Xanax, also known as alprazolam, is a short-acting benzodiazepine prescribed for various conditions, including anxiety and panic disorders. It is the fast action of Xanax that makes it challenging to taper, along with its high potency. A  .5 tablet is the equivalent of ten mg of Diazepam. In this post, I’ll discuss those challenges, strategies for success, and unique aspects of Xanax withdrawal/BIND (Benzodiazepine-induced neurological disorder). BIND is what we call the symptoms after we have withdrawn from the drug, i.e., it is no longer in our system. BIND symptoms can last for weeks, months, and for some, years. Symptoms are caused by neuroadaptation (brain changes) to the drug.

The Challenge of Tapering Xanax

Tapering Xanax can be difficult due to its short-acting nature, which means that it has a rapid onset of action and a relatively short duration of effect. As a result, withdrawal symptoms can emerge between doses, a phenomenon called interdose withdrawal. You may not experience interdose withdrawal symptoms initially, but they may arise as your brain adapts to the drug’s action, causing the GABA receptors to downregulate.

To combat interdose withdrawals, some people dose four times a day to keep a more steady state of the drug available in their system. This can be cumbersome and prone to mistakes as doses may be forgotten or taken at the wrong times. (The brain likes consistency when dosing.)

Transitioning to Diazepam

One strategy for managing Xanax withdrawal is transitioning to a longer-acting benzodiazepine, such as Diazepam (Valium). Diazepam has a slower onset of action and a longer half-life, which can make tapering off benzodiazepines more manageable. One doesn’t need to dose Diazepam frequently throughout the day. However, it is crucial to note that Xanax is approximately 20 times stronger than Diazepam, so the dose needs to be adjusted accordingly.

The Ashton Manual, a well-regarded guide for tapering off benzodiazepines, provides detailed information on transitioning from Xanax to Diazepam. According to the manual, the crossover should be done stepwise, gradually substituting a portion of the Xanax dose with an equivalent amount of Diazepam.

Pros and Cons of a Cross Over

There are pros and cons to crossing over to Diazepam. Crossing over has been a Godsend to some of my clients and a disaster for others. There is no way to know who will do well and who won’t. As with many things in the benzo world, we have to test and learn.

Pros:

  • Diazepam is long-acting.
  • Diazepam comes in small doses, making cutting and tapering easier.

Cons:

  • Some people will feel withdrawal symptoms more intensely during the crossover or afterward.
  • Not everyone can make the switch to Diazepam.
  • Diazepam is more sedating. It is metabolized into three benzodiazpines: menordiazepam, temazepam, and oxazepam.
  • Depression can be more of a problem when tapering from Diazepam.
  • Diazepam blocks the body’s ability to make DAO so that histamine issues may arise.
  • Some doctors villainize Diazepam, thinking it is the only “addictive” benzo, and won’t prescribe it.

 

Xanax Withdrawal and Pain Symptoms

All benzodiazepines can cause the same withdrawal/BIND symptoms. However, some have a “corner market” on specific symptoms. Xanax has the corner market on muscle, joint, nerve, and bone pain. These symptoms can be challenging to manage but are generally temporary and subside as the body recovers from the withdrawal process  (When a new client reports pain as a predominant symptom, and I ask if they are taking Xanax, the answer is most often “Yes!”)

Tapering Options: Water Titration, Weighing, and Compounding 

There are several methods for tapering off Xanax, and two popular options are water tapering and using a scale. Water tapering involves crushing a tablet and adding it to a known volume of water and gradually reducing the amount of liquid consumed daily  Benzodiazepines are not water soluble, so this method is less accurate than using a scale, but it requires little math and is easy for most to do  One can reduce the amount daily, known as a daily micro taper (DMT), or reduce it every few weeks, which is known as the cut-and-hold method.

Using a scale involves weighing the tablets and reducing the dose by removing small portions of the tablet based on weight. One can use a sharp knife or an emery board to file down the pill. This method is reasonably accurate, but it requires a high-precision scale. If doing a daily micro taper, a great deal of math is needed. To avoid complex math, one can do a cut-and-hold taper.

Both methods have pros and cons, depending on personal preference. There are videos on YouTube with detailed instructions on the various tapering methods. The best tapering method for you is the one you are most comfortable implementing.

Another tapering option is to ask your doctor to write a script for reduced doses and get them compounded by a pharmacy. This is the most accurate way to taper; however, many doctors don’t like to write scripts for compounding, and it can be expensive as some insurance companies won’t cover them.

The least effective method for tapering off any benzodiazepine is “eyeballing” your dose and using a pill cutter or knife. Xanax is so incredibly powerful that small crumbs of the pill pack a punch. It is almost impossible to taper accurately by simply looking at the pill’s size and guessing how much you take.

Tips for Coping with Xanax Withdrawal and BIND

Dealing with Xanax withdrawal and BIND can be challenging, but there are several strategies to help cope with the process:

  • Consult with a benzo-wise healthcare professional if you can find one.
  • Educate yourself about benzo withdrawal/BIND, so you are your best advocate. Most healthcare professionals are not educated about benzos. You must be.
  • Develop a support system: Having friends, family, or support groups who understand your situation and can provide support is helpful.
  • Practice stress reduction techniques: Engaging in techniques such as mindfulness, meditation, deep breathing exercises, and progressive muscle relaxation can be helpful.
  • Embrace the four cornerstones of well-being:  Eat right (whole-food, plant-based diet), move enough, stress less, and love well.
  • Be patient and kind to yourself: Recovery from Xanax withdrawal and BIND can be a lengthy process, and it is essential to be patient with yourself and acknowledge your progressng.
  • Join a positive, solution-focused group for education, encouragement, and support.
  • Work with a benzo-wise therapist or coach.
  • Hot or cold packs can help with the pain commonly associated with Xanax withdrawal/BIND.
  • If an OTC pain relief medication is needed, Tylenol is better tolerated in the benzo community than Advil.
  • Avoid baths with Epson Salts as the magnesium may rev up symptoms.

Conclusion

Xanax withdrawal and BIND can be challenging due to the short-acting nature of the medication and the resulting interdose withdrawals. Transitioning to a longer-acting benzodiazepine like Diazepam, following the Ashton Manual’s guidelines, can help make tapering more manageable  Coping strategies such as seeking benzo-wise professional guidance, developing a support system, and practicing stress reduction techniques can also be valuable in navigating the withdrawal and healing process  We do recover from the symptoms Xanax has caused.

Add Your Voice to the Conversation

Are you taking Xanax? Are you tapering  What has and has not worked well for you? We’d love your input.

An interesting Xanax study can be found here.