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EARLY WITHDRAWAL SYMPTOMS (1-4 DAYS):
ACUTE WITHDRAWAL (4-10 DAYS):
LATE WITHDRAWAL (10 DAYS TO A FEW WEEKS OR MORE WITHOUT TREATMENT):
The top-prescribed psychiatric medication in 2013, as published by Psych Central, Xanax (alprazolam in its generic form) is a benzodiazepine medication used to treat anxiety and panic disorders and sometimes used to treat epileptic seizures. Benzodiazepines are a class of drugs that are commonly abused, as the National Survey on Drug Use and Health (NSDUH) estimated that close to 2 million people were using tranquilizers for nonmedical reasons in 2014.
Acting on the central nervous system by slowing down the stress reaction, and therefore heart rate and blood pressure, and by lowering body temperature, Xanax works on the neurotransmitter gamma-aminobutyric acid, or GABA. Within the body and brain, GABA acts as a kind of natural tranquilizer, helping to reduce anxiety and lower stress. Xanax increases the presence of this chemical messenger and acts on other neurotransmitters that enhance pleasure like dopamine. In so doing, Xanax helps a person to feel relaxed and happy.
Regular use of Xanax can build a person’s tolerance to the drug, which will mean that they will need to take more of it to keep feeling the desired effects. Chronic use or abuse of Xanax can also cause a dependence on it to form, as the brain becomes accustomed to the drug making changes to its circuitry and begins to rely on its presence.
The National Library of Medicine (NLM) reports that there are a few main formulations of Xanax: a concentrated liquid solution, a dissolvable oral tablet, and an ingestible extended-release tablet form. Xanax is considered to be a fast-acting drug with a relatively short half-life of about 11 hours on average, the US Food and Drug Administration (FDA) publishes. This means that the drug may take effect rather quickly (depending on the form) and wear off in about 11-12 hours. After a dependence has formed, once the drug stops being active in the bloodstream, withdrawal symptoms may occur.
Benzodiazepine withdrawal syndrome can be life-threatening without medical oversight. Therefore, individuals are encouraged to seek help. They should not stop taking Xanax suddenly on their own.
Benzodiazepine withdrawal usually starts within about 12-24 hours after the last dose, with the bulk of the symptoms lasting around a week to 10 days on average. There are usually three main stages of benzodiazepine withdrawal, with the potential side effects highlighted below:
Early withdrawal symptoms (1-4 days):
Acute withdrawal (4-10 days):
Late withdrawal (10 days to a few weeks or more without treatment):
Since Xanax works by artificially increasing levels of GABA and dopamine in the bloodstream and suppressing the central nervous system (CNS), when it is removed, the brain can experience a kind of rebound as it attempts to regain its natural balance. When this occurs, levels of these neurotransmitters can dip dangerously low and cause the CNS to become overactive. Seizures and psychosis are extreme reactions to this and may even be life-threatening.
The Drug Abuse Warning Network (DAWN) reported that in 2011, almost 125,000 people sought emergency department (ED) care for a negative reaction to the abuse of alprazolam (Xanax). This accounted for a third of all ED visits involving the nonmedical use of a benzodiazepine drug. Due to the potential severity of Xanax withdrawal, medical detox, wherein medical and mental health support is provided around the clock, is ideal.
There are several factors that play a role in both the duration and severity of the withdrawal syndrome and the potential side effects. The level of a person’s dependence on Xanax is likely the main contributor to how long and intense the withdrawal symptoms last. Dependence can form both from licit use and abuse of Xanax. The FDA reports that individuals who use Xanax in higher doses for longer periods of time (doses over 4 mg a day for 12 weeks or longer) may become dependent on the drug. Generally speaking, taking more Xanax more often and for a long period of time influences how heavily dependent on the drug a person is.
The method in which Xanax is taken also can play a role in both drug dependence and addiction. Crushing Xanax to then snort, inject, or smoke it can increase tolerance and may lead to drug dependence more rapidly, thus increasing the odds for developing an addiction as well.
Xanax is often abused with other substances, as Medical New Today (MNT) reports that over 80 percent of the ED visits in 2011 that involved alprazolam abuse also included the abuse of another substance as well. Alcohol and opioid drugs are especially dangerous when mixed with Xanax, as they too are central nervous system depressants. When mixed together, they may increase the risk for a potentially fatal overdose. Polydrug abuse can also lead to crossover dependence and may heighten Xanax withdrawal symptoms and their intensity.
In addition, a person’s overall physical and mental health factor into the withdrawal process. The presence of co-occurring physical and mental health issues can complicate withdrawal and prolong the overall timeline.
Since Xanax withdrawal can be difficult and even dangerous without proper care, medical detox is the optimal choice. During medical detox, an individual will likely stay in a specialty facility for an average of 5-7 days. Depending on the person and their specific circumstances, detox may be slightly longer or shorter in duration.
Vital signs can be closely monitored during medical detox, and trained professionals can ensure that the person remains safe and comfortable. As with all benzodiazepine, a tapered approach is usually employed for Xanax withdrawal. Since Xanax is short-acting benzodiazepine, it may be replaced with a longer-acting one during this tapering process. The World Health Organization (WHO) publishes that diazepam (Valium) is often used during benzodiazepine detox for this purpose. During a taper, the drug dosage is slowly and safely lowered over a set amount of time, in a secure and closely monitored environment, to keep withdrawal symptoms from being as significant.
Other medications may also be helpful during Xanax detox to treat specific symptoms. For instance, other sleep aids may be useful for insomnia and antidepressants may be used for some of the psychological symptoms. Beta blockers like clonidine, which is technically a blood pressure medication, may be beneficial when used off-label to control some of the autonomic nervous system responses to benzodiazepine withdrawal, such as high blood pressure, irregular heart rate, and elevated body temperature. When co-occurring disorders are present, individuals may require additional medications or supplements on a case-by-case basis as well.
Once the physical side effects of Xanax withdrawal are managed during medical detox, the psychological symptoms that may linger a little longer can then be addressed. Medications and therapies as part of a comprehensive substance abuse treatment program directly following detox are the optimal course of action.