Benzodiazepine withdrawal is a set of symptoms that can occur if someone who is benzodiazepine-dependent misses a dose, or goes too long without taking another dose.
Benzodiazepines, also known as “benzos,” are a class of anxiolytics that can cause physical dependence with chronic drug use.
Symptoms of benzodiazepine withdrawal can become severe. Here, you’ll find information about symptoms of benzodiazepine withdrawal, the average timeline, and treatment for benzodiazepine withdrawal.
What Causes Benzodiazepine Withdrawal?
Benzodiazepine withdrawal syndrome is a condition that can develop in people who have become physically dependent on benzodiazepines.
The most widely prescribed benzodiazepines are:
- alprazolam (Xanax)
- clonazepam (Klonopin)
- diazepam (Valium)
- lorazepam (Ativan)
- temazepam (Restoril)
Physical dependence occurs through chronic drug use. With benzodiazepines, a person can begin to develop physical dependence in as little as a few weeks of regular benzo use.
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Signs And Symptoms Of Benzodiazepine Withdrawal
Early signs of benzo withdrawal can begin to appear within hours of a person’s last dose and may last for weeks, depending on the severity of drug dependence and the type of benzo taken.
Early symptoms of benzodiazepine withdrawal might include:
- rebound anxiety
- panic attacks
- fast heartbeat
- tremors (shaking)
- difficulty sleeping
- nausea and vomiting
- poor concentration
- muscle spasms
- physical aches
- drug cravings
- loss of appetite
- weight loss
- increased blood pressure
- shooting pains in the neck and spine
Less common but potentially severe symptoms might include:
- hallucinations (seeing, feeling, or hearing things that aren’t there)
- loss of touch with reality (psychosis)
- thoughts of harming or killing oneself
Some days or weeks later, late-stage withdrawal symptoms—also known as protracted withdrawal—can begin to set in, and may last for some time.
Protracted withdrawal symptoms might include:
- gastrointestinal distress
- difficulty concentrating
- reduced sexual interest
What Factors Can Affect The Severity Of Benzodiazepine Withdrawal?
Benzodiazepine withdrawal doesn’t look or feel the same for everyone. The severity and duration of the withdrawal process can vary based on several factors.
Factors that can affect the severity and timeline of withdrawal include:
- duration of use
- frequency of use (e.g. daily, as-needed)
- dose taken
- history of substance use issues
- co-occurring mental health disorders
- previous withdrawal attempts
- type of benzodiazepine taken (i.e. short-acting vs. long-acting)
- use of other drugs (including alcohol)
- medical support
Other personal factors, such as age, metabolism, and overall health may also influence the withdrawal process, and can affect how long withdrawal lasts.
Timeline For Benzodiazepine Withdrawal
Fully withdrawing from benzodiazepines can take anywhere from a few days to a few weeks or even months, depending on the type of detox method used and the severity of dependence.
Two common detox methods include:
- acute detox
Acute medical detox programs involve a short-term detoxification process, in which a person may enter an inpatient detox program for a short stay of seven to 14 days.
Both acute and outpatient detox programs may also utilize a tapering method, which involves gradually reducing the benzodiazepine dose individuals are taking over time.
Timeline For Acute Benzo Detox
Acute detoxification programs offer a short-term stay in a detox center or other clinical setting for 24-hour medical supervision and support.
Days 0-1: For people dependent on short-acting benzos (e.g. Xanax), withdrawal symptoms may set in within six to eight hours. This can include sweating, anxiety, headache, pain, difficulty concentrating, and seizures.
Days 1-4: Withdrawal from long-acting benzos (e.g. Valium) begins within two to seven days after a person’s last dose. Experiencing rebound anxiety and insomnia is common during this time.
Days 4-14: Withdrawal from short-acting benzos may reach its peak within the first week, while symptoms of long-acting benzo withdrawal can peak sometime during the 10- to 14-day mark.
Symptoms of acute benzodiazepine withdrawal generally last between 10 to 14 days, or up to 8 weeks with long-acting benzodiazepines.
After this, symptoms of protracted withdrawal, such as depression and anxiety, may persist for some time. This is typically more common in people with severe drug dependence.
Timeline For Gradual Tapering Benzo Detox
Acute detox is not the only option for getting off benzodiazepines. Another option is a tapering method, which may or may not involve a short, inpatient stay in a detox center.
Tapering off benzodiazepines involves gradually reducing the dose of benzodiazepines a person is taking. This can take weeks or months.
Tapering off benzodiazepines may be suitable for:
- people with severe dependence
- people who are taking a very high dose of benzodiazepines
- people who are at risk for severe benzo withdrawal
The process of tapering off benzos shouldn’t be attempted alone. It’s best to talk to a doctor about developing a tapering plan.
Tapering can be accomplished on an outpatient level, with sufficient medical support, or within an inpatient or residential treatment setting.
What Is The Treatment For Benzodiazepine Withdrawal?
Treatment for benzodiazepine withdrawal will generally involve a combination of medical and behavioral treatment interventions, including clinical supervision and behavioral therapy.
Some early symptoms of benzodiazepine withdrawal can be serious and potentially life-threatening.
An inpatient medical detox program can offer 24-hour medical supervision during the acute withdrawal period, close monitoring of vital signs, and medicine for withdrawal symptoms.
Some medications, such as flumazenil, carbamazepine, anticonvulsants, and small doses of long-acting benzos can be used to help ease withdrawal symptoms.
Cognitive-behavioral therapy (CBT), a common treatment for anxiety, can be helpful for managing anxiety, depression, cravings, and insomnia.
Visits To The Doctor
If you’re detoxing outside of a treatment center, regular check-ins with your doctor may be recommended. This can allow them to monitor symptoms and adjust your dosage, if tapering.
If you or a loved one with benzodiazepine dependence has a substance use disorder or mental health disorder, finding a substance use or dual diagnosis rehab program may be recommended.
Drug rehab programs can offer a comprehensive treatment plan for substance abuse to help prevent relapse and address associated health consequences of substance use and mental illness.
Benzodiazepine Withdrawal FAQs
Find answers to frequently asked questions about benzodiazepine withdrawal, symptoms, and treatment.
❓ How Long Does Benzo Withdrawal Last?
✔️ Acute withdrawal can last 10 to 14 days, on average. Protracted withdrawal, which is more common in people with severe dependence, can last for months.
❓ Is Benzo Withdrawal Permanent?
✔️ Some cognitive effects of long-term benzodiazepine use or misuse can improve with time. Withdrawal symptoms generally reduce in severity with time and treatment.
❓ Is Benzodiazepine Withdrawal Dangerous?
✔️ Some severe symptoms of benzo withdrawal, such as seizures and thoughts of suicide, can pose a serious risk to health. With clinical support, these symptoms can be effectively managed.
❓ Does Benzo Belly Go Away?
✔️ Benzo belly, a term commonly used to refer to bloating or gut discomfort during withdrawal, may last anywhere from a few days to a few months.
The duration of this type of symptom may depend on the type of benzo taken and the severity of a person’s benzodiazepine dependence.
❓ How Long Does Benzo Rebound Anxiety Last?
✔️ Rebound anxiety generally reaches its peak within the first two to four days after last benzo use.
Mild to moderate anxiety may persist for weeks to months after stopping benzos, although this can vary based on personal factors.
Find Treatment For Benzodiazepine Withdrawal Today
Millions of people in the U.S. struggle with prescription drug abuse and addiction. If this describes you or a loved one, you’re not alone.
To find treatment for benzodiazepine withdrawal, call our helpline today for more information about addiction treatment options.
Published on June 16, 2021
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- British Journal of Clinical Pharmacology — Benzodiazepine dependence and its treatment with low dose flumazenil
- U.S. Drug Enforcement Administration (DEA): Diversion Control Division — BENZODIAZEPINES (Street Names: Benzos, Downs, New Pills, Tranks)
- U.S. National Library of Medicine — Management of benzodiazepine misuse and dependence
- U.S. National Library of Medicine — Withdrawal Management - Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings