Are you familiar with interdose withdrawal symptoms? Can the Ashton Manual help to avoid Xanax interdose withdrawal?

Xanax use is at an all-time high. Xanax, also known as alprazolam, is one of the most commonly prescribed benzodiazepines.

Benzodiazepines are medications prescribed for anxiety and panic disorder. Ativan, Klonopin, and Valium are some well-known examples of benzos, in addition to Xanax.

When a person has been taking Xanax for a long time, and they stop suddenly, they will be at risk for severe withdrawal symptoms. Xanax withdrawal symptoms may be life-threatening.

After the acute phase of Xanax detox, a person may experience protracted withdrawal, which is a form of post-acute withdrawal syndrome. Protracted withdrawal is a period that can last for months or years, in which the person experiences insomnia, anxiety, gastrointestinal symptoms, and many other possible symptoms.

Benzodiazepine withdrawal is a serious issue, so to prevent it, going forward, doctors are now recommending only short-term use of drugs such as Xanax. For people who have already been taking Xanax long-term, a benzo taper is preferable to quitting Xanax cold turkey.

Unfortunately, when tapering off of Xanax, interdose withdrawal can be an issue. During the time between each Xanax dose, the person may experience benzo withdrawal symptoms.

Xanax works fast, and wears off fast.

Some benzodiazepines take a long time to start working. Others start working quickly.

Likewise, some benzos wear off fast, only lasting for a few hours at most. Other benzos last for many hours. Some benzodiazepines last for up to twelve hours.

A favorite benzo tranquilizer among psychiatrists is Klonopin, also known as clonazepam. Klonopin starts working fast, but it lasts for a long time. Because of this, they feel it is less addicting.

Xanax, on the other hand, wears off fast, so the patient may feel rebound anxiety between doses. The doctor may interpret the patient’s desire to take another Xanax as soon as possible as the beginning of Xanax addiction.

The knowledgeable psychiatrist will switch the patient to a longer-acting benzo. A less knowledgeable doctor may commit the patient to the psych ward, or ship them off to rehab for substance abuse treatment.

Is Xanax addictive? Does Xanax dependence mean Xanax addiction?

It is true that Xanax is used by people who misuse other drugs. Cocaine and meth addicts buy Xanax bars from their drug dealer to help come down from their drug high.

Opioid addicts use Xanax to potentiate their high. Likewise, alcoholics take Xanax to make their alcohol buzz more intense.

Yet, Xanax itself has a low addictive potential. While physical dependence to the drug is common, very few people become addicted to Xanax, or to any other benzodiazepine for that matter.

When a patient complains that their Xanax is not working, and they are getting rebound anxiety, the problem is not addiction. Some experts refer to the problem as pseudoaddiction.

Pseudoaddiction is a term used to describe the situation where a patient has symptoms from harmful treatment or a lack of adequate treatment that the doctor interprets as addiction. For example, a patient who shows up at the doctor, shivering in the corner from the effects of drug withdrawal gets labeled as a junkie.

How does interdose withdrawal make a Xanax taper difficult?

If a person takes Xanax 1 mg three times daily for an anxiety disorder, the doctor may instruct them to reduce one or more of the three daily doses by a quarter milligram to start off the taper. Before the taper, the patient had adequate coverage, without the alprazolam levels dropping low enough to trigger withdrawal symptoms.

As the total dosage is reduced, the interdose levels, or the alprazolam blood levels between Xanax doses, drop low enough to cause interdose withdrawal. For example, if the patient takes Xanax at 8 am, 4 pm, and midnight, they may feel withdrawal symptoms around noon, 8 pm, and 4 am.

The medical professional may recommend breaking up the total daily intake into six divided doses, instead of three. Or, they may decide to transition the patient to a longer-acting benzo.

Transitioning to Diazepam, or Valium, is the recommended method in the Ashton Manual. The Ashton Manual was written by Dr. Heather Ashton to document a safe and effective method for tapering off of many different types of benzodiazepines.

There are two reasons for switching to Valium. One reason is that Valium is much longer lasting compared to other benzos, so interdose withdrawal is much less likely. The other reason is that Valium is far less potent, which means that it can be broken down into smaller dose units for gradual tapering.

Why does Valium’s lower potency help with a Xanax taper?

Xanax is a very potent benzo. Xanax 0.5 mg is the same strength as Valium 10 mg. So, a person who takes Xanax 1 mg three times daily is taking the equivalent of Valium 60 mg daily.

Valium is available in 2 mg, 5 mg, and 10 mg tablets. Hence, each Xanax 1 mg tablet can be represented as 10 Valium 2 mg tablets. Instead of the messy and inaccurate method of cutting the Xanax table in halves and quarters, the patient can reduce slowly, using Valium 2 mg tablets.

If this seems confusing, think of how you would share a dollar with ten people. If you have four quarters, you can share with four people. But, with ten dimes, you have a much easier time, sharing with all ten individuals.

While tablets, unlike money, can be broken in half, and even into quarters, it is much better to have smaller dose units to facilitate the tapering process. Converting from Xanax to Valium, and then using the 2 mg tablets is sort of like converting currency and then switching from large bills to small coins.

For patients who are concerned about the complexities of converting their Xanax to Valium, and then using multiple tablets, there are alternative drug taper methods. For example, a doctor may recommend using a benzo compound solution for gradual tapering.

How does compounded Xanax liquid help to taper off of Xanax slowly?

If a patient takes Xanax 1 mg tablets, it is possible for the doctor to send a prescription to a compounding pharmacy to prepare the prescription as a liquid instead of a Xanax pill. For example, the prescription could be written as Xanax 1 mg per milliliter.

Now, the patient will take their Xanax with an oral syringe. The syringe will hold 1ml, and it will have lines to divide into tenths of a milliliter, and smaller lines for hundredths of a milliliter.

Instead of breaking Xanax tablets into pieces, or converting over to Valium, the patient is able to reduce their dosage gradually over time by filling the syringe to lesser quantities.

For example, they may only fill to 0.9 ml, instead of 1 ml. When it is time to reduce again, they may then go to 0.88 ml, and then stay at that dosage for some time.

Another method is known as a microtaper, where the dosage is reduced a tiny amount on a daily basis, rather than reducing and holding for a week or two. There are multiple methods for tapering, so each individual can use what works best for them, under the supervision of their doctor.

How does a liquid taper help to prevent Xanax interdose withdrawal?

Unfortunately, interdose withdrawal is still a risk when using alprazolam to taper, even with a compound solution. However, by reducing at a more gradual rate, using carefully measured liquid dosing, the patient may be able to better adjust during the taper.

By taking the taper slowly, as allowed by a careful liquid taper, there may be less of a risk of interdose withdrawal. Even though Xanax wears off quickly, the patient may be able to taper with a Xanax compound solution without having much of a problem with interdose symptoms.

Ideally, the patient should consult with a benzo tapering expert to discuss in detail their situation. After careful consideration, the doctor and patient can come to a conclusion and decide on the best possible course of action.

Everyone is different, and every tapering situation is unique. Additionally, during the tapering process, the patient may discover that the plan is not working for them. So, the doctor will help to reassess and reformulate a new taper plan, minimizing the effects of the withdrawal process, reducing the risk of severe symptoms.

Coming off of Xanax is possible with a good, individualized tapering program. There is no reason to fear Xanax tapering or uncomfortable withdrawal symptoms, when a solid gradual tapering plan has been implemented.