Benzodiazepine Withdrawal Symptoms and Timeline

Benzodiazepines (commonly known as benzos) are central nervous system depressants that are prescribed to treat anxiety, panic, muscle spasms, certain seizure disorders, as well as to manage acute alcohol withdrawal, but these medications may often be misused.¹ Commonly used benzodiazepines include: Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam), and Restoril (temazepam)³

Benzodiazepine withdrawal can be an unpleasant and challenging aspect of early recovery. If not medically managed, some of the symptoms of benzodiazepine withdrawal may be severe and potentially dangerous. To successfully detox from benzodiazepines, one of the key factors is to be aware of exactly what to expect during withdrawal.

The purpose of this page is to help people understand the signs of benzo withdrawal, the timeline of withdrawal symptoms, and the most appropriate way to manage those symptoms.

Benzodiazepine Withdrawal Symptoms

Depending on the specific agent being used, acute benzodiazepine withdrawal can arise within roughly one to several days after use stops.2, 3 Some people may experience a phenomenon known as protracted withdrawal; when present, protracted withdrawal symptoms may arise at the end of the acute withdrawal phase. As part of what is sometimes referred to as post-acute withdrawal syndrome (PAWS), these symptoms may be less intense than those experienced during acute withdrawal. However, they can fluctuate in character and severity over time—sometimes lasting for months or years after stopping the use of benzodiazepines.^{2, 3, 4}

Acute Benzodiazepine Withdrawal Symptoms

Withdrawal from benzodiazepines can range from uncomfortable to severe.² Relatively less intense symptoms include an inability to sleep, restlessness, light-headedness, headaches, stiffness or pain in the muscles, sweating, and increased sensitivity to scents, noises, or light.^{2, 3, 4} More intense symptoms include nausea, vomiting, hand tremors, increased heart rate, raised body temperature, cramps, severe dizziness, and low blood pressure when standing that can lead to fainting.^{2, 4}

Benzodiazepine withdrawal may also involve some potentially dangerous symptoms.² Some people attempting to detox from benzodiazepines may be at risk of agitation, seizures, psychosis, or delirium—which could include seeing, hearing, or feeling things that are not there (hallucinations), profound confusion, disorientation, loss of awareness of one’s surroundings, and autonomic nervous system hyperactivity (e.g., increases in heart rate, body temperature, and blood pressure).^{2, 3, 5} Though rare, seizures and delirium are extremely dangerous withdrawal complications. Though benzodiazepine withdrawal is rarely fatal, the risk of these severe symptoms often necessitates that it be treated by medical professionals.^{2, 3} Of note, seizures can develop without warning, even if someone isn’t showing any other signs of withdrawal.⁵

Protracted Benzodiazepine Withdrawal Symptoms

Lingering issues associated with post-acute withdrawal syndrome can include physical symptoms such as abrupt muscle contractions, eyelid twitches, a pins and needles sensation (i.e., paresthesia), feeling as though bugs are crawling under the skin (i.e., formication), ringing in the ears, or irritable bowel syndrome.^{2, 4} Mental and cognitive symptoms associated with post-acute withdrawal can include anxiety, trouble sleeping, memory problems, and depression that can be severe enough to lead to suicidal thoughts or actions.^{2, 4}

Though they may be relatively less intense, the lingering symptoms associated with post-acute withdrawal from benzodiazepines can be problematic. Many people choose to attend an inpatient or outpatient treatment program, which can offer the support and resources that can help people learn to manage any significantly troublesome symptoms. Behavioral therapeutic techniques will help you to address maladaptive thought patterns that may be worsened by post-acute symptoms, and many programs offer specialized care to treat any co-occurring mental health issues, such as depression and anxiety.

Factors That Can Affect Benzodiazepine Withdrawal

The severity of withdrawal symptoms varies between people and depends on a variety of factors. Physiological dependence on shorter-acting benzodiazepines may be more likely to elicit a shorter, more intense acute withdrawal period.² Any benzodiazepine used at higher-than-recommended doses or for longer-than-recommended periods of time can result in more pronounced dependence and increasingly severe withdrawal symptoms.² Finally, a person’s overall health status may also play a role in the severity of withdrawal symptoms—with the presence of additional medical or mental health issues potentially contributing to a more complicated withdrawal picture.

Benzodiazepine Withdrawal Timeline

There is a well-established general timeline for benzodiazepine withdrawal that occurs when use is stopped or dramatically reduced.³ However, precisely when symptoms first appear, how long they last, and at what severity they are experienced will all be influenced by the type of benzodiazepines that are used.^{2, 3} Adding to this variable timeline, some people may experience post-acute withdrawal symptoms that last long after the higher intensity symptoms of acute withdrawal have passed. ^{2, 3, 4}

Early benzodiazepine withdrawal symptoms can appear within a few hours of stopping relatively short-acting drugs such as Xanax, Ativan, and Restoril.^{1, 2, 3} Associated withdrawal symptoms may gradually worsen until they generally reach a peak on day 2 and slowly improve over the next 2 or 3 days.³ Acute withdrawal from shorter-acting benzodiazepines might be expected to last between 2 and 4 weeks.²

Early benzodiazepine withdrawal symptoms take longer to appear when stopping relatively longer-acting drugs such as Valium and Librium (chlordiazepoxide).1, 2 The withdrawal associated with these longer-acting benzos may not begin until between 2 days and a week after use is stopped, with symptoms increasing in intensity until they reach a peak after 2 weeks of abstinence and slowly improving over the next week or two.^{2, 3} Acute withdrawal from long-acting benzodiazepines can last between 2 and 8 weeks.²

Quitting Benzos Cold Turkey

A common question that people have is “Can you quit benzos cold turkey?” Though it may initially seem like a tempting option to try to detox from benzodiazepines at home, it is not a good idea for several reasons.

The first reason is that withdrawal symptoms can be severe and even life-threatening.^{3, 5} People are not advised to abruptly quit benzodiazepines without the proper support and supervision that can be provided during treatment.⁵ Though somewhat rare, the withdrawal syndrome associated with benzodiazepines can involve the development of significantly severe symptoms such as seizures and delirium. A supervised medical detox may be best equipped to manage these issues, keeping you as safe and comfortable during withdrawal as possible.^{3, 5} A controlled tapering of benzodiazepine medications can be conducted, while medications may be provided to manage certain symptoms or complications which may arise. Staff members can offer around-the-clock monitoring for any change in symptoms to ensure the safety of all patients.⁵

Withdrawal from benzodiazepines is an uncomfortable process with the potential to last for several weeks (or longer). Withdrawal symptoms often include intense cravings for benzodiazepines, especially if the person has an addiction to benzodiazepines.³ Relapse risks are high, as one might be driven to quickly ease withdrawal symptoms by taking more benzodiazepines.³ A medical detox program for benzodiazepine withdrawal management offers a secure environment with structure and support that can reduce the chances of relapse during the detoxification process.

Benzodiazepine Detox

A fundamental goal of medical detox is to ensure the safety of each person as they are stabilized during withdrawal.⁵ Professional detox facilities are staffed with medical professionals, nurses, and counseling staff who provide around-the-clock support.⁵ This structure allows facility staff to monitor the health and safety of each patient 24 hours a day, to quickly identify and treat any issues or complications that may arise.⁵

As with other types of substances such as alcohol and opioids, benzodiazepine detox is commonly managed medically, in either an inpatient or outpatient setting where medications can be provided to ease the symptoms and prevent some of the more dangerous issues that can arise during the detox process.⁵ Any benzodiazepine detox is not recommended to take place without medical supervision; unless the course of benzodiazepine treatment was only for a few days, the benzodiazepine in question should be tapered rather than stopped abruptly to minimize the risk of withdrawal.⁵

There are two ways to accomplish this, depending on what type of benzodiazepine has been used.⁵ If a long-acting benzodiazepine has been used, the detox staff may choose to continue prescribing the same medication in a slowly tapering amount and ensure that all doses are taken exactly as prescribed until the person is weaned off of the medication completely.⁵ The other option is to offer a different benzodiazepine medication, also in a slowly tapering amount that is monitored to ensure that all doses are taken exactly as prescribed until the person is completely weaned off of benzodiazepine medications.⁵ Medications that are sometimes substituted for other benzodiazepines prior to initiating a taper include Librium (chlordiazepoxide) and Klonopin (clonazepam).⁵

What Happens During Benzodiazepine Detox?

Though precise detox procedures may vary from one program to the next, a thorough patient evaluation will take place at the very start.⁵ This involves testing for any substances of abuse in the system and assessing for any other issues that a person may be facing, including physical or mental health conditions, social difficulties, legal issues, housing concerns, and employment problems.⁵ This information is used to develop a treatment plan in conjunction with the patient and identify the needs that will be addressed in detox and what type of treatment will be best for additional care after detox.⁵ Additionally, what to expect at detox will also be explained during the evaluation.

The stabilization phase will begin after evaluations are completed. At this point, the detoxification process, as briefly outlined above, will be implemented alongside of psychosocial supports to keep a person safe and comfortable during the withdrawal period.⁵ Patients will begin to be familiarized with what to expect in terms of their treatment and pending recovery process. Family and friends may be incorporated into this stage of the process if the patient wishes them to be involved.⁵

Benzodiazepine Addiction Treatment

While medical detox is an important first step in recovering from benzodiazepine abuse, it is not likely to create lasting change without additional treatment.^{5, 6} For this reason, the third essential component of any professional detoxification program will be to prepare for and help patient transition into additional substance abuse treatment.⁵

After completing detox, attending an inpatient or outpatient treatment program can help participants learn important skills that can help them maintain long-term sobriety.⁶ Treatment programs address the underlying causes that contribute to addictions, including mental, emotional, and social factors, behavioral patterns, and stressors, and provide a range of coping skills and relapse prevention techniques.⁶

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