Alprazolam: Physical dependence and withdrawal

There is a consensus among psychiatrists today that alprazolam and other benzodiazepines cause withdrawal symptoms after long-term treatment and discontinuation should be done gradually over a period of months (or even up to a year) to avoid serious withdrawal symptoms such as agitation, panic attacks, rebound anxiety, muscle cramps and seizures.[citation needed] Some patients on alprazolam (Xanax) may benefit from a substitution with diazepam (Valium) or chlordiazepoxide (Librium) as these drugs remain in the bloodstream longer and therefore have less potential for abuse and dependence.

Patients treated with alprazolam or other benzodiazepines for generalized anxiety disorder were found (when abruptly discontinuing their medication) to experience withdrawal symptoms such as a worsening of anxiety, as well as the development of physical withdrawal symptoms.[21]

Patients taking a dosing regimen larger than 4 mg per day have an increased potential for dependence. This medication may cause withdrawal symptoms, which in some cases have been known to cause seizures. The discontinuation of this medication may also cause a reaction called rebound anxiety. Other withdrawal effects reported from discontinuing alprazolam therapy include homicidal ideation, rage reactions, hyperalertness, increased nightmares, and intrusive thoughts.[22]

After 8 - 9 weeks of alprazolam taken at a fixed prescribed dose, the following symptoms have been found to occur during abrupt discontinuation; dysphoric mood, fatigue, low energy, confusion, and elevated systolic blood pressure, severe anxiety.[23]

When a patient discontinues use, they may experience the symptoms they had before taking medication. Symptoms may also be accompanied by other reactions including changes in mood, anxiety, or sleep. Rebound anxiety is usually a result of abrupt discontinuation of this medication; patients who taper off are less likely to experience these symptoms.

Physical dependence is the major limiting factor against long-term use of alprazolam and other benzodiazepines.

Factors which determine the severity of the benzodiazepine withdrawal syndrome experienced during dose reduction of alprazolam include:[24]

* dosage
* length of use
* frequency of dosing
* method of withdrawal[25]
* personality characteristics of the individual
* previous use of cross dependent/cross tolerant drugs (alcohol or other sedative hypnotic drugs)
* current use of cross dependent/cross tolerant drugs (alcohol or other sedative hypnotic drugs)
* Use of short-acting high potency benzodiazepines for example alprazolam or lorazepam

Alprazolam has an exceptional history insofar soon after its introduction a large number of case reports were published in the medical literature of severe withdrawal symptoms related case reports of withdrawal psychoses, seizures and intense rebound anxiety upon discontinuation of alprazolam. In the United States a survey of physicians showed that 84% of physicians reported alprazolam as being extremely problematic in terms of the severity and prolonged nature of the benzodiazepine withdrawal syndrome after discontinuation.

However, in 1993 the New England Journal of Medicine reported there is no reliable evidence to support the existence of a persistent benzodiazepine withdrawal syndrome, and this syndrome has been described only in anecdotal reports, with patients typically reporting “withdrawal” symptoms not present during or before benzodiazepine treatment that persist for many months or years after treatment is stopped. Experimental neuropharmacologic studies document that all the side effects of benzodiazepines, whether behavioral or neurochemical, disappear within several days or weeks after the drug is eliminated. The weight of evidence indicates that any new symptoms that persist for more than two months after the last dose of a benzodiazepine either are part of the premorbid condition or have appeared by coincidence or as a consequence of the natural history of the underlying illness.[26]

The benzodiazepines diazepam(Valium) and oxazepam(Seresta) were found to produce less severe withdrawal symptoms than alprazolam(Xanax) or lorazepam(Temesta/Ativan).[24]

Alprazolam should never be abruptly discontinued if taken regularly for any length of time because severe withdrawal symptoms may occur. Severe psychosis and seizures have been reported in the medical literature from abrupt alprazolam withdrawal,[27][28] and one death occurred from withdrawal-related seizures after gradual dose reduction.[

Related posts

• Alprazolam: Indications (0)
• Alprazolam: History (0)
• Alprazolam (0)
• Generalized anxiety disorder: Treatment (0)
• Alprazolam: Recreational use (0)

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