Xanax is the brand name for the benzodiazepine drug alprazolam, a prescription medication dispensed to treat anxiety disorders. It is a short-acting medication, which means that it takes effect and wears off quickly. It is only designed to be taken for short periods of time due to the fact that Xanax use can lead to dependence in only a matter of weeks with regular and medically directed use.
Xanax makes drastic changes to brain chemistry that involves the neurotransmitter GABA (gamma-Aminobutyric acid), one of the naturally occurring chemical messengers involved in the brain’s stress response.
When levels of GABA are increased, blood pressure, body temperature, anxiety levels, muscle tension, alertness, and heart rate go down. When GABA levels drop after Xanax wears off, all of these things can come rushing back. The brain can struggle to keep up with the dramatic chemical changes made by Xanax when the drug is taken regularly over a period of time.
Once drug dependence forms, it can begin to take longer and longer for the brain to regulate itself without Xanax. Withdrawal can include both physical and emotional symptoms. Xanax withdrawal can be dangerous and even life-threatening. It is not a medication that should ever be stopped suddenly without professional help.
The Drug Abuse Warning Network (DAWN) publishes that in 2011, there were more than 30,000 visits to emergency departments (EDs) by individuals seeking detox services for alprazolam or Xanax. Benzodiazepines like Xanax are some of the most prescribed medications in the United States, and they are also widely misused and abused. There were close to 125,000 American ED visits in 2011 related to alprazolam misuse.
Recreational Xanax use increases the odds for an adverse reaction to the drug; the chances of an overdose and hazardous withdrawal symptoms go up exponentially. Other factors that can influence the severity of benzodiazepine withdrawal, as published by EmDocs, include:
The presence of a co-occurring mental health disorder or medical illness and personal biological aspects, as well as combining other medications or illicit drugs with Xanax, can complicate and exacerbate withdrawal and its severity. Xanax withdrawal can range from mild to fatal with various symptoms, which include:
The American Journal of Forensic Medicine and Pathology reports on a case of fatal alprazolam withdrawal that was initially thought to be classified as a benzodiazepine overdose. When Xanax withdrawal is fatal, it is usually due to the heightened activity of the central nervous system functions and seizures, which can also occur during an overdose. It is possible that fatal Xanax overdoses are misdiagnosed cases of withdrawal.
Additional cases of fatal benzodiazepine withdrawal have been reported in prison and jail settings where individuals have no choice but to stop drug use immediately. There have been multiple incidents where death due to withdrawal has been suspected, the Center for Health and Justice at TASC publishes.
Xanax is a short-acting benzodiazepine, so the medication wears off quickly. Typically, withdrawal symptoms can begin as soon as the drug stops being active in the bloodstream.
The drug labeling information for Xanax, published by the U.S. Food and Drug Administration (FDA), reports that it has a half-life of about 11.2 hours. This means the drug is mostly inactive in the body within a day after the last dose. That being said, the active metabolites in Xanax peak around a few hours after ingestion of the drug. Another dose needs to be taken four-to-six hours later to keep controlling symptoms of anxiety or panic. This means that it is possible to experience Xanax withdrawal symptoms as soon as six-to-12 hours after the last dose of the drug.
The journal Emergency Medicine News publishes that benzodiazepine withdrawal symptoms typically start anywhere from 24 hours to two weeks after the last dose of one of these sedative medications. Symptoms may begin with general unease, sleep disturbances, minor behavior changes, and agitation before progressing to more serious side effects.
In general, benzodiazepine withdrawal symptoms start within three days to four days after stopping the drug. Again, if Xanax has been taken in high doses for a long time and is abruptly stopped, withdrawal can be more significant and progress more quickly.
A typical Xanax withdrawal timeline may look like this:
It can be difficult to predict exactly when Xanax withdrawal symptoms can progress to a potentially life-threatening extent, but in general, the danger zone is the first two weeks after stopping the drug. Insomnia and sleep disturbances, mood swings, cognitive issues, and cravings for Xanax can last for a few months or even years after stopping the drug in the case of significant withdrawal.
Withdrawal symptoms can be safely managed through a medical detox program that can address acute withdrawal and also attend to the potentially long-ranging side effects of protracted withdrawal. Acute withdrawal is the period during which withdrawal symptoms are the most intense, while protracted withdrawal involves lingering and ongoing symptoms.
Acute benzodiazepine withdrawal usually lasts from one to four weeks, and protracted withdrawal can last several months, although it can be minimized with proper treatment.
The most vulnerable period during Xanax detox is the first two weeks. This is when withdrawal symptoms peak and can even turn deadly.
The best way to stay safe during Xanax withdrawal is to enter a medical detox program. Medical detox generally lasts five-to-seven days and can minimize withdrawal symptoms through medications and supportive care.
Xanax should not be stopped suddenly; it is better to wean it out of the body slowly. This is often accomplished through a tapering schedule that is set up by a trained medical professional. A taper involves slowly lowering the dosage over time, and the schedule is highly individual. The level of dependence on Xanax will be the biggest factor in determining the taper.
Xanax, as a short-acting benzodiazepine, is generally replaced with a longer-acting similar medication during detox. In this way, the medication can be dosed less often and in lower doses while still controlling withdrawal symptoms.
During medical detox, vital signs can be closely monitored, and medical attention can be quickly administered when needed. Emotional support and therapeutic measures help to manage the psychological aspect of Xanax withdrawal during detox. Counseling and therapy sessions can teach coping mechanisms and techniques that can be useful to mitigate cravings and stabilize moods.
During Xanax withdrawal, it is important to attend to physical and psychological self-care. Be sure to eat healthy and balanced meals, and drink enough water to stay hydrated. It can be helpful to stay physically active by going for walks or engaging in physical activities or fitness programs.
Creative expressions and hobbies can occupy the mind and help to re-center a person. Yoga, massage therapy, chiropractic care, and mindfulness meditation can all help to alleviate stress, physical tension, and pain, and they promote wellness for the whole body and mind. Support groups and peer encouragement can help, too.
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Again, Xanax withdrawal can quickly turn deadly, so medical supervision is important, especially during the first few weeks. Once physical stability and emotional stability are reached, a person can continue on with a specialized addiction treatment program. This will help to minimize episodes of relapse and sustain long-term recovery.
(2018). Xanax Alprazolam Tablets. Pfizer. Retrieved October 2018 from from https://www.xanax.com/
(May 2013). Drug Abuse Warning Network 2011: National Estimates of Drug-Related Emergency Department Visits. Substance Abuse and Mental Health Services Administration. Retrieved October 2018 from from https://www.samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdf
(August 2017). Benzodiazepine Withdrawal Syndrome: Presentations and Emergency Department Management. EmDocs. Retrieved October 2018 from from http://www.emdocs.net/benzodiazepine-withdrawal-syndrome-presentations-emergency-department-management/ (June 2009).
(June 2009). A Fatal Case of Benzodiazepine Withdrawal. American Journal of Forensic Medicine and Pathology. Retrieved October 2018 from from https://www.ncbi.nlm.nih.gov/pubmed/19465812
(January 2018). Safe Withdrawal in Jail Settings. Center for Health and Justice at TASC. Retrieved October 2018 from from http://www2.centerforhealthandjustice.org/sites/www2.centerforhealthandjustice.org/files/publications/Safe%20Withdrawal%20in%20Jail_010918.pdf
(September 2016). Xanax. Alprazolam Tablets. U.S. Food and Drug Administration. Retrieved October 2018 from from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/018276s052lbl.pdf
(December 2001). Benzodiazepine Withdrawal: Potentially Fatal, Commonly Missed During Benzodiazepine Cessation, Withdrawal Symptoms May Begin Within 24 Hours or Take Up to Two Weeks to Develop. Emergency Medicine News. Retrieved October 2018 from from https://journals.lww.com/em-news/fulltext/2001/12000/Benzodiazepine_Withdrawal__Potentially_Fatal,.13.aspx