Sudden Discontinuation of Xanax (Alprazolam) Can Cause Severe Withdrawal Syndrome
Suddenly stopping daily Xanax use will likely result in a withdrawal syndrome that can include seizures, severe anxiety, and potentially life-threatening complications. 1
Withdrawal Symptoms
Abrupt discontinuation of alprazolam after daily use typically leads to a withdrawal syndrome characterized by:
- Physical symptoms: sweating, tremors, muscle cramps, muscle twitching, diarrhea, blurred vision, appetite decrease, weight loss, nausea, vomiting, and potentially seizures 1
- Psychological symptoms: heightened sensory perception, impaired concentration, clouded sensorium, paresthesias, anxiety, insomnia, irritability, and potentially hallucinations 1, 2
- Cardiovascular symptoms: tachycardia and hypertension 3
- Neurological complications: The most serious risk is seizures, which typically occur 24-72 hours after discontinuation and can progress to status epilepticus in severe cases 1, 2
Severity Factors
The severity of withdrawal depends on several factors:
- Duration of use: Longer periods of use increase withdrawal severity 1, 4
- Dosage: Higher doses (particularly >4 mg/day) lead to more severe withdrawal 1
- Rate of discontinuation: Abrupt discontinuation causes more severe symptoms than gradual tapering 1, 4
- Individual factors: History of seizures, alcohol abuse, or previous benzodiazepine dependence increases risk of severe withdrawal 5
Timeline of Withdrawal
Withdrawal symptoms typically follow this pattern:
- Initial symptoms: Begin within 24-48 hours of the last dose due to alprazolam's relatively short half-life 3, 1
- Peak intensity: Symptoms typically peak around day 5 6
- Duration: The acute withdrawal syndrome usually lasts 10-14 days, but protracted withdrawal symptoms can persist for months in some cases 4, 7
Potential Serious Complications
- Seizures: The risk of withdrawal seizures increases significantly with doses above 4 mg/day and with abrupt discontinuation 1, 2
- Status epilepticus: Multiple seizures and status epilepticus have been reported in some cases 1
- Delirium: Particularly in those with prolonged high-dose use 3
- Psychological distress: Severe anxiety, panic attacks, and in some cases, homicidal ideation have been reported 5
Risk Mitigation
To avoid these dangerous outcomes, benzodiazepines should never be stopped abruptly but rather tapered gradually:
- FDA guidance recommends tapering alprazolam over 10-14 days to limit withdrawal symptoms 1
- For patients on higher doses or with longer duration of use, even slower tapering schedules may be necessary 1, 4
- In some cases, switching to a longer-acting benzodiazepine before tapering may help manage withdrawal symptoms 4
Special Considerations
- Patients with a history of seizures or epilepsy are at particularly high risk and should never discontinue alprazolam abruptly 1
- Individuals with a history of alcohol or drug abuse may experience more severe withdrawal symptoms 5
- Even short-term therapy at therapeutic doses can result in withdrawal symptoms if discontinued abruptly 1, 4
The FDA drug label explicitly warns that withdrawal seizures have occurred after discontinuation from even a single dose of 1 mg after tapering from higher doses, highlighting the importance of proper discontinuation protocols 1.