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Xanax (Alprazolam) Withdrawal

Xanax, pharmaceutically known as alprazolam, is a popular anti-anxiety drug used by millions of Americans each year. However, regular use of Xanax, which is classified as a benzodiazepine, can easily lead to physical dependence.

In addition to the millions of people that have prescriptions for these medications, Xanax and similar benzodiazepines have become popular recreational drugs for people of all ages. Benzodiazepine dependence can develop within four to six weeks of continuous use. 

At least one-third of people who use Xanax will experience withdrawal symptoms when reducing their dosage.

Xanax Withdrawal Symptoms

Addiction to Xanax is almost always accompanied by physical and psychological dependence, making it very difficult to stop using.

Withdrawal symptoms and side effects usually accompany Xanax discontinuation. These are often severe and can include:

  • Headaches
  • Blurred vision
  • Muscle pain
  • Tremors
  • Diarrhea
  • Numb fingers
  • Sensitivity to light and sound
  • Loss of appetite
  • Insomnia
  • Heart palpitations
  • Sweating
  • Anxiety disorder 
  • Mental health issues
  • Panic attacks or panic disorder
  • Paranoia
  • Seizures

In addition to these symptoms, benzodiazepine withdrawal syndrome is a set of symptoms that appear as those who are physically addicted to benzodiazepines begin reducing their usage. It is considered a ‘syndrome’ because the symptoms occur together and are associated with the same cause. 

Although these symptoms vary from person to person, every person experiences some withdrawal level when tapering off.

Xanax withdrawal syndrome is serious. Symptoms can be mild and manageable, but this is a rare occurrence. Most users require professional treatment to successfully stop using the drug.

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Xanax Withdrawal Timeline 

Detoxing from Xanax can be a long process. Due to often severe withdrawal symptoms, quitting “cold turkey” is not advised by experts. Gradually reducing dosages is the most effective way to safely reduce withdrawal symptoms while increasing the chances of successfully quitting. 

Below is a typical timeline of Xanax withdrawal symptoms:

8 – 12 hours after the last dose

Within six hours, the effects of Xanax fade, and the effects of withdrawal begin kicking in. Users begin feeling anxiety and irritability that often gets worse as the body is deprived of the drug it has become physically dependent upon. 

Note that this only applies to those with Xanax addictions. Addiction can occur within less than three weeks of continued use for both prescription and recreational users.

1 – 4 days after the last dose

Withdrawal symptoms are the most intense within the first few days. Rebound anxiety and insomnia are the most common symptoms. Other symptoms such as shaking, muscle pain, and sweating may also occur. After the fourth day, patients usually begin to see symptomatic improvements.

7 – 14 days after the last dose

Withdrawal symptoms can last between one and two weeks after taking the last dose. While the worst is over by this point, anxiety and insomnia usually persist to varying degrees.

15+ days after the last dose

Any lingering symptoms are usually mild by this point. For some, protracted withdrawal symptoms—which can last up to two years—may begin suddenly, even if the initial symptoms are completely gone.

Factors Affecting Xanax Withdrawal

Withdrawal is different for each person. The withdrawal timeline may be affected by various factors. The more dependent the body and brain are on the drug, the more prolonged and intense the withdrawal will be.

Some other factors that affect the Xanax withdrawal timeline include:

  • Dose
  • Method of ingestion
  • Combination with other drugs or alcohol
  • Age at first use
  • Genetics
  • Length of time using or abusing Xanax
  • Stress levels
  • History of addiction
  • Mental health issues
  • Underlying medical complications
  • Environmental factors

These factors can all affect how quickly a dependence is made and how strong it may be. Xanax withdrawal can be more comfortable and safer with the help of medical and mental health professionals, who are experts in treating substance abuse and dependency.

Dangers of Withdrawing from Xanax Alone

Experts strongly encourage Xanax users to get professional help when detoxing because managing withdrawal symptoms is dangerous to do alone.  Even when properly managed by medical staff, withdrawal symptoms can be severe. 

Medically-assisted detox is the safest method of tapering off Xanax. Doctors are nearby in case withdrawal symptoms become life-threatening.

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Coping and Relief from Xanax Withdrawal

The best way to avoid a challenging withdrawal from Xanax is to taper down your dose slowly. Tapering involves taking progressively smaller amounts over several weeks. You should not taper without the help and suggestions from your prescribing doctor.

Xanax is a short-acting drug. This means your body metabolizes it very quickly.

Tapering Xanax is difficult because the amount of the drug is going up and down in your body. To help prevent these peaks and valleys, doctors often switch you from Xanax to a long-acting benzodiazepine like diazepam.

Moving from short-acting Xanax to a long-acting benzodiazepine like diazepam will make it easier for you to quit. Once you are on a steady dose of diazepam, your doctor will help you slowly taper down a little bit at a time.

This allows your body and mind to adjust without Xanax. If you experience breakthrough withdrawal symptoms when your dose is reduced, your doctor can stop or stretch out your taper. It is up to you and your doctor to determine the best tapering schedule for your needs.

Here are some ways to reduce symptoms of breakthrough withdrawal:

  • Herbal sleep aids, such as valerian root and chamomile
  • Cognitive-behavioral therapy (CBT)
  • Meditation
  • Mindfulness practice
  • Exercise
  • Melatonin

Warnings

There are some risks and warnings to consider when it comes to Xanax withdrawal.

Seizures may occur in some patients undergoing untreated withdrawal from Xanax. Benzodiazepine withdrawal can be complex. Sometimes it can be life-threatening.

If you have been diagnosed with a severe mental illness in the past, like panic disorder, bipolar disorder, PTSD, or borderline personality disorder, then extreme care should be taken when withdrawing from Xanax. Your doctor’s help and suggestions are invaluable at this time.

It can be challenging to predict which dormant symptoms, if any, may return when Xanax is removed from your system. People with a history of withdrawal syndromes and those with underlying health issues should work closely with their doctors.

Older adults and those with cognitive decline should also work closely with medical staff.

Some women continue taking benzodiazepines while pregnant, while others follow a dose tapering plan.

If you are concerned about the risks and warnings involved in Xanax withdrawal, discuss these concerns with your doctor. You may be suitable for inpatient detoxification rather than outpatient, where you live in a facility and receive round-the-clock care. While inpatient treatment is usually more expensive than outpatient treatment, it is covered by several insurance plans.

Xanax Addiction Treatment Options

There are several treatment options for Xanax addictions of varying severeness. They all require different detox levels, and several options require medications or additional treatments. 

Xanax Detox

Detox is the first step in any treatment. Detox programs can help Xanax users free themselves from their physical dependence on the drug while simultaneously addressing the psychological aspects of addiction. 

These programs help provide supervision from experts and prescribe often needed medications, as well as offering a sense of comfort for those going through struggles of dealing with withdrawal symptoms. 

Typically, those who complete medical detox are able to continue with further treatment.

Detox Medications

Under medical supervision, symptoms of withdrawal are often managed through:

  • Antidepressants — selective serotonin reuptake inhibitors (SSRIs) may be prescribed to people who suffer from depression during alprazolam withdrawal. SSRIs include fluoxetine (Prozac) and paroxetine (Paxil).
  • Clonidine — this hypertension medication helps provide sedative, analgesic, and anxiolytic effects to aid in easing physical withdrawal symptoms.
  • Flumazenil low doses of flumazenil, a benzodiazepine receptor agonist/partial agonist, can help reduce Xanax withdrawal symptoms.
  • Over-the-counter medications — for symptoms such as headache, diarrhea, and vomiting.

Additional Treatments 

Additional treatment options for Xanax addiction may include:

  • Psychotherapeutic interventions
  • Strategies to make the patient as comfortable as possible
  • Inpatient and outpatient treatment programs

Xanax addiction is serious, and it can be dangerous to try and detox without assistance. Professional help is strongly encouraged to safely ease off of Xanax or other benzodiazepines. If you are concerned for yourself or someone you know, find treatment today.

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Resources

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Pétursson H. “The benzodiazepine withdrawal syndrome.” Addiction. 1994;89(11):1455‐1459. doi:10.1111/j.1360-0443.1994.tb03743.x https://pubmed.ncbi.nlm.nih.gov/7841856/.

Olfson M, King M, Schoenbaum M. Benzodiazepine use in the United States. JAMA Psychiatry. 2015;72(2):136‐142. doi:10.1001/jamapsychiatry.2014.1763 https://pubmed.ncbi.nlm.nih.gov/25183003/?from_term=benzodiazepine&from_pos=2

Platt LM, Whitburn AI, Platt-Koch AG, Koch RL. Nonpharmacological Alternatives to Benzodiazepine Drugs for the Treatment of Anxiety in Outpatient Populations: A Literature Review. J Psychosoc Nurs Ment Health Serv. 2016;54(8):35‐42. doi:10.3928/02793695-20160725-07 https://pubmed.ncbi.nlm.nih.gov/27479478/?from_term=benzodiazepine&from_pos=4

Reeves RR, Kamal A. Complicated Withdrawal Phenomena During Benzodiazepine Cessation in Older Adults. J Am Osteopath Assoc. 2019;119(5):327‐331. doi:10.7556/jaoa.2019.055 https://pubmed.ncbi.nlm.nih.gov/31034071/?from_term=benzodiazepine&from_pos=6

Ait-Daoud, Nassima et al. “A Review of Alprazolam Use, Misuse, and Withdrawal.” Journal of addiction medicine vol. 12,1 (2018): 4-10, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846112/

Onyett, S R. “The benzodiazepine withdrawal syndrome and its management.” The Journal of the Royal College of General Practitioners vol. 39,321 (1989): 160-3, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1711840/

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