There are several benzodiazepine medications available to treat anxiety disorders, panic attacks, insomnia, and seizures. Among the most popular and widely prescribed drugs in the United States is Xanax, the brand name for alprazolam.
It is a medication used as needed to reduce anxiety and panic in people who struggle with potentially debilitating symptoms and need occasional, immediate relief. This medication was approved for prescription use in the U.S. in 1981 under the brand name Xanax. The Food and Drug Administration (FDA) has approved a generic form as well.
Xanax and other benzodiazepines bind to the brain’s gamma-aminobutyric acid (GABA) receptors. Both barbiturates and alcohol affect the same receptors as well. Benzodiazepines were developed as a safer alternative to barbiturates; however, Xanax became widely abused.
Benzodiazepines, including Xanax, can quickly lead to physical dependence. Dependence is a state when someone takes higher doses of Xanax as prescribed. People who take 4 milligrams (mg) or more of Xanax daily, which is the upper limit for prescription use, are more likely to develop a physical dependence on the substance even if they do not compulsively take it to get high. Typically, someone who has a prescription for Xanax will work with their doctor to taper off this medicine due to the high risk of dependency.
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When a dose of Xanax is taken, it is quickly absorbed through the stomach lining into the bloodstream. The medication’s effects will begin in less than one hour after it is taken. The half-life of Xanax is about 11 hours, so all metabolites are gone from the body within two to three days after the last dose is taken. However, this is an average for healthy adults, and the true half-life can range from six to almost 27 hours. Age, gender, body weight, hormone levels, gastrointestinal function, and much more can influence the length of the drug’s half-life and how effectively the body will metabolize it.
Some people may receive a Xanax prescription for as-needed use, so they do not take it daily. Some people may receive a prescription to take Xanax up to three times per day for a short time. How you are prescribed Xanax can depend on how your body is affected by benzodiazepines, and how your anxiety, panic, or insomnia respond to this medication.
For most people, consistent and high-dose use or abuse of Xanax for several weeks or months can lead to physical dependence on and tolerance to the medication. This may be due to the slow degradation of GABA receptors in the brain over time.
If you suddenly quit Xanax cold turkey, your brain will not be able to produce enough of GABA.
This can lead to uncomfortable rebound symptoms of the underlying anxiety, and cause disbalance of other neurotransmitters in the brain leading to mood changes and physical discomfort, and even increase the risk of serious effects like a seizure disorder.
Symptoms of benzodiazepine withdrawal can be divided into three groups:
Anxiety: rebound panic, anxiety, worry, tremors, hyperventilation, sleep disturbances, muscle spasms, weight loss, anorexia, visual disturbances, altered mood, and excessive sweating.
Perceptual: hypersensitivity to loud noises, abnormal body sensations, derealization, and depersonalization
Major: delirium, psychotic symptoms, and seizures
Tolerance to Xanax builds fast in regular users, which can lead to physical dependence quickly. This means that people who struggle with Xanax use disorder must find a medical professional to ease them off benzodiazepine withdrawal symptoms. Otherwise, they are at risk of developing protracted withdrawal syndrome, meaning that symptoms of Xanax withdrawal may last for longer than 10 days, and they can be very uncomfortable and life-threatening.
In some rare cases, you may need to taper for one to three months to end physical dependence. If you struggle with Xanax addiction and enter treatment, physicians and addiction specialists will determine this long-term taper for you.
Tapering works well to ease people off benzodiazepine abuse, including addiction to Xanax. Entering addiction treatment means you get medical oversight to manage your withdrawal symptoms during detox. This helps to prevent withdrawal symptoms from becoming very uncomfortable.
People who struggle with benzodiazepine addiction, including Xanax, may be able to quit without developing a taper if they have not abused the drug for a long time or taken large doses. However, if you abused Xanax for a long time and increased the dose over that time, your physician may prescribe a specific dose of Valium for you, which will then be slowly tapered over several days or weeks until your body no longer needs any benzodiazepine to feel normal.
There are two basic rules regarding tapering a benzodiazepine during detox:
You should never create a tapering schedule on your own. Addiction specialists and physicians understand Xanax and its effects well, and they will work with you to monitor withdrawal symptoms and moderate your tapering regimen as needed. For example, this may involve cutting down your dose of Xanax by one-quarter every month, or about one-eighth every two weeks; or you could cut by half every two weeks. This is largely an individual process, based on your biochemistry, potential history of substance abuse, environmental stress, genetics, and many other factors.
Often, people who have tried to quit abusing drugs or alcohol before and relapsed have higher physical tolerance and need more of a substance than people who have not abused drugs like Xanax. Those who tried repeatedly and unsuccessfully to quit Xanax are at greater risk of more intense and even life-threatening withdrawal symptoms, especially seizures, so their taper may take much longer.
A doctor will examine you when you enter a detox program to understand how you are affected by Xanax withdrawal symptoms and how slow your taper needs to be. This will include a physical exam and a series of questions. You should receive regular checkups during detox, so your physician can continue to monitor your withdrawal progress and adjust your taper when you need it. A physician can also determine if some of your withdrawal symptoms are so serious that you need additional prescription medications.
Once you have completed detox safely and successfully, you should enter a rehabilitation program. Again, whether you need inpatient (residential) or outpatient treatment involves a discussion between you and your medical team. They will be able to help you find a program that gives you the support you need, in a safe environment, to change your behaviors around drugs and alcohol. Most rehabilitation programs require that you complete detox first, but some allow you to enter their program while you are in the process of detoxing, especially if you are on a long-term taper.
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