Table 1. Anxiolytic Medications and Recommended Dosing for Use in Older Adults.

Generic (Brand) Name	Initial Dosage	Maximum Daily Dosage	Major Adverse Effects
Benzodiazepines
Alprazolam (Xanax®)	0.125 mg to 0.25 mg twice per day	0.25 mg to 2 mg twice per day	Incoordination, cognitive impairment, depression, drowsiness, fatigue, irritability, light headedness, sedation, appetite changes, weight loss or gain, constipation, dry mouth, difficulty urinating, dysarthria
Lorazepam (Ativan®)	0.25 mg to 0.5 mg twice per day	0.5 mg to 4 mg twice per day	Sedation and respiratory depression
Oxazepam (Serax®)	10 mg twice per day	10 mg to 30 mg twice per day	Edema, drowsiness, ataxia, dizziness, memory impairment, headache, paradoxical excitement, incontinence, blood dyscrasia, jaundice, dysarthria, tremor, diplopia, syncope (rare)
Temazepam (Restoril®)	7.5 mg at night	7.5 mg to 5 mg at night	Confusion, dizziness, drowsiness, fatigue, anxiety, headache, lethargy, hangover, euphoria, vertigo, diarrhea, dysarthria, weakness, blurred vision, diaphoresis
Hypnotic agents
Eszopiclone (Lunesta®)	1 mg to 2 mg at bedtime	1 mg to 2 mg at bedtime	Headache, unpleasant taste
Gabapentin (Neurontin®)	100 mg at bedtime	100 mg to 300 mg/3600 mga at bedtime	Somnolence, dizziness, ataxia, fatigue, peripheral edema, diarrhea, tremor, weakness, nystagmus, diplopia
Mirtazapine (Remeron®)	7.5 mg at bedtime	7.5 mg to 45 mg at bedtime	Somnolence, increased appetite with weight gain, increased serum cholesterol, constipation, dry mouth
Nortriptyline (Pamelor®)	10 mg to 25 mg at bedtime	10 mg to 100 mg at bedtime	Orthostasis, hypertension, myocardial infarction, ataxia, extrapyramidal symptoms, seizures, glucose dysregulation, syndrome of inappropriate antidiuretic hormone, sexual dysfunction, dry mouth, anorexia, constipation, nausea, vomiting, diarrhea, weight gain (or loss), urinary retention, impotence, blood dyscrasia, increased levels in liver function test values, paresthesia, mydriasis
Trazodone (Desyrel®)	25 mg at bedtime	25 mg to 200 mg at bedtime	Orthostasis, ventricular irritability, sedation, dizziness, gait instability, mild cognitive impairment, seizures, weight gain, priapism, headache, dry mouth, edema, nausea, diarrhea
Zaleplon (Sonata®)	5 mg at bedtime	5 mg to 10 mg at bedtime	Few common adverse effects. Less common effects: Chest pain, edema, amnesia, dizziness, hallucinations, light headedness, incoordination, anorexia, dyspepsia, nausea, constipation, dry mouth, tremor, weakness, arthralgia
Zolpidem (Ambien®)	5 mg at night	5 mg to 10 mg at night	Few common adverse effects. Less common effects: Palpitations, headache, dizziness, light headedness, amnesia, nausea, diarrhea, dry mouth, constipation

Sources. Jacobson, Pies, and Katz (2007); Smith (2005).

^aFor insomnia, the recommended dosage of gabapentin is up to 300 mg per day; for essential tremor, restless leg syndrome, and neuropathic pain, the recommended dosage is up to 3600 mg per day.