Alprazolam and other benzodiazepines cause withdrawal symptoms during dose reduction or cessation of therapy after long-term treatment. 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. Some patients on alprazolam (Xanax) may benefit from a substitution with a benzodiazepine equivalent dose of another benzodiazepine drug such as diazepam (Valium) or chlordiazepoxide (Librium) as these drugs remain in the bloodstream longer and therefore have less potential for abuse and dependence. There is a higher chance of withdrawal symptoms if the drug is administered in a higher dosage than recommended, or if a patient stops taking the medication altogether without slowly allowing the body to wean itself off the drug.

If a consumer of the drug feels the need to end treatment with alprazolam, they should consult their doctor/physician before discontinuing medication. Some immediate symptoms of alprazolam withdrawal include:

Common Withdrawal Symptoms

* A rapid heartbeat (Tachycardia)
* Depression
* Dry mouth/chapped lips
* Temporary inability to stop talking/moving
* Mental sensitivity
* Strong loss of appetite
* Extreme Insomnia
* Anxiety
* Dizziness
* Minor tremors

Possible/Less Common Withdrawal Symptoms

* Nausea, vomiting, or diarrhea
* Panic attacks
* Mood swings
* Heart palpitations
* Hallucinations
* Memory loss
* Seizures
* Fever

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.

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.

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.

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:

* dosage
* length of use
* frequency of dosing
* method of withdrawal
* 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.

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

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, and one death occurred from withdrawal-related seizures after gradual dose reduction.

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