Alprazolam (Xanax) is a benzodiazepine medication used to treat anxiety and panic disorders. Benzodiazepines can be addictive - one reason that they are often prescribed for short-term use only.1
Over time, someone who is using or abusing alprazolam will build up a tolerance to the drug. Tolerance often goes hand-in-hand with the development of physical dependence. As the user takes increasingly higher doses to achieve the same effect as before their brain may more quickly begin to rely on the drug to function normally.
If a dependent user tries to quit taking alprazolam, he or she will likely experience withdrawal effects as the body and brain adjust to living without the drug. These effects can last anywhere from a few days to several weeks and include trouble sleeping, tremors, sweating, anxiety, and seizures.
Alprazolam withdrawal symptoms can be life-threatening,7 and a medical detox program is the safest method for withdrawing from alprazolam and recovering from addiction.
Signs, Symptoms, and Effects
Signs and symptoms may include insomnia, tremors, headache, anxiety, and seizures.
Alprazolam withdrawal may consist of a number of unpleasant symptoms. However, every person will react differently to the withdrawal process and may experience different mental and medical health effects.
Alprazolam withdrawal signs and symptoms include: 3,8
- Sleep problems.
- Hand tremors.
- Nausea and dry retching.
- Unintentional weight loss.
- Muscle stiffness and pain.
- Heart palpitations.
- Panic attacks.
- Difficulty concentrating.
- Changes in perception.
- Psychotic reactions.
- Prolonged dependence. People who have abused alprazolam or other benzodiazepines for long periods of time are likely to suffer more intensely unpleasant withdrawal symptoms than short-term alprazolam abusers. 7
- Multi-substance abuse. Alprazolam withdrawal is likely to be more severe for people who abuse alcohol and other sedative-hypnotic drugs while using alprazolam. Abusing these substances together can also lead to overdose and death. 8
- Mental health conditions. People who suffer from underlying mental health conditions such as depression or anxiety may find it more challenging to get through the withdrawal process because symptoms may re-emerge during recovery.5
Post-Acute Withdrawal Symptoms
After the initial alprazolam withdrawal phase, users may experience “post-acute” withdrawal symptoms including:
- Increased anxiety.
- Memory problems.
- Depression. 5
Not everyone will experience these effects. But they can last for weeks or months. 5
To improve chances of long-term recovery, the Substance Abuse and Mental Health Services Administration (SAMHSA) recommends that people educate themselves about post-acute withdrawal, get involved with support groups, and stay physically active. 5
The alprazolam withdrawal timeline depends on how frequently the person was using alprazolam and the average dose being used. The user’s age and overall health also influence how quickly alprazolam is metabolized, which can influence the speed of onset of the withdrawal syndrome.
|Duration of Symptoms||Symptoms|
|1 – 4 days||Increased anxiety, insomnia3|
|10 – 14 days||Physical symptoms: hand tremors, sweating, nausea and dry retching, unintentional weight loss, heart palpitations, headache, muscle pain, muscle stiffness, seizures|
Mental and behavioral symptoms: difficulty falling or staying asleep, or periodically waking up; panic attacks; increased anxiety; difficulty concentrating; changes in perception of the environment and people; irritability; psychotic reactions 3
|7 – 28 days||Increased anxiety, insomnia5|
The worst of the alprazolam withdrawal symptoms last 10 to 14 days.3 During this time, it is crucial that the person be monitored and supported by trained addiction specialists. It is common for people to relapse during this time. The risk is greater for people who take alprazolam with other substances such as alcohol.
After four weeks, it may be difficult to determine whether the person is continuing to suffer from alprazolam withdrawal signs or an underlying anxiety disorder.5
Substance abuse causes an array of physiological problems and medical complications. People who are struggling with alprazolam withdrawal effects may experience the following medical problems:
- Seizures: Seizures are extremely dangerous and common in heavy alprazolam users. The risk is exacerbated if the user also abused alcohol prior to withdrawal.
- Delirium or psychotic episodes: The lack of alprazolam in the system can cause changes in perception and psychotic reactions.
- Abnormal body sensations: Twitching, muscle stiffness, and lack of coordination are common alprazolam withdrawal effects.
- Hypersensitivity to loud noises: In general, alprazolam abusers will be hypersensitive to stimuli during withdrawal.
- Weight loss: Alprazolam withdrawal lowers appetite, which can lead to unintended weight loss.
- Hyperventilation and panic attacks: The most common physical alprazolam withdrawal signs - anxiety, panic attacks, tremors, and hyperventilation - are serious complications throughout the withdrawal process.
Read next: Alprazolam Withdrawal Medications and Help
. National Institute on Drug Abuse. (2012). Well-known Mechanism Underlies Benzodiazepines’ Addictive Properties.
. Substance Abuse and Mental Health Services Administration. (2013). Detoxification and Substance Abuse Treatment: A Treatment Improvement Protocol (TIP 45).
. Petursson, H. (1994). The benzodiazepine withdrawal syndrome. Addiction, 89(11), 1455-1459.
. Vintage Pharmaceuticals. (2008). Alprazolam Tablets, USP 0.25 mg, 0.5 mg and 1 mg.
. Substance Abuse and Mental Health Services Administration. (2010). Protracted withdrawal. Substance Abuse Treatment Advisory, 9(1), 1-8.
. South Australia Health. (2012). Benzodiazepine withdrawal management.
. Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington, D.C.: American Psychiatric Association.
. Food and Drug Administration. (2011). Xanax.