From the Guidelines
Xanax withdrawal should always be managed under medical supervision due to potentially dangerous symptoms, with a gradual tapering schedule being essential to minimize risks. According to the most recent and highest quality study 1, a gradual reduction over many weeks is recommended to attain success, with the EMPOWER trial demonstrating that 62% of independent seniors expressed interest in benzodiazepine changes, and 27% of patients stopping benzodiazepines compared with 5% in the control group.
When considering Xanax withdrawal, it is crucial to prioritize a gradual tapering schedule, typically reducing the dose by 10-25% every 1-2 weeks depending on individual factors, as suggested by 1 and further supported by 1. For example, someone taking 2mg daily might decrease to 1.5mg for two weeks, then 1mg, and so on until safely discontinued. Alternative longer-acting benzodiazepines like diazepam may be substituted to ease the process.
Some key points to consider during Xanax withdrawal include:
- Withdrawal symptoms can include anxiety, insomnia, irritability, tremors, and in severe cases, seizures or psychosis, as the brain has adapted to Xanax enhancing GABA activity, and sudden removal creates neurochemical imbalance.
- Supportive measures during withdrawal include maintaining hydration, regular sleep patterns, avoiding caffeine and alcohol, and possibly using adjunctive medications like propranolol for physical symptoms.
- Psychological support is also valuable, with nonpharmacological psychosocial interventions, such as education and self-empowerment, showing promise in reducing benzodiazepine use.
- Never stop Xanax abruptly, especially after prolonged use, as this significantly increases the risk of severe withdrawal effects, and instead, a gradual withdrawal strategy is recommended to minimize potential discontinuation effects.
From the FDA Drug Label
DRUG ABUSE AND DEPENDENCE Physical and Psychological Dependence Withdrawal symptoms similar in character to those noted with sedative/hypnotics and alcohol have occurred following discontinuance of benzodiazepines, including alprazolam tablets 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.
WARNINGS Dependence and Withdrawal Reactions, Including Seizures Certain adverse clinical events, some life-threatening, are a direct consequence of physical dependence to alprazolam tablets. These include a spectrum of withdrawal symptoms; the most important is seizure
Xanax Withdrawal Symptoms may include:
- Mild dysphoria and insomnia
- Abdominal and muscle cramps
- Vomiting
- Sweating
- Tremors
- Convulsions
- Seizures
Key Points:
- Withdrawal symptoms can occur after discontinuance of alprazolam tablets
- The risk of withdrawal seizures may be increased at doses above 4 mg/day
- Patients should be gradually tapered under close supervision when reducing dosage
- Psychological dependence is a risk with all benzodiazepines, including alprazolam tablets 2 2
From the Research
Xanax Withdrawal Symptoms
- Xanax, also known as alprazolam, is a benzodiazepine that can cause withdrawal symptoms when stopped or reduced in dosage 3
- Withdrawal symptoms from benzodiazepines like Xanax can be severe and similar to those of alcohol withdrawal, including life-threatening symptoms 4
- The dependence on benzodiazepines generally leads to withdrawal symptoms, requiring careful tapering of the medication when prescribed 4
Treatment of Xanax Withdrawal
- The current treatment for benzodiazepine withdrawal is through tapering with clonazepam, but many drugs have been tested as alternative treatments with few proving efficacious in randomized control trials 4
- Future research is warranted for further exploration into alternative methods of treating benzodiazepine withdrawal 4
- Individualizing therapy with withdrawal scales results in administration of significantly less medication and shorter treatment 5
Benzodiazepine Pharmacology and Classification
- Benzodiazepines are a class of gabaminergic psychoactive chemicals used in hypnotics, sedation, in the treatment of anxiety, and in other CNS disorders 6
- There are two distinct types of pharmacological binding sites for benzodiazepines in the brain (BZ1 and BZ2), which are classified as short, intermediate, or long-acting 6
- Benzodiazepines quickly diffuse through the blood-brain barrier to affect the inhibitory neurotransmitter GABA and exert sedative effects 4