Can You Fill A Xanax (Alprazolam) Change In Dose?

The answer depends on a variety of factors.

Question

If my Xanax is changed from 0.5 mg twice a day to 0.25 mg three times a day, will my pharmacy fill it because it's a change in dose?

Asked by Johnnyd On Oct 22, 2018

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Oct 24, 2018
PrescriptionWhether or not you can fill a dose change of Xanax (alprazolam), a schedule IV-controlled substance, early depends on a variety of factors, including:
  • Your insurance company
  • Pharmacy
  • Pharmacist discretion
  • Prescriber discretion
  • State you are located
  • Your controlled substance fill history


Controlled Substance Refills

Unfortunately, it is difficult to give a one-size fits all answer. In regard to the actual laws on the matter, they are fairly ambiguous and vary by state.


Federal law doesn't state anything regarding dose changes for controls, only for refills:

"Prescriptions for schedule II controlled substances cannot be refilled. A new prescription must be issued. Prescriptions for schedules III and IV controlled substances may be refilled up to five times in six months. Prescriptions for schedule V controlled substances may be refilled as authorized by the practitioner."

All states have their own version of controlled substance laws, but they typically don't discuss rules regarding dose changes, only refills.


For example, below is Part 80: Rules and Regulations on Controlled Substances in NYS:

"No additional prescriptions for a controlled substance may be issued by a practitioner to an ultimate user within 30 days of the date of any prescription previously issued unless and until the ultimate user has exhausted all but a seven days' supply of that controlled substance provided by any previously issued prescription."


Dose Changes

While a dose change (from Xanax 0.5 mg to 0.25 mg for example) is technically not a refill, but rather a 'new prescription', they are often treated as refills since it is for the same drug, just a different strength. How a pharmacist or pharmacy handles it can vary considerably, which is why it is difficult to give a definitive answer.


Consider the following situation:

  • You fill Xanax 0.5 mg on 11/1 for 60 tablets.
  • Your doctor changes your dose, and gives you a new prescription for Xanax 0.25 on 11/7 for 60 tablets.


After only 7 days, you will still have a considerable quantity of your older prescription. If you still have those, and they have not been surrendered, you may find the pharmacist unwilling to a new prescription it unless they get authorization from the doctor.


Even insurance companies have their own rules. Your insurance company may deny paying for a dose change if you still have medication left from your older prescription, especially if the change is a dose decrease. They may instruct you to split your old medication to get to your new dose (if applicable). Not all insurance companies do this, but it wouldn't be unheard of.


Your best bet is to speak with your pharmacy regarding how to get your new prescription filled and their policies.


About Xanax

Xanax (alprazolam) is a rapid acting oral benzodiazepine used for the treatment of anxiety and panic disorders. It is also used off-label for the short-term treatment of insomnia.


Xanax has a short half-life but has relatively high potential for abuse due to its quick acting effects. Discontinuation can sometimes be difficult as there is a high risk of withdrawal symptoms in-between doses and it may need to be tapered over weeks to months.


The onset of action of Xanax is around 15 to 30 minutes after taking by mouth, with peak concentrations occurring within 1—2 hours. Xanax is also available as an extended release dosage form, Xanax XR.

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of PharmacistAnswers.com. He graduated from the University At Buffalo with a Doctor of Pharmacy degree in 2010. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Please feel free to reach out to him directly if you have any inquiries or want to connect! He's answered thousands of medication and pharmacy-related questions and he's ready to answer yours! Brian.Staiger@PharmacistAnswers.com Office: 716-389-3076

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