Is Benzodiazepine Withdrawal Dangerous? The Medical Risks of Stopping Without Supervision, and When a Taper at Home Is Safe

Yes. The FDA label for alprazolam (Xanax) warns that stopping suddenly or cutting the dose quickly can cause withdrawal reactions that can be life threatening, such as seizures. Every benzodiazepine carries the same boxed warning.

The FDA put that warning in a boxed warning, its strongest, on the whole drug class in 2020. It says physical dependence can start after several days to weeks of steady use, even as prescribed. It also says the most important withdrawal risk is a seizure.

Seizures are not the only danger. The label lists other severe reactions: delirium, hallucinations, psychosis, mania, catatonia and suicidal thinking. They are less common, but they are why a sudden stop after long or heavy use is treated as a medical event. The worst drug to detox from page explains why benzodiazepines and alcohol sit at the top of that list.

Source: Alprazolam tablets, prescribing information, sections 5.3 and 9.3, DailyMed, National Library of Medicine; FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class, U.S. Food and Drug Administration, September 23, 2020.

The people most at risk take higher doses, have taken them for longer, also drink or use opioids, have had a seizure, or are using pills that did not come from a pharmacy.

The FDA label names the first two. People who take higher doses, or take them more often, and people who have used them longer face a greater risk. For alprazolam, it points to doses above 4 mg a day and use for more than 12 weeks.

Alcohol adds to the danger, because it works on the same brain system. Stopping both at once stacks two withdrawals that can each cause seizures. The alcohol and benzo cross-tolerance page explains why. A past seizure, from any cause, raises the stakes too.

Opioids add a different danger. The CDC found that from 2019 to 2020, 92.7 percent of overdose deaths involving benzodiazepines also involved opioids, mostly illicit fentanyl.

Source: Alprazolam tablets, prescribing information, DailyMed; Trends in Nonfatal and Fatal Overdoses Involving Benzodiazepines, 38 States and the District of Columbia, 2019–2020, Liu et al., MMWR, August 27, 2021.

Street benzos are more dangerous because nobody knows what is in them. Pills sold as Xanax may contain stronger illicit benzodiazepines or fentanyl, so neither the dose nor the drug is known.

The CDC tracked this in its 2021 report. Deaths involving illicit benzodiazepines, such as etizolam, flualprazolam and flubromazolam, rose 519.6 percent from 2019 to 2020. These drugs are not approved in the United States and are often pressed into pills that look like real Xanax.

That changes withdrawal in two ways. A taper depends on knowing the starting dose, and with a pressed pill nobody does. And a pill that also contains fentanyl means opioid withdrawal on top. The admission drug test helps sort that out. The heroin and fentanyl testing page explains why a standard test can miss fentanyl.

Source: Trends in Nonfatal and Fatal Overdoses Involving Benzodiazepines, 38 States and the District of Columbia, 2019–2020, MMWR, 2021.

Briarwood treats benzodiazepine withdrawal with a medically supervised taper, inpatient in Austin and Houston. The physician starts from what was actually taken and lowers it on a schedule that keeps the nervous system below the seizure threshold.

The assessment asks what was taken, how much, for how long, and from where. It also asks about alcohol, opioids and any past seizure. A pharmacy prescription and a bag of pressed pills lead to very different plans. Benzodiazepine detox explains the approach.

Briarwood is a detox center, not a hospital. Someone who is seizing, confused or hallucinating needs an emergency room first. San Antonio is an outpatient program and is not the setting for withdrawal that could cause seizures.

The step after detox is arranged before discharge, because a long taper and the months after it are where people need support most. Cost and insurance covers what a stay costs. Admissions answers at every hour.