Can withdrawal cause muscle spasms?

Can Withdrawal Cause Muscle Spasms?

Yes, withdrawal from several classes of medications and substances can definitively cause muscle spasms, muscle cramps, and related neuromuscular symptoms.

Benzodiazepine Withdrawal

Benzodiazepine withdrawal is the most clearly documented cause of muscle spasms among commonly prescribed medications. 1

• Muscle cramps and muscle pain/stiffness are recognized acute withdrawal symptoms when benzodiazepines are abruptly discontinued or rapidly tapered 2, 3
• Additional neuromuscular manifestations include tremor, muscle twitching (myoclonus), and abnormal involuntary movements 2, 3
• Withdrawal symptoms typically begin 1-4 days after discontinuation (depending on the drug's half-life) and the full syndrome usually lasts 10-14 days 4
• More severe manifestations can include seizures, which represent life-threatening muscle activity 1, 2, 3

The FDA drug labels for both lorazepam and diazepam explicitly list "muscle pain and stiffness" and motor symptoms including "muscle twitches" as established withdrawal reactions 2, 3. Protracted withdrawal syndrome may persist for weeks to over 12 months and includes motor symptoms such as weakness, tremor, and muscle twitches 2, 3.

Opioid Withdrawal

Opioid withdrawal produces significant musculoskeletal symptoms including myalgias (muscle pain) and muscle cramping. 1

• Acute opiate withdrawal includes myalgias, abdominal cramping, and restlessness as cardinal features 1
• Symptoms can occur within 12 hours of discontinuation and typically resolve within 7-14 days 1
• Tremor and muscle twitching are also documented withdrawal manifestations 1
• The Clinical Opiate Withdrawal Scale (COWS) specifically assesses tremor and muscle twitching as objective signs 1

Alcohol Withdrawal

Alcohol withdrawal syndrome produces tremor as one of its most characteristic features, along with muscle tension and hyperreflexia. 1

• Tremor develops within 6-24 hours after the last drink in light to moderate withdrawal 1
• Alcohol withdrawal tremor is an 8-12 Hz postural tremor with synchronous activity in antagonist muscles, representing a variant of enhanced physiological tremor 5
• More severe forms can progress to seizures (generalized muscle spasms) 1, 6
• Muscle spasms and tension are recognized components of the withdrawal syndrome 6, 7

Baclofen Withdrawal

Abrupt cessation of baclofen—ironically a muscle relaxant—can cause severe withdrawal symptoms including increased muscle spasticity. 8

• Baclofen withdrawal can result in hyperactive delirium with movement disturbances 8
• This occurs with both intrathecal and oral baclofen administration 8
• The mechanism involves sudden loss of GABA-B receptor agonism 8

Clinical Management Implications

To prevent withdrawal-induced muscle spasms, medications should be tapered gradually rather than discontinued abruptly:

• For benzodiazepines: Use a gradual taper over several days to weeks to reduce withdrawal risk 2, 3
• For opioids: Taper over several days when administered for prolonged periods 1
• For alcohol: Benzodiazepines are the gold standard treatment for preventing severe withdrawal symptoms including tremor 1, 6
• For baclofen: Reinstate and slowly taper rather than abrupt cessation 8

Common pitfall: Clinicians may not recognize muscle spasms, cramps, or tremor as withdrawal symptoms and may attribute them to other causes, leading to inappropriate management. Always obtain a detailed medication history including recent discontinuations when evaluating new-onset muscle spasms 1.