How do I safely taper off Xanax (alprazolam)?

Safely Tapering Off Alprazolam (Xanax)

To safely taper off Xanax (alprazolam), reduce the daily dose by no more than 0.5 mg every 3 days, with slower tapering needed for long-term users to minimize withdrawal symptoms. 1

Understanding Alprazolam Withdrawal Risks

• Abrupt discontinuation of alprazolam can lead to severe withdrawal symptoms including seizures, rebound anxiety, hallucinations, and in rare cases, death 1
• Withdrawal symptoms from benzodiazepines can range from mild dysphoria and insomnia to a major syndrome including abdominal and muscle cramps, vomiting, sweating, tremors, and convulsions 1
• Withdrawal risk increases with higher doses (>4 mg/day) and longer duration of use 1

Recommended Tapering Protocol

General Approach

• For most patients, reduce alprazolam by no more than 0.5 mg every 3 days as recommended in the FDA label 1
• For long-term users (≥1 year), use a much slower taper of approximately 10% per month 2
• The taper should be gradual with the understanding that some patients may require an even more gradual discontinuation 1

Step-by-Step Process

1. Calculate your current total daily dose of alprazolam
2. Consider switching to divided doses if currently taking once daily 1
3. Begin with small dose reductions to build confidence in the process 3
4. Reduce by no more than 0.5 mg every 3 days (or slower if needed) 1
5. If withdrawal symptoms become significant, pause the taper temporarily and resume at a slower rate 2
6. Schedule follow-up appointments at least monthly during the taper 2

Managing Withdrawal Symptoms

• Common withdrawal symptoms include anxiety, insomnia, irritability, tremors, and increased sensitivity to sensory stimuli 1
• If significant withdrawal symptoms develop, reinstate the previous dosing schedule until stabilization, then attempt a slower taper 1
• Consider adjunctive treatments to manage withdrawal symptoms:
  • Non-pharmacological approaches: cognitive behavioral therapy, exercise, relaxation techniques 2
  • In some cases, adjunctive medications may help manage specific withdrawal symptoms 3

Special Considerations

• Older adults or those with advanced liver disease may be more sensitive to withdrawal effects and require an even slower taper 1
• If you've been taking alprazolam for anxiety, consider evidence-based alternatives such as cognitive behavioral therapy or specific antidepressants 3
• Never attempt to taper benzodiazepines while simultaneously tapering opioids; if both must be tapered, taper opioids first due to greater risks of benzodiazepine withdrawal 3

Common Pitfalls to Avoid

• Never discontinue alprazolam abruptly as this significantly increases seizure risk 1
• Avoid substituting other sedatives or alcohol during the taper 2
• Don't rush the taper; slower is generally better, especially for long-term users 2
• Don't attempt to power through significant withdrawal symptoms; this increases risk of complications and relapse 3

When to Seek Additional Help

• If you experience severe withdrawal symptoms such as seizures, hallucinations, or severe confusion, seek immediate medical attention 1
• Consider specialized addiction treatment if you've been taking doses higher than prescribed or have a history of substance use disorders 3
• If multiple attempts at outpatient tapering have failed, more intensive support may be needed 3