Benzo Withdrawal: Symptoms, Timeline & Treatment
Up to Date
Edit HistoryView our editorial policy
Article at a Glance
- Benzodiazepines, or benzos, are prescription medications often used for treating conditions like anxiety and insomnia but can lead to dependence and withdrawal symptoms
- Withdrawal symptoms can range from sleep changes and irritability to more severe issues like seizures, especially if the medication is stopped abruptly
- The timeline for withdrawal varies, with symptoms potentially lasting from days to years depending on various factors like age, general health and co-occurring mental conditions
- Medical and outpatient detox options are available for managing withdrawal symptoms, with medical detox providing 24-hour supervision
- Various medications such as buspirone, flumazenil and anticonvulsants can be used to manage withdrawal symptoms, but they should be administered under medical supervision
Benzodiazepines are helpful for treating many mental health conditions. However, quitting a benzo abruptly can lead to potentially life-threatening withdrawal symptoms.
Benzodiazepines, commonly known as benzos, are a class of prescription medications often used to treat anxiety or insomnia. Benzodiazepines are classified as Schedule IV medications under the Controlled Substances Act, meaning they carry a risk for abuse even when taken as prescribed.
Benzos can also lead to the development of dependence and addiction. When someone is dependent on benzos, they will experience uncomfortable withdrawal symptoms when they stop using the drug. Severe withdrawal symptoms such as seizures can be dangerous, so it’s important to seek help when trying to stop benzodiazepine use.
What Is Benzo Withdrawal?
Benzos slow down signals between the body and the brain by activating gamma-aminobutyric acid (GABA). Because of this, benzos have a calming or sedative effect and can effectively treat anxiety or seizures. However, when benzos are taken for a prolonged period, your body can become dependent on the drug. Dependence occurs when your body adjusts to the presence of the drug, and this can impact the drug’s effects. When you suddenly stop taking the medication, your body does not have time to adjust to the drug’s sudden absence, which can cause withdrawal.
Benzo Withdrawal Symptoms
Benzo withdrawal occurs after stopping the drug too quickly, and it creates many symptoms related to the hyper-excitability of the brain. These symptoms include:
- Sleep changes
- Panic attacks
- Difficulty concentrating
- Weight loss
- Muscle pain and stiffness
Benzo Withdrawal Seizure
One of the biggest risks of abruptly stopping benzos is seizures. This risk is highest about five to seven days after stopping benzo use, but seizures can happen as soon as the day after quitting the drug. Unfortunately, even if benzos are taken as prescribed, the risk of seizures is present when quitting.
Epilepsy during withdrawal can happen even if you use benzos at a low dose and for as little as one week, but the risk is higher with larger doses or long-term use. Benzo withdrawal seizures are possible for up to six months after stopping Benzo use. Higher doses or longer-term use make the risk of developing epilepsy more likely.
If someone has a seizure from benzo withdrawal seizure, you can help them by doing the following:
- Call 911.
- Roll the person to their side and tilt their mouth toward the ground in case they drool or vomit.
- Place a soft object or pillow under the person’s head and neck so they don’t hurt themselves.
- Keep sharp objects away from the person to avoid injury.
- Stay with the person and time how long each seizure lasts.
- Loosen any tight items like belts, neckties, or necklaces.
Benzo Belly From Benzo Withdrawal
“Benzo belly” is a term that describes certain symptoms that can occur after stopping a Benzo. These can include bloating, stomach pain, constipation and other painful GI symptoms. These effects may occur because of the relationship between the gut and the brain. Researchers believe that bacteria in the gut may produce some of the same chemicals used in the brain. While more information is necessary regarding benzo withdrawal, it could be possible that the changes in the brain cause these changes to the GI system.
Benzo Withdrawal Timeline
The benzo withdrawal timeline may vary depending on which benzo a person takes and how much. In general, benzo withdrawal occurs in a few different phases.
- Phase one: One to four days after stopping benzos, rebound anxiety and insomnia can occur.
- Phase two: Symptoms intensify as benzodiazepine withdrawal syndrome develops. This phase may last for 10 to 14 days.
- Phase three: Anxiety may return and can remain for many months if left untreated.
After a few months, most people who stop taking benzos will no longer experience withdrawal symptoms. However, some people experience protracted withdrawal syndrome, which may result in symptoms that continue for years. This syndrome may occur due to structural changes to the brain after prolonged benzo use.
Factors Affecting Benzo Withdrawal Duration
Although the general timeline of benzo withdrawal duration is a good guide, it is not possible to accurately predict how long benzo withdrawal symptoms last. Withdrawal from benzodiazepines varies from person to person. However, benzodiazepine withdrawal symptoms, duration and severity may be influenced by many factors, including:
- Age and gender
- General health
- The health of the liver and kidneys
- Genetic and biological make-up of the individual
- Concurrent use of other drugs
- Co-occurring mental health disorders
- Whether the withdrawal is medically assisted or not
Can You Die from Benzo Withdrawal?
The most considerable health risk of stopping benzos is the possibility of seizures. Although it is uncommon, this type of seizure can lead to death in some cases. In addition, complications like aspiration are possible, particularly if you have an unwitnessed seizure and cannot call for help. In one case report, a woman stopped taking Xanax after running out of medication and died. She took a very large drug dose (200 mg over six days, despite the maximum recommended dose being less than 24mg).
If you want to stop taking Benzos, talk with your health care provider. There are safe and effective ways to discontinue this medication while reducing your chance of uncomfortable withdrawal symptoms or health risks.
How To Taper off Benzos
Similar to how your brain needs time to adjust to the presence of benzos, it will take your brain time to adjust to the absence of them. To minimize the risk of withdrawal or seizures, the safest way to stop benzos is to taper off them. Tapering is a process in which you slowly decrease how much you take until you can safely stop. For most, this process will last at least 10 weeks.
How Long Does Detox Take?
The timeline for acute benzodiazepine withdrawal symptoms suggests that most people will have fully detoxed from benzodiazepines within 14 days. Two weeks is typically how long it takes most benzos to be eliminated from your body altogether. However, because benzodiazepine withdrawal syndrome can include protracted symptoms, it is not possible to reliably predict how long it will take to detox from benzos.
How To Find a Detox Center
Detox refers to when your body eliminates substances such as benzodiazepines from its system. During this time, withdrawal symptoms can be particularly intense, leading some to return to benzo use. There are three settings where detox can happen: medical detox, where you are admitted to a medical facility; outpatient detox, where you have regular and frequent visits with a health care provider; or at home.
Medical detox can help you to get through withdrawal safely and comfortably. By providing you with 24-hour medical supervision, healthcare professionals can treat withdrawal symptoms while also prioritizing your mental well-being. Medical detox facilities also offer the opportunity to meet others in similar situations and create meaningful connections.
Outpatient detox is similar to medical detox, but it does not provide around-the-clock medical care. In outpatient detox, you and your healthcare provider determine a safe plan for a Benzo taper. Although outpatient detox provides more flexibility, a drawback is that it lacks 24-hour medical attention.
Detoxing at home is possible, but it can be dangerous because medical personnel cannot monitor you for risks such as seizures. However, detoxing at home may be an option if you have taken benzos for a short period or at low doses. A solid support system at home is essential, and you should always speak with your healthcare provider before attempting an at-home detox.
Benzo Detox Medications
Various medications can help with the uncomfortable symptoms of withdrawal. Detox facilities will monitor you for withdrawal symptoms and prescribe medications as needed.
Buspirone is an anti-anxiety medication that can also help to treat depression. This can be particularly helpful in patients going through benzo withdrawal who experience both anxiety and depression. This medication has few side effects and is usually well tolerated.
Flumazenil is a prescription medication that reverses benzos. It is often used in emergencies as a rescue medication to counteract benzos, similar to how naloxone reverses opioids rapidly. When used at low doses or as a subcutaneous infusion given over four days, flumazenil can help rapidly counteract benzos. However, it is essential to note that this rapid change can sometimes cause seizures, and the drug should only be used in a medical setting with extensive monitoring.
Clonidine is traditionally prescribed as a blood pressure medication. However, this medication has helped many going through withdrawal. It is believed that clonidine helps alleviate anxiety during withdrawal because of its effects on brain neurotransmitters. However, its use is limited by its effects on blood pressure.
Magnesium may be effective in helping to treat drug addiction and abuse. In one study, magnesium was found to reduce the intensity of addiction to various substances. It may also alter brain neurotransmitters in a way that reduces the intensity of withdrawal symptoms. Additionally, magnesium may become deficient in times of stress and lead to a higher likelihood of relapse, so taking magnesium supplements may help.
Keppra is the brand name of levetiracetam and is another antiepileptic medication. Keppra has demonstrated some promise as an option for benzo withdrawal in animal and small-scale human studies. However, as with many other drugs, Keppra may not be for everyone because it has the possibility of severe side effects.
Ondansetron is an antiemetic (antinausea) medication. This medication has been studied as a possible treatment for anxiety experienced during benzo withdrawal. However, more studies are necessary before ondansetron can be widely prescribed for this purpose, as it can have potential cardiac side effects.
Many anticonvulsants have been studied for benzo withdrawal, including lamotrigine, valproic acid and carbamazepine. Many are mood stabilizers that can benefit those undergoing benzo withdrawal. While each medication in this class works differently, they all work to decrease excitability in the brain. This change in the brain reduces the chances of seizures. Unfortunately, many of these drugs require close monitoring and have side effect profiles that may restrict their use.
Treatment for Benzo Withdrawal in South Florida
If you or a loved one are struggling with benzo addiction, The Recovery Village Palm Beach at Baptist Health is here to help. Our compassionate medical staff can support you through medical detox as you tackle the first step toward a healthier, substance-free life in recovery. From there, we offer a continuum of care that includes inpatient treatment, outpatient services and long-term aftercare programming. Contact us today to learn more about benzo addiction treatment programs that can work well for your situation.
Drug Enforcement Administration. “Benzodiazepines.” August 2023. Accessed September 3, 2023.
Griffin, Charles E.; Kaye, Adam M.; et al. “Benzodiazepine Pharmacology and Central Nervous System–Mediated Effects.” Ochsner Journal, Summer 2013. Accessed September 3, 2023.
Pétursson, H. “The benzodiazepine withdrawal syndrome.” Addiction, November 1994. Accessed September 3, 2023.
Harnod, Tomor; Wang, Yu-Chiao; Kao, Chia-Hung. “Association Between Benzodiazepine Use and Epilepsy Occurrence.” Medicine, September 18, 2015. Accessed September 3, 2023.
Mayer, Emeran A.; Tillisch, Kirsten; Gupta, Arpana. “Gut/brain axis and the microbiota.” Journal of Clinical Investigation, February 17, 2015. Accessed September 3, 2023.
Ashton, H. “Protracted withdrawal syndromes from benzodiazepines.” Journal of Substance Abuse Treatment, 1991. Accessed September 3, 2023.
Ogbonna, Chinyere I.; Lembke, Anna. “Tapering Patients Off of Benzodiazepines.” American Family Physician, 2017. Accessed September 3, 2023.
Lann, Meredith A.; Molina, D. Kimberley. “A fatal case of benzodiazepine withdrawal.” American Journal of Forensic Medicine and Pathology, June 2009. Accessed September 3, 2023.
Brett, Jonathan; Murnion, Bridin. “Management of benzodiazepine misuse and dependence.” Australian Prescriber, October 1, 2015. Accessed September 3, 2023.
Fluyau, Dimy; Revadigar, Neelambika; Manobianco, Brittany E. “Challenges of the pharmacological management of benzodiazepine withdrawal, dependence, and discontinuation.” Therapeutic Advances in Psychopharmacology, February 9, 2018. Accessed September 3, 2023.
Nechifor, Mihai. “Magnesium in drug abuse and addiction.” University of Adelaide Press, 2011. Accessed September 3, 2023.
Lamberty, Yves; Gower, Alma J.; Klitgaard, Henrik. “The new antiepileptic drug levetiracetam normalises chlordiazepoxide withdrawal-induced anxiety in mice.” European Journal of Pharmacology, March 29, 2002. Accessed September 3, 2023.
Krebs, Michael; Richter, C. “Levetiracetam for the treatment of alcohol withdrawal syndrome: An open prospective trial.” Suchtmedizin in Forschung und Praxis, January 2006. Accessed September 3, 2023.