Xanax, Klonopin, Valium, and Ativan belong to the class of medications known as benzodiazepines or “benzos”. They are frequently prescribed for anxiety. I will discuss Xanax here as it is the most addictive because of it’s short half-life. The effect of the drug wears off quickly. As a result, patients start taking it more frequently. With more frequent administration, tolerance (need more of the drug to have the same effect) develops quickly. This can eventually lead to physiologic dependence and/or addiction.

For any drug, withdrawal symptoms are the opposite of the effect of the drug. If Xanax is taken for an anxiety disorder, symptoms of the primary anxiety disorder return. In addition, withdrawal anxiety symptoms develop on top of the baseline anxiety. One can imagine that getting a “double dose” of anxiety causes a lot of suffering for the patient.

Outpatient (and inpatient) detoxification from benzodiazepines requires a lot of determination and patience from both the physician and the patient. A close therapeutic relationship is essential. This includes being available to the patient by phone, as well as a minimum of weekly office visits.

In addition to anxiety, symptoms of Xanax (and all benzodiazepine) withdrawal can include insomnia, irritability, tremor, hallucinations, and seizures. Xanax actually has the highest risk of withdrawal seizures because of it’s short half. To attenuate and/or minimize these symptoms and risks, a long acting benzodiazepine such as Valium or Klonopin is substituted for the short acting Xanax. An approximate dose equivalent is formulated, and a long slow taper is initiated.

I will continue outpatient detoxification from Xanax in my next blog post…..