How to taper off Xanax (alprazolam)?

From the Guidelines

To taper off Xanax (alprazolam), a gradual reduction in dose under close medical supervision is recommended, with a typical schedule involving a decrease of 25% of the daily dose every 1-2 weeks, as suggested by 1. When considering tapering off alprazolam, it's essential to prioritize a gradual approach to minimize the risk of severe withdrawal symptoms and rebound anxiety.

Key Considerations

• Consult with a prescribing physician to create a personalized tapering plan, which may involve switching to a longer-acting benzodiazepine like diazepam (Valium) to ease the process 1.
• Reduce the total daily dose by 5-10% every 1-2 weeks, with a common approach being to decrease the dose by 0.25 mg every 2-4 weeks 1.
• Monitor for withdrawal symptoms like anxiety, insomnia, or tremors, and adjust the tapering schedule as needed.
• Avoid alcohol and other sedatives during the tapering process.
• Consider cognitive behavioral therapy or other non-medication approaches to manage anxiety.

Tapering Schedule Example

For a patient taking 1 mg of alprazolam twice daily, a possible tapering schedule could be:

• Week 1-2: 0.75 mg twice daily
• Week 3-4: 0.5 mg twice daily
• Week 5-6: 0.25 mg twice daily Then, gradually decrease the frequency of doses.

Importance of Gradual Tapering

Gradual tapering allows the brain to adjust to decreasing levels of the drug, reducing the risk of severe withdrawal symptoms and rebound anxiety. Abruptly stopping alprazolam can lead to dangerous withdrawal effects, making a gradual tapering schedule crucial for a safe and successful discontinuation of the medication, as emphasized by 1.

From the FDA Drug Label

In all patients, dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage. Although there are no systematically collected data to support a specific discontinuation schedule, it is suggested that the daily dosage be decreased by no more than 0.5 mg every 3 days. Some patients may require an even slower dosage reduction.

If significant withdrawal symptoms develop, the previous dosing schedule should be reinstituted and, only after stabilization, should a less rapid schedule of discontinuation be attempted

It is suggested that the dose be reduced by no more than 0.5 mg every 3 days, with the understanding that some patients may benefit from an even more gradual discontinuation.

To taper off Xanax (alprazolam), the dosage should be gradually reduced. The recommended taper schedule is to decrease the daily dosage by no more than 0.5 mg every 3 days. However, some patients may require an even slower dosage reduction. If withdrawal symptoms develop, the previous dosing schedule should be reinstituted and a less rapid schedule of discontinuation should be attempted 2.

From the Research

Tapering Off Xanax (Alprazolam)

To taper off Xanax (alprazolam), it is essential to follow a gradual reduction schedule to minimize withdrawal symptoms. The following points outline the key considerations:

• Alprazolam discontinuation must be tapered due to the risk of withdrawal and rebound symptoms 3.
• There is no specific tapering schedule recommended for alprazolam in the provided studies, but a gradual reduction in dosage is suggested.
• A study on tapering clonazepam, another benzodiazepine, recommends reducing the dosage by 0.25 mg per week after intermediate-term use 4.
• For patients with a history of alcohol abuse or benzodiazepine dependence, the potential for severe withdrawal reactions should be considered, even with gradual tapering 5.
• A general guideline for benzodiazepine detoxification suggests gradual tapering over 4 weeks on an outpatient basis for low-dose withdrawal, and a more gradual tapering schedule for high-dose withdrawal 6.
• Alprazolam should be titrated at a rate of 0.5 mg three times a day, regardless of whether the patient is being tapered for low- or high-dose withdrawal 6.

Key Considerations

• Gradual reduction in dosage is crucial to minimize withdrawal symptoms.
• Patients with a history of substance abuse or dependence may require closer monitoring during the tapering process.
• The tapering schedule may need to be adjusted based on individual patient needs and responses to dosage reductions.
• Close medical supervision is necessary during the tapering process to manage any potential withdrawal symptoms or reactions.