Xanax Withdrawal Symptoms and How to Treat Them

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Xanax withdrawal is caused by abruptly stopping or lowering your dose.⁴ It is more likely to happen after taking higher doses and over longer periods, but it can happen at low doses over only a few weeks. People who are prescribed Xanax for panic disorder generally receive higher doses than those who take it for anxiety. For that reason, among those prescribed it, those with panic disorder are most vulnerable to withdrawal.⁴

Xanax withdrawal symptoms are known to be worse than withdrawal from other benzodiazepines¹ and can occur even after only a few weeks of consistent Xanax use.³

Xanax Withdrawal Symptoms

Xanax tolerance happens over time as you need higher doses to achieve the same effect.³ One unique feature of benzodiazepines is that you may become susceptible to withdrawal even before tolerance has begun.⁵

Worse withdrawal symptoms are more likely if you have been using Xanax longer and at a higher dose, but there is no magic number for dosage or duration used to know when you’ll experience tolerance or withdrawal.⁵

According to the manufacturer, Xanax withdrawal can occur even after short-term use at recommended doses.⁴ Xanax is FDA approved for panic and anxiety symptoms and is usually safe for short-term use, under two weeks. Half of the people who take Xanax or other benzodiazepines for a month develop dependence.⁵

Xanax withdrawal symptoms include physical, psychological, and sensory changes, such as:³

Increase in heart rate
Fast breathing
High blood pressure
Body temperature increase and sweating
Hand tremors
Lack of sleep
Nausea and vomiting
Anxiety
Irritability and restlessness
Delirium and hallucinations
Seizures

The most common Xanax withdrawal symptoms are a “rebound” of the symptoms that Xanax treats: anxiety, restlessness, and muscle tension. You may also experience:⁴

Sinusitis-like symptoms
Muscle cramps and spasms
Difficulty concentrating
Tingling or prickly sensations
Loss of appetite

Seizures are considerably common, especially if you stop taking Xanax suddenly.⁵

Xanax Withdrawal from Overdosing

Xanax overdose can happen if you take Xanax alone, or if you combine Xanax with alcohol.⁴ If you overdose on Xanax, you should be brought to the emergency room immediately.

Benzodiazepine overdose can be a medical emergency, but evidence suggests that recovery from a Xanax withdrawal takes longer than other benzodiazepines.¹ The first phase of treatment involves ruling out any other causes of your overdose symptoms, like:⁶

Low blood sugar
Alcohol intoxication
Head trauma
Presence of other substances

In the event of severe overdose, you may need to have your stomach pumped, get assistance for breathing, and receive medications to keep your blood pressure from dropping.

When you experience Xanax withdrawal because of an overdose, it’s usually because you’re given Flumazenil⁴which quickly reverses the physiological effects of Xanax. It is a controversial treatment because it can potentially cause a seizure, especially if you have had long-term dependence, or taken any other medications with risk for seizures.⁶

Xanax Withdrawal Timeline

Symptoms of Xanax withdrawal can begin anywhere from 24 hours to 3 weeks after your last dose of a benzodiazepine. It depends on the half-life (the time it takes for the drug to reduce to half of its initial value) of the specific medication you take. Both immediate and extended-release Xanax both have a half-life of just over 11 hours and peak between 1-2 hours after you take it.⁴

Most medical professionals agree that the safest way to stop using Xanax and other benzodiazepines is to taper off the medication over 4-6 weeks (or more for people taking higher doses), vs going cold turkey.⁵

Tapering involves a gradual reduction in your dose until you can go without it. If you take a short-acting benzodiazepine like Xanax immediate release, you may be switched to a similar medication that is in its extended-release form. Medical providers usually opt to reduce your dose at a speed you can tolerate, and to minimize withdrawal symptoms. It’s common to be fully tapered off within 8 weeks.⁵

Treatment and Medications for Xanax Withdrawal

Medications you may receive during treatment for withdrawal will relate to your specific symptoms.^.5 If you have any mental health conditions that require medication, or are withdrawing from other substances, those will also be addressed during treatment. Examples of Xanax withdrawal medications include:⁵

Antidepressants and mood stabilizers
Non-benzodiazepine anxiety medications (e.g., gabapentin or beta-blockers)
Sleep medication

These medications may be used short or long-term, depending on your needs.

Non-Medical Xanax Withdrawal Treatment

Non-medical treatment for Xanax withdrawal can take on multiple approaches. Cognitive-behavioral therapy (CBT) is a therapeutic approach that focuses on addressing stress triggers and building coping skills.

It helps you prepare for situations that may put you at risk for relapse, and how to get through it. It is a very common approach for Xanax and other benzodiazepine misuse treatments.

Other approaches include:⁵

Marital and family therapy
Group therapy
12-step programs like Narcotics Anonymous (NA)

The Dangers of Xanax Withdrawal

Like Xanax intoxication, Xanax withdrawal symptoms resemble alcohol withdrawal because both substances instigate the same response in our nervous system.

For both Xanax and alcohol, the more severe symptoms of withdrawal are seizures and hallucinations. When going through Xanax withdrawal without medical care, you have a 30% chance of having a seizure, which is why seeking professional help is important.

When hallucinations occur, it may be difficult to tell whether something is real or not. If you aren’t able to distinguish hallucinations from reality, you are considered to be in substance-induced psychosis.³

Xanax withdrawal can be life-threatening.⁴ This is particularly true if you are withdrawing while taking other controlled substances, and alcohol. For this reason, Xanax withdrawal should be overseen by a medical professional.

Call 800-681-1058 (Who Answers?) if you want to speak to a treatment specialist about your options to detox from Xanax.

What is Xanax?

Alprazolam, or Xanax, is a type of benzodiazepine that falls under the category of sedative, hypnotic (sleep-inducing), and anxiolytic drugs. Xanax is not only the most commonly prescribed benzodiazepine, it is the most commonly prescribed psychiatric medication.¹ Xanax is prescribed for anxiety and panic disorders, and it comes in immediate and extended-release forms.

Other benzodiazepines like Xanax include:

Clonazepam (brand name: Klonopin)
Diazepam (brand name: Valium)
Lorazepam (brand name: Ativan)
Chlordiazepoxide (brand name: Librium)

Benzodiazepines as a class are a very commonly prescribed medication. They can be used to treat seizures, to help with insomnia, and as muscle relaxants, in addition to anxiety and panic disorders. They are one of the most commonly prescribed types of medication.

One in 20 people fill a benzodiazepine prescription each year. That, combined with a 400% increase in benzodiazepine-related overdose deaths between 1996 and 2013, makes the potential hazards of using Xanax and other benzodiazepines worthy of cautious consideration.²

Xanax Precautions

Xanax should only be taken if prescribed by a doctor. Furthermore, certain people should not take it for any reason:⁴

Pregnant women: Xanax can cause damage to the fetus and cause postnatal withdrawal symptoms in the infant.
Nursing women: infants can experience weight loss and drowsiness from receiving Xanax through breast milk.
Children: there is not any clinically proven safe or effective use of Xanax in children.
Elderly: because they may not be able to metabolize and clear Xanax, they should be given the minimal effective dose.
People taking other medications, particularly opioids, which can be a dangerous combination.²

Despite these recommendations, quite often people in these categories often take Xanax and other benzodiazepines. This is especially true of the elderly and those who take other controlled substances.¹

Xanax Intoxication from Recreational Use

A big risk factor for Xanax withdrawal is Xanax intoxication. In addition to those who are prescribed Xanax, many people also take it recreationally, or to self-medicate. If you take Xanax, you may experience Xanax intoxication, which consists of: ³

Slurred speech
Lack of coordination
Unstable walking and other movements
Eye twitching and rapid movement
Attention and memory deficits
Lethargy and even coma
Mood instability
Poor judgment
Inappropriate behavior

When mixed with any other substances including alcohol, Xanax intoxication is exacerbated and varies according to the effects of the other substances.¹

Xanax and Other Sedative Use Disorders

Many people who go through withdrawal do so as a result of sedative use disorder. Sedative use disorder is defined by experiencing at least 2 of the following in a 1-year period:³

Taking more medication than intended
Consistent cravings
Unsuccessful attempts at quitting
Inability to meet personal, professional, or educational responsibilities related to use
Continuing to use despite interpersonal problems related to use
Exposing oneself to physical hazards related to using (e.g., driving under the influence)
Increasing tolerance to the medication
Withdrawal when use is disrupted

The most common age group for sedative use disorders is young adults, often beginning between age 18-25. A high percentage of adults over 50 are prescribed Xanax and other sedatives, despite the increased effects on both liver and kidney functions. The percentage of those who misuse Xanax and other sedatives in this older age group doubled from 2006 to 2014.²

Not everyone who goes through Xanax withdrawal has sedative use disorder. Withdrawal can occur even after several weeks of consistent Xanax use.³ Xanax withdrawal can happen to anyone who takes it, and is not limited to those who misuse it. It is caused by abruptly stopping or lowering your dose.⁴

Treatment for substance use disorder related to Xanax and other benzodiazepines has been on the rise since the early 2000s, but a high percentage of people who misuse Xanax often misuse other substances as well, like opioids.² This can exacerbate intoxication and withdrawal.

References

Ait-Daoud, N., Hamby, A., Sharma, S., & Blevins, D. (2018). A Review of Alprazolam Use, Misuse, and Withdrawal. Journal of Addiction Medicine, 12(1), 4–10.
Votaw, V. R., Geyer, R., Rieselbach, M. M., & McHugh, R. K. (2019). The epidemiology of benzodiazepine misuse: A systematic review. Drug and alcohol dependence, 200, 95–114.
Diagnostic and statistical manual of mental disorders: DSM-5. (Fifth edition.). (2013). American Psychiatric Association.
Package Insert Xanax. (2011). (PDF) New York, NY: Pfizer.
Soyka, M. (2017). Treatment of benzodiazepine dependence. The New England Journal of Medicine, 376(12), 1147-1157.
Greller, H., & Gupta, A. (2021). Benzodiazepine Poisoning and Withdrawal. In J Grayzel (Ed.)