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Xanax Withdrawal: Timelines and Medications

Xanax is a brand name for alprazolam, a prescription drug primarily used for the short-term management of anxiety and panic disorder.1 This drug is a benzodiazepine, a class of central nervous system (CNS) depressants. Xanax alleviates anxiety by inhibiting abnormal excitatory signaling in the brain.2

  • Xanax—whether taken acvcording to prescription or when misused as a recreational drug—is associated with the development of some physiological dependence.
  • When use of the drug exceeds recommended dosing amounts and frequency, dependence may develop more swiftly. When an individual becomes significantly physically dependent on Xanax, they will have to take precautions prior to discontinuing the medication.Xanax Withdrawal
  • Withdrawal from Xanax is frequently accompanied by several unpleasant symptoms, and in some cases, life-threateningly severe ones.2

Withdrawal from Xanax

Suddenly discontinuing Xanax may result in symptoms such as:1,2,3

  • Problems concentrating.
  • Anxiety/nervousness.
  • Insomnia.
  • Depression.
  • Irritability.
  • Aggression.
  • Decreased appetite.
  • Nausea.
  • Diarrhea.
  • Sweating.
  • Paresthesias.
  • Muscle cramping.
  • Sensitivity to light and noise.
  • Blurry vision.
  • Altered sense of smell.
  • Headache.
  • Seizures.
  • Delirium.

One potential feature of acute benzodiazepine withdrawal is rebound anxiety, a return of anxiety symptoms that are greater in severity than they were before Xanax treatment was initiated.1, The rebound anxiety should resolve within 2-3 days; however, the baseline-level anxiety may recur afterward and remain until it is treated in some other way.

Timeline

For short-acting benzodiazepines such as Xanax, withdrawal will begin relatively quickly, within 6-12 hours. Symptoms will generally peak in intensity on the second day and many will largely resolve within 4 or 5 days.5

This timeline is only an estimate and individual differences and patterns of Xanax use may influence the timeline. Factors that may influence the severity of acute withdrawal include:4

  • The usual dose (higher doses tend to result in more severe withdrawal syndromes).
  • How quickly the dose is tapered.
  • Whether the individual is dependent on multiple substances.

Shorter-acting benzodiazepines may be associated with more severe withdrawal syndromes than longer-acting benzodiazepines.4 For those wanting to quit Xanax, it’s important to seek medical assistance. Inpatient medical detox provides 24-hour supervision and care for acute Xanax withdrawal and also often serves as an entry point into further addiction treatment.

Detox and Treatment

  • Without appropriate withdrawal management, such as might occur when someone tries to cold-turkey quit their stuff at home, there could be a higher likelihood of unpleasant symptoms and certain medical complications (e.g., seizures). Left unmanaged, such occurrence could also increase the risk of immediate relapse.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) states that the benzodiazepine withdrawal syndrome is similar to that of alcohol (a syndrome that is known to be very dangerous and also may elicit seizures and delirium). For this reason, SAMHSA recommends that people attempting to detox from benzodiazepines such as alprazolam do so with medical supervision and also recommends that the drug be tapered slowly instead of abruptly discontinued.3
  • During medical detox from Xanax, the individual may first be switched to a longer-acting benzodiazepine, such as clonazepam or chlordiazepoxide. Longer-acting agents such as these are easier to manage throughout the ensuing benzodiazepine taper, and may help lessen the severity of the withdrawal symptoms.3
  • For people who have a history of chronic, high-dose Xanax use, the relative intensity of care that a hospital setting offers may be the safest option for detox and withdrawal. While under the care of medical professionals, withdrawal progress may be more-easily evaluated, symptom progression may be monitored, and appropriate medications given as needed. For example, additional medications can be used, as needed, for seizure prophylaxis or antidepressant coverage. For those experiencing significantly troublesome autonomic symptoms such as increased heart rate or blood pressure, clonidine or propranolol may be given.3

Detox from Xanax can be an intense experience.

It is most likely to be successful when:3

  • The individual is not surrounded by external stressors.
  • There is a plan to manage the underlying anxiety without benzodiazepines.
  • The individual understands what to expect and is committed to the process.

While detox is necessary, more comprehensive therapeutic treatment will benefit those who are addicted to the drug. Detox is an invaluable part of treatment but primarily focuses on the physical dependence and withdrawal management.

The compulsion to use Xanax will likely still be there even after withdrawal syndrome resolution. Addiction treatment can address the issues behind this compulsion and help you grow your motivation to stay sober.

In treatment, you may also learn new drug-refusal skills and will work on developing a sober support network you can lean on should you feel compelled to use Xanax again. Finally, several behavioral therapeutic techniques may offer you non-pharmacologic ways to help manage your anxiety (even if alternate medication treatment is initiated).

Sources:

  1. Pfizer. (2016). Xanax alprazolam tablets, USP.
  2. U.S. National Library of Medicine. (2018). Alprazolam.
  3. Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 45.) 4 Physical Detoxification Services for Withdrawal From Specific Substances.
  4. Gliatto, M. (2000). Generalized Anxiety DisorderAm Fam Physician, 62(7), 1591-1600.
  5. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Edition). Arlington, VA: American Psychiatric Publishing.
  6. https://www.aafp.org/afp/2000/1001/p1591.html
About The Contributor
Scot Thomas, M.D.
Senior Medical Editor, American Addiction Centers
Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating... Read More