Can you stop taking Xanax (alprazolam) cold turkey?

Abrupt Discontinuation of Xanax (Alprazolam) Is Dangerous and Potentially Life-Threatening

Xanax (alprazolam) should never be stopped "cold turkey" as this can lead to severe withdrawal symptoms including seizures that may be life-threatening. 1

Risks of Abrupt Discontinuation

Abrupt discontinuation of alprazolam can cause:

• Seizures (potentially life-threatening)
• Severe anxiety and panic attacks
• Insomnia
• Tremors and muscle twitching
• Sweating
• Tachycardia (rapid heart rate)
• Cognitive impairment
• Perceptual changes
• Derealization
• Nausea/vomiting
• Headaches

The FDA drug label specifically warns that benzodiazepines, even when used as recommended, may produce emotional and/or physical dependence, and patients should not stop taking this medication abruptly or decrease the dose without consulting their physician, since withdrawal symptoms can occur 1.

Proper Tapering Protocol

The proper approach to discontinuing Xanax involves a gradual taper:

1. Duration-based approach: 2

   • Less than 7 days of use: May be discontinued without formal taper
   • 7-14 days of use: Brief taper needed
   • More than 14 days of use: Formal gradual taper required

2. Recommended tapering schedule: 1

   • Reduce dosage by no more than 0.5 mg every three days
   • Some patients may benefit from an even slower reduction

3. For longer-term use: 2

   • Consider a reduction of 25% every 1-2 weeks
   • For high-dose or long-term users, an even slower taper may be necessary

Managing Withdrawal Symptoms

During the tapering process, withdrawal symptoms should be actively managed:

• Adjunctive medications may be used to manage specific symptoms:

  • Clonidine for autonomic symptoms (sweating, tachycardia)
  • Gabapentin (100-300 mg at bedtime or three times daily) for anxiety symptoms 2
  • Propranolol for physical symptoms of anxiety

• Non-pharmacological approaches:

  • Cognitive behavioral therapy significantly increases tapering success rates 2
  • Sleep hygiene education
  • Relaxation techniques

Special Considerations

• Seizure risk: Withdrawal seizures have been reported with benzodiazepines including alprazolam, ranging from a single episode to coma and death 3

• Duration of withdrawal: Symptoms may gradually disappear over a four-week period, but can persist longer in some patients 4

• Short vs. long-acting benzodiazepines: Withdrawal symptoms occur earlier in patients who have received short-acting benzodiazepines (like alprazolam) compared to long-acting ones 4

• Rebound symptoms: Many patients experience rebound anxiety and insomnia that may be more severe than their original symptoms 5

Warning Signs Requiring Medical Attention

Seek immediate medical attention if any of these occur during withdrawal:

• Seizures
• Severe confusion or disorientation
• Hallucinations
• Severe agitation or psychosis
• Thoughts of self-harm

Conclusion

The evidence is clear that abrupt discontinuation of Xanax is dangerous. In a controlled study, patients switched abruptly to placebo experienced more severe symptoms that appeared earlier compared to those on a tapering schedule 4. Even with proper tapering, 15 out of 17 patients in another study experienced recurrent panic attacks and 9 developed significant new withdrawal symptoms 5.

Remember that the safest approach is always a gradual taper under medical supervision, with the rate determined by the duration of use, dosage, and individual response to dose reduction.