Symptoms of Xanax (Alprazolam) Withdrawal
Abrupt discontinuation of Xanax (alprazolam) can lead to a spectrum of withdrawal symptoms ranging from mild anxiety to life-threatening seizures, with symptoms typically beginning 24-72 hours after the last dose.
Common Withdrawal Symptoms
Xanax withdrawal symptoms can be categorized into several domains:
Psychological Symptoms
- Anxiety and panic attacks (often more severe than pre-treatment)
- Irritability and agitation
- Insomnia and sleep disturbances
- Difficulty concentrating
- Perceptual changes and hypersensitivity to stimuli
- Depression
- Dysphoria (feeling unwell)
Physical Symptoms
- Tremors and muscle twitching
- Headaches
- Sweating
- Muscle cramps and pain
- Nausea and vomiting
- Diarrhea
- Blurred vision
- Tachycardia (increased heart rate)
- Hypertension (elevated blood pressure)
- Sensory hypersensitivity
- Weight loss
Severe Withdrawal Manifestations
- Seizures (risk is greatest 24-72 hours after discontinuation) 1
- Status epilepticus (multiple seizures without full recovery between them)
- Delirium with psychosis 2
- Hallucinations
- Severe cognitive impairment
Risk Factors for Severe Withdrawal
The severity of withdrawal symptoms is influenced by several factors:
- Dose: Higher doses (particularly >4 mg/day) increase withdrawal severity 1
- Duration of use: Longer periods of use (especially beyond 12 weeks) increase risk 1
- Rate of discontinuation: Abrupt discontinuation significantly increases risk of severe symptoms including seizures 1
- Short-acting benzodiazepines: Alprazolam's short half-life contributes to more severe withdrawal compared to longer-acting benzodiazepines 3
- History of seizures or epilepsy: Increases risk of withdrawal seizures 1
- Concurrent substance use: Particularly alcohol or other sedatives 3
Timing of Withdrawal Symptoms
Withdrawal from alprazolam typically follows this timeline:
- Early symptoms (1-4 days after discontinuation): Rebound anxiety and insomnia 3
- Peak withdrawal (typically days 2-4): Highest risk period for seizures 1
- Full withdrawal syndrome (usually lasting 10-14 days) 3
- Protracted withdrawal: Some symptoms may persist for weeks or months in certain individuals 3
Special Considerations
- Interdose withdrawal: Some patients experience withdrawal symptoms between scheduled doses, indicating the development of tolerance 1
- Psychological dependence: Risk increases with doses >4 mg/day and longer duration of use 1
- Rebound symptoms: Return of original symptoms at greater intensity than before treatment 1
- Relapse vs. withdrawal: Distinguishing between withdrawal symptoms and return of original anxiety disorder can be challenging 1
Withdrawal Management
While not directly asked, it's important to note that:
- Gradual tapering is essential to minimize withdrawal symptoms 1
- Abrupt discontinuation should be avoided due to seizure risk 1
- Tapering schedules typically recommend 10% dose reduction per month for long-term users 4
- Patients with a history of seizures require especially careful monitoring during withdrawal 1
Warning Signs Requiring Immediate Medical Attention
- Development of seizures
- Severe confusion or delirium
- Psychotic symptoms
- Significant changes in vital signs
- Severe agitation or suicidal thoughts
Alprazolam withdrawal can be dangerous and potentially life-threatening. The FDA label specifically warns that seizures attributable to alprazolam have been reported in patients discontinuing the medication, with the highest risk occurring 24-72 hours after discontinuation 1.