From the Guidelines
Common withdrawal symptoms when tapering off alprazolam include anxiety, insomnia, irritability, tremors, headaches, muscle aches, sweating, nausea, and difficulty concentrating, and a proper taper should be gradual, typically reducing the dose by 25% every 1–2 weeks under medical supervision, as recommended by the CDC guideline for prescribing opioids for chronic pain - united states, 2016 1.
Withdrawal Symptoms
The withdrawal symptoms from alprazolam can be severe and include:
- Anxiety
- Insomnia
- Irritability
- Tremors
- Headaches
- Muscle aches
- Sweating
- Nausea
- Difficulty concentrating More severe symptoms may include sensory hypersensitivity, heart palpitations, blood pressure changes, and in serious cases, seizures, as discussed in the study on a primary care approach to substance misuse 1.
Tapering Strategy
A gradual taper is essential to minimize the risk of severe withdrawal symptoms.
- The CDC guideline for prescribing opioids for chronic pain - united states, 2016 1 recommends reducing the benzodiazepine dose by 25% every 1–2 weeks.
- The study on evidence-based guidelines for mental, neurological, and substance use disorders in low- and middle-income countries: summary of who recommendations 1 suggests a planned tapering dose over 8–12 weeks and conversion to long-acting benzodiazepines.
Supportive Measures
Supportive measures during tapering include:
- Maintaining regular sleep patterns
- Exercise
- Stress management techniques
- Avoiding caffeine and alcohol It is crucial to prioritize the patient's safety and well-being during the tapering process, and medical supervision is essential to monitor for any potential complications, as emphasized in the study on a primary care approach to substance misuse 1.
From the FDA Drug Label
Withdrawal symptoms were identified as those which were generally not characteristic of panic disorder and which occurred for the first time more frequently during discontinuation than at baseline In a controlled clinical trial in which 63 patients were randomized to alprazolam tablets and where withdrawal symptoms were specifically sought, the following were identified as symptoms of withdrawal:
- heightened sensory perception
- impaired concentration
- dysosmia
- clouded sensorium
- paresthesias
- muscle cramps
- muscle twitch
- diarrhea
- blurred vision
- appetite decrease
- weight loss The symptoms can range from mild dysphoria and insomnia to a major syndrome that may include abdominal and muscle cramps, vomiting, sweating, tremors and convulsions.
Common withdrawal symptoms when tapering off of alprazolam (Xanax) include:
- Heightened sensory perception
- Impaired concentration
- Dysosmia
- Clouded sensorium
- Paresthesias
- Muscle cramps
- Muscle twitch
- Diarrhea
- Blurred vision
- Appetite decrease
- Weight loss
- Mild dysphoria
- Insomnia
- Abdominal cramps
- Vomiting
- Sweating
- Tremors
- Convulsions 2 2
From the Research
Common Withdrawal Symptoms
When tapering off of alprazolam (Xanax), common withdrawal symptoms include:
- Malaise
- Weakness
- Insomnia
- Tachycardia
- Lightheadedness
- Dizziness 3 Other symptoms that may occur during withdrawal from benzodiazepines, such as alprazolam, are:
- Sleep disturbance
- Irritability
- Increased tension and anxiety
- Panic attacks
- Hand tremor
- Sweating
- Difficulty in concentration
- Dry wretching and nausea
- Some weight loss
- Palpitations
- Headache
- Muscular pain and stiffness 4
Severe Withdrawal Symptoms
In some cases, severe withdrawal symptoms can occur, including:
- Seizures
- Psychotic reactions
- Homicidal ideation 5 These symptoms are more likely to occur in patients who have been taking high doses of alprazolam or have a history of substance abuse.
Tapering Regimens
To minimize withdrawal symptoms, it is recommended to taper alprazolam gradually, rather than stopping abruptly 6, 4. The exact tapering regimen may vary depending on the individual patient and the dose of alprazolam being taken. However, a gradual taper over a period of weeks or months is often recommended to reduce the risk of severe withdrawal symptoms.