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Xanax Withdrawal Symptoms & The Xanax Withdrawal Timeline

People who regularly use Xanax and are interested in quitting may want to know what the Xanax withdrawal process and timeline is like. Xanax is a short- to intermediate-acting benzodiazepine that acts as a central nervous system (CNS) depressant, also known as a sedative. As with withdrawal from other prescription benzodiazepines, Xanax withdrawal symptoms can be uncomfortable, distressing, and potentially life-threatening, and as a result many people relapse during the withdrawal phase.1 This is why people should not attempt to detox from Xanax at home on their own. Withdrawal symptoms of Xanax usually start between 1-2 days after a person’s last use.2,3

Xanax, the brand name for alprazolam, is a benzodiazepine that is one of the most commonly prescribed medications to treat generalized anxiety and panic disorder.4 Chronic administration of the drug, even when used as prescribed by a doctor, has the potential to lead to Xanax addiction.1

According to the 2020 National Survey on Drug Use and Health (NSDUH), 6.2 million people aged 12 and older misused tranquilizers/sedatives like alprazolam in 2019; additionally, 1.2 million people aged 12 and older had a prescription tranquilizer use disorder or sedative use disorder (the diagnostic term used by the NSDUH that includes benzodiazepine addiction) in the past year.5


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American Addiction Centers can improve treatment outcomes for those in recovery for Xanax misuse and benzodiazepine use disorder. To find out if your insurance covers treatment at an American Addiction Centers facility, click here or fill out the form below. Your information is kept 100% confidential. You can also click here to find a rehab near me.


Xanax Withdrawal, Dependence, & Tolerance

People can become addicted to substances due to brain changes that occur because of repeated administration of a drug.6 Chronic substance use can lead to tolerance, dependence and/or addiction; three very different terms but they can often be related to one another.

Dependence occurs when a person’s body has adapted to the presence of the substance, and they experience withdrawal symptoms when they stop or reduce their use. Withdrawal symptoms occur in the absence of the substance because when the body is dependent on a drug it believes it needs it to function properly. The brain and body need to readjust to functioning without the substance.6 This is why it is important to gradually reduce your dose under medical supervision, rather than just quitting cold turkey.7 Even when tapered under a doctor’s care, people may still experience severe alprazolam withdrawal symptoms. There is no set time frame for how long it takes to develop Xanax dependence.

The American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) explains that benzodiazepine withdrawal occurs when people significantly decrease or stop their substance intake after several weeks or more of regular use.8

Tolerance is when the individual needs more of the drug to feel the same desired effects. Tolerance tends to build up over time. Tolerance and dependence can fuel the cycle of substance abuse; while they are not the same thing as addiction, they are often features of addiction.6 However, an individual can develop either a tolerance or dependence on a drug but not have an addiction. Addiction means that a person compulsively uses substances despite the negative effects on their life, therefore addiction can be described as a compulsive behavior.6


What are the Symptoms of Xanax Withdrawal?

The intensity and duration of withdrawal symptoms of alprazolam can vary from person to person. Xanax withdrawal can include both physical and psychological symptoms that can range from mild to severe.8,9 Withdrawal can also be affected by a wide range of factors, including the severity of the dependence, the duration of your Xanax use, your overall health, whether you have a co-occurring psychiatric disorder, whether you also use other substances, and more.2


Physical Withdrawal Symptoms of Xanax

Physical withdrawal symptoms from Xanax can be very uncomfortable, unpleasant, and potentially life-threatening.1 Some common Xanax withdrawal symptoms may include:7,8

  • Muscle twitch.
  • Autonomic hyperactivity, meaning symptoms like sweating, increased respiratory rate, or rapid pulse rate.
  • Hand tremor.
  • Insomnia.
  • Muscle cramps.
  • Blurry vision.
  • Weight loss.
  • Appetite loss.
  • Nausea.
  • Vomiting.
  • Psychomotor agitation, meaning purposeless and uncontrollable movements, such as fidgeting.


Physical withdrawal symptoms from Xanax tend to cause a lot of distress and can impair your ability to function.8 In addition to the above-mentioned symptoms, the APA says that up to 20-30% of people undergoing untreated withdrawal are reported to experience grand mal seizures, which involve a loss of consciousness and violent muscle contractions.8 According to the manufacturer of Xanax, the greatest risk of seizure appears to be between 24-72 hours after Xanax discontinuation.7 Seizures can be life-threatening.11

Psychological Symptoms of Xanax Withdrawal

Along with a wide range of physical symptoms, many people going through Xanax withdrawal will also experience various psychological effects. These symptoms can be intense and overwhelming, especially for those who are struggling with a co-occurring mental health disorder.4,12

Some common psychological withdrawal symptoms of Xanax include:2,4,12

  • Anxiety.
  • Panic attacks.
  • Insomnia.
  • Restlessness.
  • Irritability.
  • Agitation.
  • Cognitive impairments.


These symptoms can cause significant distress. People who have used Xanax to treat underlying symptoms of anxiety can experience a rebound of their symptoms that may intensify during withdrawal.2

Less common but more serious psychological symptoms of Xanax withdrawal can include:9,10,12

  • Psychosis.
  • Delirium.
  • Hallucinations (seeing or hearing things that aren’t there).
  • Depersonalization (feeling detached from yourself).


These symptoms can be extremely challenging and represent the most extreme end of the spectrum of withdrawal symptomatology.12 Since Xanax detox side effects can be unpredictable, it’s advisable to consider seeking professional withdrawal treatment instead of trying to detox from Xanax at home on your own.2,12

How Long Does Xanax Withdrawal Last?

Xanax is a short-acting benzodiazepine with a half-life of around 11 hours.7 The Xanax withdrawal timeline can be different for everyone and may be influenced by the previously mentioned factors.2 The intensity and type of symptoms you may experience can also change depending on where you are in the alprazolam withdrawal timeline. Some symptoms can come and go while some can last for an extended period of time.4,8


Initial Xanax Withdrawal

Withdrawal from Xanax usually starts between 24-48 hours days after your last use.2 The intensity of symptoms can gradually build until the peak, which tends to occur around the 2nd day of withdrawal.8,9 Some of the most common symptoms during this time include sweating, rapid heart rate, nausea, changes in vision, tremor, confusion, and restlessness.9


Peak Xanax Withdrawal

Typically, alprazolam withdrawal symptoms tend to peak, meaning your symptoms will be at their worst, around 48 hours after your last Xanax use.8 You may also experience some new symptoms. The risk of seizures and delirium can be at the highest level during peak withdrawal.2,11 Symptoms usually start to improve after around 5 days but can last up to 2 weeks.8

The most common symptoms during this time are those previously mentioned (i.e., sweating, rapid heart rate, nausea, changes in vision, tremor, confusion, and restlessness) but they are likely at a higher level of intensity.9


Post-Peak Xanax Withdrawal

Post-peak withdrawal refers to symptoms that can persist or arise after the peak withdrawal period has ended. You may experience an intensification of previous symptoms or new symptoms, such as reported common symptoms like malaise, weakness, insomnia, tachycardia, and dizziness as well as an intensification of anxiety.4 These symptoms can persist for several months before gradually subsiding.8


Lingering Xanax Withdrawal Symptoms

Most of the physical symptoms of withdrawal from Xanax should subside after several months.8 There is not much research on lingering or protracted withdrawal symptoms from Xanax, but some reports indicate that people can experience persisting psychological symptoms or symptoms that come and go.3,9

Some of the symptoms that have been reported include anxiety, depression, psychosis, cognitive impairment, insomnia, sensory and motor disturbances, and gastrointestinal disturbances, as well as symptoms that resemble agitated depression, generalized anxiety, panic, or obsessive-compulsive disorders, and schizophrenia.3,9 Symptoms typically resolve with prolonged abstinence, but some symptoms can persist for years.3,9


Getting Help for Xanax Withdrawal Symptoms

It’s important to remember that quitting cold turkey or trying to detox on your own without medical support can be dangerous, especially due to the risk of seizures and other complications.12 This is why the Substance Abuse and Mental Health Services Administration (SAMHSA) says that hospitalization, or some form of 24­-hour medical care, is the preferred setting for detoxification from benzodiazepines.12

A drug detox program can provide many benefits, such as 24-hour supervision and monitoring, support, and a medically-supervised tapering schedule so you can undergo withdrawal as safely and comfortably as possible.12 The detox and tapering process is different for everyone, so you will receive a customized plan that is right for your unique needs.12 In addition to a benzodiazepine taper, you may also receive supportive medications to help you stay comfortable and address any additional symptoms that may arise.12

As mentioned previously, acute Xanax withdrawal can last up to 2 weeks on average.2 The manufacturer advises that the daily dosage of Xanax be tapered off by no more than 0.5 mg every three days; you will receive medical guidance for the right tapering regimen for your needs.7 Once you have completed withdrawal, you may receive symptomatic treatment for persistent symptoms.2

Once detox is complete, people often continue their recovery journey in therapy or by participating in treatment at an outpatient, inpatient, or residential treatment to help address the underlying issues that contributed to their addiction.11,13 In addition to working through these issues, Xanax addiction treatment can help you learn different skills that may help you avoid relapse.


Sources

  1. National Institute on Drug Abuse. (2018). Prescription CNS depressants DrugFacts.
  2. World Health Organization. (2009). Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings. 4. Withdrawal management. Geneva: World Health Organization.
  3. Substance Abuse and Mental Health Services Administration. (2010). Protracted withdrawal. Substance abuse advisory, 9(1), 1-8.
  4. Ait-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018). A review of alprazolam use, misuse, and withdrawal. Journal of addiction medicine, 12(1), 4–10.
  5. Substance Abuse and Mental Health Services Administration. (2021). Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
  6. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: a research-based guide (Third edition): Is there a difference between physical dependence and addiction?
  7. S. Department of Health and Human Services—Food & Drug Administration. (2016). Labelling-Medication Guide: Xanax.
  8. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA: American Psychiatric Publishing.
  9. Cosci, F., & Chouinard, G. (2020). Acute and persistent withdrawal syndromes following discontinuation of psychotropic medications. Psychotherapy and psychosomatics, 89(5), 283–306.
  10. Liebrenz, M., Gehring, M. T., Buadze, A., & Caflisch, C. (2015). High-dose benzodiazepine dependence: a qualitative study of patients’ perception on cessation and withdrawal. BMC psychiatry, 15, 116.
  11. Brett, J., & Murnion, B. (2015). Management of benzodiazepine misuse and dependence. Australian prescriber, 38(5), 152–155.
  12. Center for Substance Abuse Treatment. (2015). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  13. Substance Abuse and Mental Health Services Administration. (2019). Treatment options: Types of treatment.

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