Role of alprazolam in the management ot tinnitus

Alprazolam: the commonly used anxiolytic drug has demonstrated beneficial effects in the management of tinnitus. This was in fact an accidental finding when a large number of patients who were suffering from anxiety and tinnitus were prescribed this drug to relieve anxiety. A majority of them reported relief from tinnitus also. At first this beneficial effect was attributed to the fact that a less anxious patient will be able to handle tinnitus better.

Further studies have without doubt demonstrated the beneficial effects of the drug.

Dosage regimen: There is a high degree of variability in the patient response to tinnitus and the dose of drug administered. After a lot of trial and error the following dosage schedule has been evolved:

1. Weeks 1 and 2 - 0.5 mg alprazolam is prescribed each evening before bed time. This dose is not sufficient to relieve tinnitus, but it allows patients to adapt to the drowsiness that is associated with the drug usage. Patients should be warned about this problem of drowsiness.

2. Weeks 3 and 4 - 0.5 mg alprazolam is given in twice a day dose (morning and evening). If this dose fails to relieve tinnitus then this drug should be continued in the same dose indefinitely, under supervision of the physician.

3. Weeks 5 and 6 - the dosage administered can also be increased to thrice a day. If the patient derives benefit the patient can continue the drug indefinitely under supervision

4. If the benefit is not sufficient to the patient's liking then the drug can be tapered off and discontinued. The tapering dose is as follows:

0.5 mg aprazolam twice a day for 3 days and then once a day for 3 days. Eventually the drug is stopped on the 7th day.