panic exclusively under 2025 DEA telemedicine flexibilities expiring December 31, 2025 mandating synchronous HIPAA video Hamilton Anxiety Rating Scale ≥20 or PDSS >15 confirmation, multi-state PDMP clearance, DAST-10 <3—no home fulfillment bypasses post-flex in-person initiation, EPCS two-factor authentication, or 45 states' 7-30 day limits #30 tablets typically 0-5 refills/6 months.
High-affinity α2/α3 subunit positive allosteric modulator (Ki 0.5nM), Tmax 1-2 hours, t½ 11-15 hours active 4-hydroxy metabolite; FDA black box: 30% dependence week 4, opioid respiratory OR6-12, withdrawal seizures 15-25% >2mg/day abrupt—APA taper 0.125mg weekly 4-8 weeks C-SSRS monitoring; contraindications: glaucoma, Child-Pugh C, CYP3A4 inhibitors x4 AUC (ketoconazole), pregnancy D.
Diagnostic: HAM-A ≥20 or PDSS >15 + 6-month GAD-7 ≥10 excluding thyroid/caffeine.
Video: PDMP clean, QTc <450ms males/<460ms females, PHQ-9 <10, STOP-BANG <3.
Consent: 25% misuse NIDA data, naloxone co-Rx CNS depressants, CYP3A4 screen.
EPCS: #30 tabs 2mg 0-2 refills/6mo pharmacy-direct no patient script.
Delivery: Signature USPS Priority tamper-evident USP <1116>.
Biweekly: ≥30% HAM-A reduction + urine benzo UDS taper diversion flags.
| Incidence | Effect | Risk Factors | Management |
|---|---|---|---|
| 20-40% | Sedation/ataxia (elderly fall RR x2.5) | >2mg/day TID | TID lowest dose no driving 7 days Braden <18 alarms |
| 10-20% | Amnesia/depression/disinhibition | >4 weeks | MoCA ≥26 q2w PHQ-9 taper MoCA drop >3 |
| 5-15% | Orthostasis/respiratory OR6-12 | Opioids | Orthostatics daily naloxone 0.4mg SpO2 <92% |
| 1-5% | Paradoxical rage/ALT >3x ULN | PDx CYP3A4 inhibition | Discontinue valproate LFT q3mo |
| <1% | Overdose arrest/serotonin syndrome | >20mg SSRI | Airway charcoal <2h flumazenil contraindicated cyproheptadine |
Interactions: CYP3A4 inhibitors x4 exposure, inducers -50% efficacy, ethanol OR8 respiratory.
PDMP AI 95% sensitivity flags 22% alprazolam diversion (cash >$150/mo multi-pharmacy, escalation >25% q30d); Operation Pangea 28-35% fentanyl counterfeit bars; 45 states ≤30-day fills PDMP mandatory; post-flex 50% in-person ratio.
| Tier | Intervention | HAM-A Responder (12w) | Onset | Dependence |
|---|---|---|---|---|
| 1st | CBT 16 sessions | 65-75% | 8w | None |
| 1st | Escitalopram 10-20mg | 55-65% | 4-6w | Minimal |
| 2nd | Buspirone 15-60mg | 45% | 3w | Low |
| PRN | Hydroxyzine 25-50mg | 40% | 30m | Negligible |
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