Alprazolam has a fast onset of action and symptomatic relief. Ninety percent of peak effects are achieved within the first hour of using either in preparation for panic disorder, and full peak effects are achieved in 1.5 and 1.6 hours respectively.^[6]^[7] Peak benefits achieved for generalized anxiety disorder (GAD) may take up to a week.^[8]^[9] Tolerance to the anxiolytic/antipanic effects is controversial with some authoritative sources reporting the development of tolerance,^[10] and others reporting no development of tolerance;^[3]^[11] tolerance will however, develop to the sedative-hypnotic effects within a couple of days.^[11] Withdrawal symptoms or rebound symptomsmay occur after ceasing treatment abruptly following a few weeks or longer of steady dosing, and may necessitate a gradual dose reduction.^[8]^[12]

Patients taking a dosing regimen larger than 4 mg per day have an increased potential for dependence. This medication may cause withdrawal symptoms upon abrupt withdrawal or rapid tapering, which in some cases have been known to cause seizures. The discontinuation of this medication may also cause a reaction called rebound anxiety.

Delirium similar to that produced by the tropane alkaloids (gaba antagonists) of Datura (scolopamine and atropine) and seizures have been anecdotally reported in the medical literature from abrupt alprazolam discontinuation.^[72]^[73]^[74]

^{Some common symptoms of alprazolam discontinuation include malaise,
weakness, insomnia, tachycardia, lightheadedness, and dizziness.^[71]}

In a 1983 study of patients who had taken long-acting benzodiazepines, e.g., clorazepate, for extended periods, the medications were stopped abruptly. Only 5% of patients who had been taking the drug for less than 8 months demonstrated withdrawal symptoms, but 43% of those who had been taking them for more than 8 months did. With alprazolam – a short-acting benzodiazepine – taken for 8 weeks, 35% of patients experienced significant rebound anxiety. To some degree, these older benzodiazepines are self-tapering.^[75]

^{end partial quotes from:}

end quote from:

Alprazolam - Wikipedia, the free encyclopedia

More on general drug withdrawal symptoms from multiple kinds of drugs:

Drug withdrawal

From Wikipedia, the free encyclopedia

Withdrawal
Classification and external resources
ICD-10	F 10.3-F 19.3
ICD-9	292.0
eMedicine	article/819502
MeSH	D013375

Addiction glossary
• addiction – a state characterized by compulsive engagement in rewarding behavior or compulsive drug use, despite adverse consequences
• reinforcing stimuli – stimuli that increase the probability of repeating behaviors paired with them
• rewarding stimuli – stimuli that the brain interprets as intrinsically positive or as something to be approached.
• addictive drug – a drug that is both rewarding and reinforcing
• addictive behavior – a behavior that is both rewarding and reinforcing
• sensitization - an amplified response to a stimulus resulting from repeated exposure to it
• drug tolerance – the diminishing effect of a drug resulting from repeated administration at a given dose
• drug sensitization or reverse tolerance – the escalating effect of a drug resulting from repeated administration at a given dose
• drug dependence – an adaptive state associated with a withdrawal syndrome upon cessation of repeated drug intake
• physical dependence – dependence that involves physical–somatic withdrawal symptoms (e.g., fatigue)
• psychological dependence – dependence that involves emotional–motivational withdrawal symptoms (e.g., dysphoria and anhedonia)
(edit \| history)

Drug withdrawal is the group of symptoms that occur upon the abrupt discontinuation or decrease in intake of medications or recreational drugs.
In order to experience the symptoms of withdrawal, one must have first developed a physical or mental dependence. This happens after consuming one or more substances for a certain period of time, which is both dose dependent and varies based upon the drug consumed. For example, prolonged use of an anti-depressant is most likely to cause a much different reaction when discontinued than the repeated use of an opioid, such as heroin. Withdrawal symptoms from opiate abuse (such as heroin/morphine) include anxiety, sweating, vomiting, and diarrhea. Alcohol abuse withdrawal symptoms include irritability, fatigue, shaking, sweating, and nausea. Withdrawal from nicotine brings on irritability, fatigue, insomnia, headache, and difficulty concentrating. Symptoms and body response to the absence can vary from mild discomfort, or to the return of previous underlying medical problems and their respective symptoms. Many legal and unrestricted chemicals and/or substances available without prescriptions and over the counter can cause withdrawal effects when users stop consuming them, even if taken as directed.
The route of administration, whether intravenous, intramuscular, oral or otherwise, can also play a role in determining the severity of withdrawal symptoms. There are different stages of withdrawal as well; generally, a person will start to feel worse and worse, hit a plateau, and then the symptoms begin to dissipate. However, withdrawal from certain drugs (benzodiazepines, alcohol) can be fatal. While it is seldom fatal to the user, withdrawal from opiates (and some other drugs) can cause miscarriage, due to fetal withdrawal. The term "cold turkey" is used to describe the sudden cessation use of a substance and the ensuing physiologic manifestations.
The symptoms from withdrawal may be even more dramatic when the drug has masked prolonged malnutrition, disease, chronic pain, infections (common in intravenous drug used) or sleep deprivation, conditions that drug abusers often suffer as a secondary consequence of the drug. Many drugs (including alcohol) suppress appetite while simultaneously consuming any money that might have been spent on food. When the drug is removed, the discomforts return in force and are sometimes confused with addiction withdrawal symptoms.

Substances

Examples (and ICD-10 code) of withdrawal syndrome include:

F10.3 alcohol withdrawal syndrome (which can lead to delirium tremens)
F11.3 opioids, including methadone withdrawal
F12.3 cannabis withdrawal
F13.3 benzodiazepine withdrawal syndrome
F14.3 cocaine withdrawal
F15.3 caffeine withdrawal
F17.3 nicotine withdrawal
----- Antidepressant discontinuation syndrome

The term "withdrawal" can sometimes be used to describe the results of discontinuing prescription medicine, as in SSRI discontinuation syndrome, though the term rebound effect is also used to characterize these conditions.

Prescription medicine

As noted above, many drugs should not be stopped abruptly^[1] without the advice and supervision of a physician, especially if the medication induces dependence or if the condition they are being used to treat is potentially dangerous and likely to return once medication is stopped, such as diabetes, asthma, heart conditions and many psychological or neurological conditions, like epilepsy, hypertension, schizophrenia and psychosis. With careful physician attention, however, medication prioritization and discontinuation can decrease costs, simplify prescription regimens, decrease risks of adverse drug events and polypharmacy, focus therapies where they are most effective, and prevent cost-related underuse of medications.^[2]
Sudden cessation of the use of an antidepressant can deepen the feel of depression significantly (see "Rebound" below), and some specific antidepressants can cause a unique set of other symptoms as well when stopped abruptly.
Discontinuation of selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed class of antidepressants, (and the related class serotonin-norepinephrine reuptake inhibitors or SNRIs) is associated with a particular syndrome of physical and psychological symptoms known as SSRI discontinuation syndrome. Effexor (venlafaxine) and Paxil (paroxetine), both of which have relatively short half-lives in the body, are some of the most likely antidepressants to cause withdrawals. Prozac (fluoxetine) is the least likely of SSRI and SNRI antidepressants to cause any withdrawal symptoms, due to its exceptionally long half-life.

References

Peter Lehmann, ed. (2002). Coming off Psychiatric Drugs. Germany: Peter Lehmann Publishing. ISBN 1-891408-98-4.
Alexander, GC; Sayla MA; Holmes HM; Sachs GA (11 April 2006). "Prioritizing and stopping prescription medicines.". Canadian Medical Association Journal. 8 174 (8): 1083–1084. doi:10.1503/cmaj.050837. PMC 1421477. PMID 16606954. Retrieved 2011-11-11.

External links

Fact sheets, detox information and harm reduction strategies concerning illicit drugs

[hide]

Psychoactive substance-related disorder (F10–F19, 291–292; 303–305)

General

SID
- Substance intoxication / Drug overdose
- Withdrawal
- Substance-induced psychosis
SUD
- Substance abuse
- Physical dependence / Substance dependence

Alcohol

SID

Diseases

Neurological disorders	Alcoholic hallucinosis Alcohol withdrawal Fetal alcohol spectrum disorder (FASD) Fetal alcohol syndrome (FAS) Korsakoff's syndrome Wernicke–Korsakoff syndrome Wernicke's encephalopathy

Digestive system	Alcohol flush reaction Alcoholic hepatitis Alcoholic liver disease

Nervous system	Alcohol dementia Alcoholic hallucinosis Hangover

Cardiovascular system	Alcoholic cardiomyopathy