Xanax is a brand name of alprazolam and belongs to a group of drugs called benzodiazepines. Xanax is an intermediate-acting benzodiazepine. Despite its effectiveness for certain clinical uses, it has dangerous and unpredictable withdrawal effects, sometimes even after low-dose or short-term use.
Xanax and other benzodiazepine are almost always abused in conjunction with other drugs of abuse, like opioids. Combining opioids with benzodiazepines is dangerous because benzodiazepines enhance the side effects of opioids, including their deadly respiratory depression effects. People who take Xanax and opioids can overdose and die from a much lower dose than they may anticipate.
These factors highlight the need for people who abuse Xanax to get help to overcome their addiction. The first part of recovery from Xanax use is Xanax withdrawal and Xanax detox, the subject of this article.
What Causes Xanax Withdrawal?
Xanax works by binding to specific receptors that allow brain cells to communicate with each other and pass on electrical charges, known as gamma-Aminobutyric acid (GABA) receptors. By doing so, Xanax reduces the excitability of the brain, producing a calming effect. That is why Xanax helps reduce or prevent anxiety or seizures.
When people take Xanax for even short periods, the brain tries to compensate for the calming effects of Xanax by activating fewer GABA receptors and less GABA. As a result, when people suddenly stop taking Xanax or reduce the dose too quickly, the brain rebounds and becomes hyperexcitable.
This sudden hyperexcitability produces Xanax withdrawal symptoms, including anxiety. For people who had anxiety problems before taking Xanax, this rebound anxiety can be worse. The rebound hyperexcitability of the brain can cause jitteriness, muscle tension, stiffness and seizures. Many other symptoms can occur during Xanax withdrawal.
Xanax Withdrawal Symptoms
Acute (immediate) Xanax withdrawal symptoms are grouped into what is known as benzodiazepine withdrawal syndrome, which includes many physical and psychological symptoms. People are at risk for Xanax withdrawal syndrome even with a low dose or with a short duration of use.
The main concern when discontinuing or reducing Xanax use is seizures. These seizures are of the generalized tonic-clonic type, also known as grand-mal seizures, and can be fatal.
There are several physical symptoms, ranging from mild to severe, that an individual may experience when withdrawing from Xanax. Some of the physical symptoms of Xanax withdrawal are:
- Muscle spasms and twitching
- Muscle pain and stiffness
- Heart palpitations
- Diaphoresis (profuse sweating)
- Dizziness, light-headedness
- Numbness and tingling, pins and needles sensation
- Visual disturbances
- Ringing in the ears
- Loss of appetite
Psychological/mental withdrawal symptoms may be especially noticeable because they can result in odd behaviors. People should not withdraw from Xanax alone because they may exhibit behaviors that can cause themselves harm without even being aware of what they are doing. Typical psychological/mental Xanax withdrawal symptoms include:
- Xanax withdrawal depression
- Confusion, disorientation
- Delusions, paranoia
- Visual or auditory hallucinations
- Anxiety, panic attacks
- Memory difficulties
- Feelings of separation from reality
Xanax post-acute withdrawal syndrome (PAWS) refers to a lingering collection of symptoms that may persist following acute withdrawal, often lasting for a year or more. Many of the symptoms of PAWS are acute withdrawal symptoms that last longer than the usual duration, especially:
- Sleep disturbances
- Depressive symptoms
- High blood pressure and heart rate
- Low energy, fatigue or apathy
While PAWS is predominantly associated with alcohol use disorder (AUD), it can occur following withdrawal from other drug use as well. However, much more commonly seen in Xanax withdrawal is protracted withdrawal syndrome, which has its own characteristics.
Protracted withdrawal symptoms from benzodiazepines are common and unique enough to classified separately.
Protracted withdrawal syndrome can occur in up to one-third of people who experience withdrawal symptoms following long-term (even if low-dose) use of benzodiazepines. Symptoms are somewhat different than those seen in PAWs. The main symptoms are anxiety and insomnia. However, other symptoms may occur:
- High blood pressure and heart rate
- Muscle spasms
- Numbness and tingling, pins-and-needles sensations
Protracted withdrawal syndrome differs from PAWs in that it usually starts during acute withdrawal and can seem to resolve and then come back in full force throughout the duration of the syndrome.
Can Xanax Withdrawal Kill You?
A case report discussed the Xanax withdrawal death of a woman after having withdrawal seizures. However, she had been taking massive doses. She took 200 mg in six days and the maximum safe dose in six days is less than 24 mg. The woman stopped Xanax use after running out of her supply of the drug.
The danger of Xanax withdrawal death lies in the seizures if they occur. The type of seizures seen with Xanax withdrawal can be deadly, especially in individuals who are alone when a seizure happens.
Xanax Withdrawal Timeline
When does Xanax withdrawal start? The onset of acute benzodiazepine withdrawal syndrome usually starts one to two days after the last dose for short-acting benzodiazepines and two to four days for long-acting. Xanax is intermediate-acting, so withdrawal syndrome symptoms can be anticipated somewhere in between.
The Xanax withdrawal seizure timeline mirrors that of other acute withdrawal symptoms, with the risk of symptoms appearing one to two days after the last dose, peaking at five to seven days and lasting until about two weeks after the last dose.
Withdrawal symptoms peak at about five to seven days. Acute withdrawal symptoms usually begin tapering off after the peak, at about eight days, and resolve by 12 to 14 days after the last dose.
Prolonged withdrawal syndrome symptoms arise during the acute withdrawal period and can wax and wane. Sometimes they taper off and seem to have resolved and then re-emerge. They can last a year or more.
Factors Affecting Withdrawal Duration
Withdrawal from Xanax is somewhat unpredictable in that the duration and amount of the drug use are not necessarily reliable predictors of how Xanax withdrawal duration will play out. However, Xanax withdrawal symptoms duration and severity may be influenced by many factors, including:
- The age and gender of the individual
- The general health of the individual
- The health of the liver and kidneys
- The genetic and biological make-up of the individual
- Whether there was concurrent use of other drugs
- Whether there is a co-occurring mental health disorder
- Whether the withdrawal is being medically assisted
Xanax Detox for Treatment of Withdrawal
To recover from substance misuse– including Xanax misuse – people must first go through the process of ridding the body of the substances and their toxic metabolites. This process is known as detoxification, or detox. It is while the body clears the substances and the brain adjusts to the absence of the drug that the unpleasant experience of withdrawal occurs.
Many people who use Xanax are aware that the drug should not be suddenly discontinued but do not know how to detox from Xanax properly. Xanax withdrawal treatment, known as medical detox, makes the potentially dangerous and difficult process of Xanax withdrawal much safer and easier.
For many people who use Xanax, the fear of withdrawal symptoms is a major barrier to getting off the drug, and that fear may keep them from even trying. Fortunately, professional help is available for drug detox and withdrawal management. By participating in a medical detox program, such as is offered at The Recovery Village Palm Beach at Baptist Health, people can get through the experience safely while in the care of medical professionals.
Medical detox involves staying at a detox facility during the withdrawal period, with proper medical supervision. Individuals can be offered medications to help reduce uncomfortable symptoms and prevent dangerous withdrawal effects, and they have help immediately available.
Medical detox also has other benefits. It enables staff to assess individuals for the physical and mental effects of their drug use and to identify and discuss the presence of other substance use and mental health disorders. This process allows for making a treatment and recovery plan that will ensure the reasons behind the substance use are properly addressed.
Medical detox also allows people to connect with other people in recovery from substance use and to benefit from the fellowship of a network of recovery.
Tapering using benzodiazepines is the mainstay method for Xanax detox. The benzodiazepine flumazenil is the usual first choice for helping people detox from benzodiazepine abuse.
People who are addicted to substances tend to overestimate their ability to control their drug use and may try to taper themselves off the drug. However, experience has shown that this method seldom works. After all, one of the core characteristics of addiction is an inability to control substance use.
The medication clonidine is occasionally used to reduce withdrawal symptoms when detoxing from substance use. However, clonidine may not be especially useful for benzodiazepine detox, other than for reducing blood pressure.
The muscle relaxant baclofen may be helpful for short-term use in benzodiazepine detox.
The medication trazodone is periodically used for treating insomnia during Xanax withdrawal because it works differently than benzodiazepines do, so it is not affected by benzodiazepine tolerance.
Various non-benzodiazepine anti-seizure medications may be useful for preventing withdrawal seizures as well.
Beta-blocker medications, like propranolol, that are used to treat high blood pressure, heart rhythm abnormalities, heart attacks and other heart problems are occasionally used to reduce the physical withdrawal symptoms of Xanax withdrawal.
Alternative therapies for Xanax may be helpful, especially for treating the returning anxiety symptoms for those who were using Xanax to treat anxiety. For people with substance addictions, alternative therapies contribute to the holistic approach to treatment, which involves treating the whole person and not simply the disease.
When it comes to “natural” Xanax withdrawal treatment, in the form of drugs or chemicals that are marketed to help with withdrawal, it is always a good idea to check with a physician or pharmacist first.
Outpatient detox involves detoxing at home with approval from a physician. The major disadvantages to this approach are the increased danger due to severe withdrawal symptoms that may occur without a proper drug taper, the lack of professional support in case of a medical emergency and the absence of addiction counselors for putting together a plan for treatment and recovery. Inpatient detox can address all of those concerns.
- Detoxing at Home
Given the dangers involved and the unpredictability of benzodiazepine withdrawal syndrome, people should take care when deciding whether to attempt a Xanax detox at home. When making the decision, individuals should do so in conjunction with their physician and should be forthcoming about the extent of their Xanax usage, as well as any other drug use.
The major risk in detoxing at home is being alone without help if a seizure, psychosis or delirium occurs. Even if not alone, people should ensure that people who are at home are aware of the withdrawal symptoms and know what to do if serious side effects occur.
People who decide to detox off Xanax at home should be sure to get appropriate medical advice on how to detox from Xanax at home.
- Risks of Abrupt Discontinuation
The dangers of Xanax withdrawal are greatly increased if the drug is abruptly discontinued. This danger includes the risk of serious withdrawal effects, such as seizures, psychosis and delirium. Even people who are using Xanax without a prescription should consult with a doctor for help in tapering off the drug rather than putting themselves through a sudden withdrawal.
- Controlled Taper
Because of these concerns, weaning off Xanax is appropriate, rather than sudden discontinuation. Tapering off Xanax and discontinuing the drug should only be done under the supervision of a doctor. The FDA recommends a Xanax taper by decreasing the dose by no more than 0.5 mg every three days, or even less rapidly if the drug has been used for an extended period or at high doses.
Finding a Detox Center
Finding the right detox center can be daunting. There are many options and the terms used to describe treatment may be difficult for people to understand. However, there are a few points to consider in the search are:
- Staff to Patient Ratio
The location should be a primary consideration because some people may want to detox close to their homes, while other people may wish for a fresh environment that will allow them to better focus on their health and healing. Cost should also be a consideration. People should consider what facilities accept their insurance plans or can work with them to establish a payment plan.
Key Points: Understanding Xanax Withdrawal and Detox
Remember the following key points when considering Xanax withdrawal and detox:
- Xanax abuse is a serious substance use disorder, particularly when the drug is used with other substances
- Withdrawal from Xanax can have serious and long-lasting symptoms that are a safety concern
- Supervised medical detox is the safest and most comfortable way to detox from Xanax
- One of the biggest dangers of Xanax withdrawal is the seizures that can occur
If you struggle with Xanax addiction, contact The Recovery Village Palm Beach at Baptist Health to speak with a representative about how professional addiction treatment can help you achieve the healthier future you deserve. Take the first step toward that healthier future by calling today.
Ait-Daoud, Nassima; Hamby, Allan; Sharma, Sana; et al. “A review of alprazolam use, misuse, and withdrawal.” Journal of Addiction Medicine, January-February 2018. Accessed July 10, 2019. American Psychiatric Association. “Study finds increasing use, and misuse, of benzodiazepines.” December 17, 2018. Accessed July 10, 2019. Bachhuber, Marcus; Hennessy, Sean; Cunningham, Chinazo; et al. “Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996-2013.” American Journal of Public Health, April 2016. Accessed July 10, 2019. Brett, Jonathan; Murnion, Bridin. “Management of benzodiazepine misuse and dependence.” Australian Prescriber, October 1, 2015. Accessed July 10, 2019. Fluyau, Dimy; Revadigar, Neelambika; Manobianco, Brittany. “Challenges of the pharmacological management of benzodiazepine withdrawal, dependence, and discontinuation.” Therapeutic Advances in Psychopharmacology, May 2018. Accessed July 10, 2019. Food and Drug Administration (FDA). “Xanax.” September 2016. Accessed July 10, 2019. Landry, Mom; Smith, David; McDuff, David; et al. “Benzodiazepine dependence and withdrawal: Identification and medical management.” Journal of the American Board of Family Practice, March 1, 1992. Accessed July 10, 2019. Lann, Meredith; Molina, D. “A fatal case of benzodiazepine withdrawal.” American Journal of Forensic and Medical Pathology, June 2009. Accessed July 10, 2019. Liebrenz, Michael; Gehrig, Marie-Therese; Buadze, Anna; et al. “High-dose benzodiazepine dependence: a qualitative study of patients’ perception on cessation and withdrawal.” BMC Psychiatry, May 13, 2015. Accessed July 10, 2019. Ogbonna, Chinyere; Lembke, Anna. “Tapering patients off of benzodiazepines.” American Family Physician, November 1, 2017. Accessed July 10, 2019.
Ait-Daoud, Nassima; Hamby, Allan; Sharma, Sana; et al. “A review of alprazolam use, misuse, and withdrawal.” Journal of Addiction Medicine, January-February 2018. Accessed July 10, 2019.
American Psychiatric Association. “Study finds increasing use, and misuse, of benzodiazepines.” December 17, 2018. Accessed July 10, 2019.
Bachhuber, Marcus; Hennessy, Sean; Cunningham, Chinazo; et al. “Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996-2013.” American Journal of Public Health, April 2016. Accessed July 10, 2019.
Brett, Jonathan; Murnion, Bridin. “Management of benzodiazepine misuse and dependence.” Australian Prescriber, October 1, 2015. Accessed July 10, 2019.
Fluyau, Dimy; Revadigar, Neelambika; Manobianco, Brittany. “Challenges of the pharmacological management of benzodiazepine withdrawal, dependence, and discontinuation.” Therapeutic Advances in Psychopharmacology, May 2018. Accessed July 10, 2019.
Food and Drug Administration (FDA). “Xanax.” September 2016. Accessed July 10, 2019.
Landry, Mom; Smith, David; McDuff, David; et al. “Benzodiazepine dependence and withdrawal: Identification and medical management.” Journal of the American Board of Family Practice, March 1, 1992. Accessed July 10, 2019.
Lann, Meredith; Molina, D. “A fatal case of benzodiazepine withdrawal.” American Journal of Forensic and Medical Pathology, June 2009. Accessed July 10, 2019.
Liebrenz, Michael; Gehrig, Marie-Therese; Buadze, Anna; et al. “High-dose benzodiazepine dependence: a qualitative study of patients’ perception on cessation and withdrawal.” BMC Psychiatry, May 13, 2015. Accessed July 10, 2019.
Ogbonna, Chinyere; Lembke, Anna. “Tapering patients off of benzodiazepines.” American Family Physician, November 1, 2017. Accessed July 10, 2019.
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