What is the recommended rate for tapering off Xanax (alprazolam)?

Xanax (Alprazolam) Tapering Protocol

For Xanax specifically, taper at a rate of 0.5 mg every 3 days if you've been on therapeutic doses, or use a slower 10% per month reduction if you've been on the medication for extended periods (over 12 weeks) or at higher doses (above 4 mg/day). 1, 2

Critical Context: Xanax Is High-Risk for Withdrawal Seizures

• Seizures can occur during Xanax tapering, particularly 24-72 hours after discontinuation or abrupt dose reduction 1
• The FDA reports 8 documented seizure cases in panic disorder patients tapering from doses above 4 mg/day used for over 3 months, with 5 clearly occurring during abrupt dose reduction 1
• Seizures have been reported even with gradual tapering (one case after tapering 1 mg every 3 days from 6 mg daily) 1
• Alprazolam is a triazolobenzodiazepine with unique withdrawal characteristics that may require special consideration compared to other benzodiazepines 2

Recommended Tapering Schedules Based on Your Situation

For Short-Term Use (Less Than 12 Weeks) at Therapeutic Doses

• Taper at 0.5 mg every 3 days regardless of total daily dose 2
• This faster schedule is appropriate because physical dependence is less established 2
• Monitor closely for withdrawal symptoms between each reduction 1

For Long-Term Use (Over 12 Weeks) or High Doses (Above 4 mg/day)

• Use a much slower taper of approximately 10% per month of the original dose 3
• The CDC guidelines specifically recommend tapers slower than 10% per week (preferably 10% per month) for patients on benzodiazepines for extended periods 3
• Patients on doses above 4 mg/day have significantly more difficulty tapering to zero than those on lower doses 1
• Duration of treatment beyond 12 weeks increases dependence risk and severity 1

Practical Tapering Example for 2 mg Daily (Long-Term User)

• Month 1: Reduce to 1.8 mg daily (10% reduction = 0.2 mg)
• Month 2: Reduce to 1.6 mg daily
• Month 3: Reduce to 1.4 mg daily
• Continue this pattern, monitoring for withdrawal symptoms at each step 3

Withdrawal Symptoms to Monitor

Physical symptoms include: 3, 1

• Anxiety, insomnia, muscle cramps, muscle twitches
• Heightened sensory perception, paresthesias, blurred vision
• Diarrhea, appetite decrease, weight loss
• Drug craving, tremor, tachycardia, sweating

Neuropsychiatric symptoms include: 1

• Impaired concentration, clouded sensorium
• Dysosmia (altered smell perception)
• Rebound anxiety substantially greater than baseline
• Seizures (most dangerous complication)

Critical Management Points

If Withdrawal Symptoms Occur

• Slow the taper further or pause at the current dose until symptoms resolve 3, 4
• Consider returning to the previous well-tolerated dose if symptoms are severe 3
• The taper can be paused and restarted when ready—success is defined by making progress, even with temporary pauses 3

Avoiding Common Pitfalls

• Never abruptly discontinue Xanax—this dramatically increases seizure risk 1, 5
• Do not forget doses or inadvertently reduce doses (e.g., during hospitalization), as this can trigger withdrawal 1
• Avoid "interdose symptoms" (early morning anxiety between doses) by dividing the total daily dose into more frequent administrations rather than increasing the total dose 1
• Be aware that even relatively short-term use (as little as 15 days) at therapeutic doses can cause withdrawal symptoms 6

When to Extend Dosing Intervals

• Once you reach the smallest available dose (0.25 mg for alprazolam), extend the interval between doses before complete discontinuation 3
• For example, take 0.25 mg every other day, then every third day, before stopping completely 3

Special Considerations for Alprazolam

• Alprazolam has a short half-life, making withdrawal symptoms potentially more severe and rapid in onset compared to longer-acting benzodiazepines like diazepam 4
• Some clinicians prefer switching to a longer-acting benzodiazepine (like diazepam) before tapering, though this adds complexity 4
• The whole tapering process may take weeks to months depending on your starting dose and duration of use 4, 5

Post-Discontinuation Risks

• If you return to Xanax after successful tapering, do NOT restart at your previous dose—this creates overdose risk 3
• Withdrawal symptoms can be mistaken for return of the original anxiety disorder 1
• Some patients may need alternative anxiety management strategies (psychotherapy, non-benzodiazepine medications) after discontinuation 4