Alprazolam (Xanax) Withdrawal Timeline
Alprazolam (Xanax) withdrawal symptoms typically begin within 24-48 hours after the last dose due to its short half-life, with symptoms peaking in severity around 72 hours and potentially lasting 1-2 weeks for acute withdrawal. 1
Withdrawal Timeline
Early withdrawal (6-24 hours after last dose): Initial symptoms begin to emerge as blood levels of alprazolam decline, particularly with this short-acting benzodiazepine 1, 2
Acute withdrawal phase (1-4 days): Symptoms intensify and typically peak within 72 hours, characterized by rebound anxiety, insomnia, irritability, and potential physical symptoms 1, 2
Subacute withdrawal (5-14 days): Symptoms gradually diminish but may persist for up to 2-3 weeks depending on duration of use and dosage 3, 2
Protracted withdrawal (weeks to months): Some patients experience lingering symptoms that can persist for extended periods, especially after long-term or high-dose use 4, 2
Factors Affecting Withdrawal Onset and Severity
Duration of use: Longer periods of alprazolam use increase risk and severity of withdrawal symptoms 1
Dosage: Higher doses (particularly >4 mg/day) correlate with more severe withdrawal symptoms and greater difficulty discontinuing 1
Half-life: Alprazolam's relatively short half-life contributes to earlier onset of withdrawal compared to longer-acting benzodiazepines 2, 5
Individual factors: Personal metabolism, concurrent medications, and history of substance dependence can influence withdrawal timeline 1, 4
Common Withdrawal Symptoms
Psychological symptoms: Rebound anxiety, irritability, insomnia, panic attacks, difficulty concentrating, and in severe cases, potential psychosis 1, 2
Physical symptoms: Tremors, sweating, headache, nausea, muscle pain/stiffness, palpitations, and sensory hypersensitivity 1, 2
Severe symptoms: Seizures may occur in 2-11% of cases, typically 24-72 hours after discontinuation, representing the most dangerous withdrawal complication 1, 6
Clinical Considerations
Seizure risk: Withdrawal seizures are most likely to occur 24-72 hours after discontinuation, especially with abrupt cessation 1, 6
Tapering importance: Gradual dose reduction is essential to minimize withdrawal symptoms and prevent serious complications like seizures 1
Interdose withdrawal: Some patients may experience withdrawal symptoms between scheduled doses, indicating the need for more frequent administration or adjusted tapering 1
Monitoring period: Close observation is warranted during the first 72 hours of withdrawal when risk of severe symptoms including seizures is highest 1, 6
Prevention Strategies
Gradual tapering: Recommended for all patients to minimize withdrawal symptoms, with slower tapering needed for those on higher doses or with longer duration of use 1
Increased monitoring: Patients with history of seizures, alcohol use disorder, or prior benzodiazepine dependence require closer observation during withdrawal 4
Patient education: Informing patients about potential withdrawal symptoms can improve compliance with tapering schedules and prompt reporting of concerning symptoms 3