Alprazolam Withdrawal Medication & Treatment
Alprazolam (Xanax) is used to treat anxiety and panic disorders. It belongs to a group of medications called benzodiazepines (benzos) and achieves its calming effects by decreasing excitatory signaling within the central nervous system.1
Long-term alprazolam use can lead to physical dependence, and users may go through withdrawal when they stop taking it or reduce their dose.1,3
Alprazolam withdrawal is often unpleasant. In rare cases, it can even be dangerous and may include seizures. Other symptoms of alprazolam withdrawal include insomnia, muscle cramps, and rebound anxiety.1,3 People who are ready to stop using alprazolam should consider supervised withdrawal treatment or speak to their doctor about discontinuing the medication.
Treatment options for alprazolam withdrawal include inpatient programs, detox centers, intensive outpatient, and partial hospitalization. Types of medications that may be used during alprazolam withdrawal include antidepressants and over-the-counter medications to manage certain symptoms. Often, treatment consists of “tapering,” or gradually reducing the dose.
If you are addicted to alprazolam, detoxification (detox) is the first step of recovery. Following up detox with further treatment can help you avoid relapse and remain sober.
Treatment Options for Alprazolam Withdrawal
The following is a list of treatments that provide help for alprazolam withdrawal:
- Detox centers: These programs provide medical supervision for individuals undergoing detox. Healthcare providers on staff can prescribe medications, treat medical conditions, and make sure you are comfortable throughout the process. Typically, those who complete detox continue on with further treatment.
- Inpatient: Many inpatient rehab programs offer detox services. They provide 24-hour medical care for people experiencing alprazolam withdrawal. When the person finishes detox, they can transition into an addiction treatment program that often includes substance abuse education, therapy, relapse prevention, 12-step meetings, and other recovery activities.
- Outpatient: Outpatient detox programs offer medical treatment and supervision, but the person is not admitted to the treatment facility. The person will typically see a physician or other healthcare provider who offers medical advice, prescribes medications to help manage withdrawal symptoms, or helps the person taper off alprazolam.
- Intensive outpatient: As the name suggests, intensive outpatient programs offer a relatively intense form of outpatient treatment. During withdrawal, the person receives care from a healthcare provider while attending regularly scheduled counseling sessions, often multiple times a week. These sessions may be individual and/or group, and they are centered on recovery and maintaining abstinence from the person’s drug of choice.
- Partial hospitalization: These are outpatient programs that provide structured recovery services and medical care. They can help the person through withdrawal and assist them with recovery and abstinence. These programs require a significant time commitment of up to 20 hours a week. 7
Generally, people slowly taper off alprazolam. However, medications can be used to treat certain alprazolam withdrawal symptoms.
- Antidepressants. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) may be prescribed to people who suffer from depression during alprazolam withdrawal.9 SSRIs include fluoxetine (Prozac) and paroxetine (Paxil).
- Flumazenil. One study found that low doses of flumazenil, a benzodiazepine receptor agonist/partial agonist, can help reduce benzodiazepine withdrawal symptoms. More data is needed to determine if this could become a widespread treatment for benzodiazepine withdrawal. 8
- Over-the-counter medications. Physicians may prescribe over-the-counter drugs for symptoms such as headache, diarrhea, and vomiting.
Alprazolam withdrawal medications also include other benzodiazepines. People addicted to relatively short-acting benzos such as alprazolam may be placed on longer-acting benzos and tapered down during withdrawal to maintain quality of life and decrease the severity of withdrawal symptoms.
Tapering Off Alprazolam
You may taper off alprazolam or be placed on a similar, longer-acting medication. Tapering off alprazolam is a common withdrawal treatment. It involves gradually reducing the dose or prescribing a longer-acting benzodiazepine, which is then itself tapered down. These methods help ease symptoms and prevent relapse.
Each person will react to tapering differently, and the timeline will vary for each person. The safest way to taper is to work with a healthcare provider.
General tapering timelines for alprazolam and a long-acting benzodiazepine substitute are below:
- Long-acting benzodiazepine substitute taper. The physician prescribes 10 to 20 mg of diazepam (Valium) 3 to 4 times daily and tapers over a 7- to 10 day period until the dose is 5 to 10 mg. The physician may adjust the dose as needed. 6
- Alternative long-acting benzodiazepine taper. The physician calculates the equivalent dose of a longer-acting benzodiazepine and prescribes 50% of the original dose. They then taper the dose over a period of 7 to 10 days. 6
Alprazolam taper. The user continues on an alprazolam regimen, but the monitoring clinician lowers the dose by 10% every 2–4 weeks, depending on withdrawal severity and response to the taper.2
Detoxing Cold Turkey at Home
Detoxing from alprazolam cold turkey at home may seem convenient, but it carries serious risks. Benzodiazepine withdrawal can be deadly without medical attention, and it increases the risk of relapse. Unmanaged alprazolam withdrawal can cause mental health problems, such as rebound anxiety, irritability, or depression, which can lead to thoughts of self–harm or suicide.4,5
Additionally, alprazolam withdrawal can cause a number of unpleasant physical symptoms such as:
- Blurred vision.
- Heart palpitations.
- Nausea and vomiting.
- Muscle cramps. 4,5
These symptoms can be very difficult to manage on your own. The safest method is to detox in a treatment program that has a staff that can manage any medical or mental health symptoms.
. MedlinePlus. (2016). Alprazolam
. Curran H.V., Bond A., O’Sullivan, G.O., Bruce, M., Marks, I., Lelliot, P., Lader, M. (2009). Memory functions, alprazolam and exposure therapy: a controlled longitudinal study of agoraphobia with panic disorder. Psychological Medicine, 24(4), pp. 969-976.
. Food and Drug Administration (FDA). (2011). XANAX.
. Food and Drug Administration (FDA). (2006). Xanax CIV.
. Petursson, H. (November 1994). The Benzodiazepine Withdrawal Syndrome. Addiction Journal: 89(11). 1455-9.
. Miller, N. and Gold, M. (1998). Management of Withdrawal Syndromes and Relapse Prevention in Drug and Alcohol Dependence. American Family Physician, 58(1), 139-146.
. John Hopkins Medicine: Center for Substance Abuse Treatment and Research. Treatment Settings.
. Hood, S. et al. (2014). Benzodiazepine dependence and its treatment with low dose flumazenil. British Journal of Clinical Pharmacology 77(2):285-294.
. Lader, M. and Kyriacou, A. (2016). Withdrawing Benzodiazepines in Patients With Anxiety Disorders. Current Psychiatry Reports, 18(1), 8.