Benzodiazepine Withdrawal

Benzodiazepines are central nervous system (CNS) depressants that work by calming an otherwise overexcited nervous system. Doctors prescribe benzos to treat conditions like panic and anxiety disorders, but these medicines are also commonly misused for non-medical purposes, as well as diverted from prescription supplies to be sold illicitly on the street.1,2

Long-term use or misuse of benzodiazepines can increase the likelihood of significant physiological dependence and associated withdrawal symptoms when a person attempts to stop taking the drug. This page will cover what happens during the process of benzo withdrawal, including symptoms, timeline, and treatment options.

What Is Benzodiazepine Withdrawal?

Benzo withdrawal is a set of symptoms an individual may experience when they attempt to stop or reduce their benzodiazepine use after using the drugs for an extended period of time. It can happen when a person has been misusing benzos without a prescription or taking the medication as prescribed.1

Withdrawal is the result of physical dependence, which occurs when people become so used to the presence of a drug in their system that they feel unpleasant effects as the body rebalances itself after use slows or stops.3

Withdrawal from benzodiazepines can be severe and is one of the withdrawal syndromes, along with acute opioid and alcohol withdrawal, where medical detox is generally recommended to manage symptoms and minimize the risk of complications.4

Benzodiazepine Withdrawal Symptoms

The symptoms of benzodiazepine withdrawal can range in character and severity. These symptoms may vary in intensity depending on how much of the drug a person has been using and for how long.3

 Symptoms of benzo withdrawal may include:5        

  • Anxiety.
  • Sleeping problems.
  • Restlessness.
  • Hand tremors.
  • Increased heart rate.
  • Sweating.
  • Nausea.
  • Vomiting.
  • Hallucinations.
  • Seizures.

Benzodiazepine Withdrawal Seizures

Like alcohol withdrawal, benzo withdrawal can cause grand mal or generalized seizures, which may include complete loss of consciousness, intermittently disrupted breathing, and full-body muscle rigidity. The risk of seizures may be greater for people taking high doses of benzodiazepines for longer periods of time, but any amount or length of use can potentially lead to seizures when benzos are abruptly stopped.4

Left inadequately managed, benzo withdrawal seizures can be dangerous and potentially fatal. Medical detox is strongly recommended to reduce the risk of seizures and other complications that may arise during withdrawal.4

Rebound Anxiety and Insomnia

When a person goes through benzo withdrawal, it is common to experience withdrawal symptoms that are the opposite of what is experienced while on the medication.6

For example, benzo’s pharmacologic effects include symptoms such as relaxation and drowsiness. But during withdrawal, a person may experience anxiety and insomnia, sometimes at levels that exceed those experienced prior to benzo use.1,6

With continued abstinence, rebound anxiety and insomnia will generally resolve in a few weeks.6

Benzodiazepine Withdrawal Timeline

The onset and duration of benzodiazepine withdrawal can vary depending on the specific type of benzo.5

 For relatively short-acting benzodiazepines (e.g., Ativan, Xanax), withdrawal effects typically begin 6–8 hours after the last use, peak in intensity around the second day, and start to resolve by the fourth or fifth day.5

For relatively longer-acting benzodiazepines (e.g., Valium), withdrawal effects may not develop for more than a week after the last use, peak in intensity during the second week, and markedly improve during the third or fourth week.5

However, these are just approximate timelines, and people’s experiences will vary.

Protracted Benzo Withdrawal (Post-Acute Withdrawal)

Some people who suddenly stop taking benzos may experience protracted withdrawal, also known as post-acute withdrawal syndrome (PAWS). These lingering symptoms are typically milder than what is experienced after a person first stops taking a drug or medication and gradually decrease over time.6

When it comes to benzos, protracted withdrawal syndrome may fluctuate for months before gradually subsiding.6

Possible protracted withdrawal symptoms include:6,7

  • Depression.
  • Anxiety.
  • Insomnia.
  • Restlessness.
  • Weakness.
  • Panic attacks.
  • Trouble concentrating or remembering.
  • Muscle twitching or shaking.
  • A burning or prickling feeling in the hands, arms, legs, or feet.
  • Ear ringing.

With symptoms that potentially include anxiety and panic, protracted withdrawal can make recovery additionally challenging. People who might have originally taken benzos to treat anxiety may find it challenging to navigate these symptoms without returning to benzo use.6

Benzodiazepine Withdrawal Treatment

Professional treatment can help those experiencing withdrawal from benzodiazepines manage their symptoms and reduce the risk of relapse. Attempting to detox from benzos cold turkey is dangerous and should be avoided.4

Medical detox is a form of treatment focused on helping a person safely and comfortably come off substances like benzos and preparing them for more comprehensive rehab. It is provided in a structured clinical environment where medical professionals monitor and treat acute withdrawal symptoms.4

This can reduce the severity of withdrawal and the risk of complications like seizures. During benzo detox, treatment may include the use of medications to manage specific withdrawal symptoms and behavioral therapy.4

While it can be a helpful first step, detox alone is typically not enough to support a person’s long-term recovery from drug addiction. To sustain recovery over time, individuals need to address the underlying thoughts, behaviors, and emotions that led to their substance use.8

Addiction treatment can take place in a variety of settings, such as inpatient or outpatient, depending on a person’s individual needs. Medical detox programs provide assistance with the transition to addiction treatment once detox is complete.4

Withdrawal Medications

During medical detox, certain medications may be used to help relieve discomfort and minimize the risk of potentially dangerous withdrawal complications, such as seizures. In many cases of benzo withdrawal, a relatively longer-acting sedative—such as Librium (chlordiazepoxide)—may first be substituted for the benzo being used or misused.4

The treatment team will use this longer-acting agent to stabilize the patient. Then, as they progress through detox, the team will monitor closely as the medication dose is gradually decreased (or tapered) over time.4

Sometimes for various reasons (e.g., practitioner preference, withdrawal severity, response to first-line drugs), doctors may instead use the anti-convulsant medication phenobarbital to stabilize a person in withdrawal.4

Supportive comfort medications targeting specific symptoms like insomnia or nausea may also be used.

Finding Professional Benzodiazepine Detox

River Oaks Treatment Center is an inpatient rehab near Tampa that offers high-quality, professional medical detox.

Our facility in Riverview, Florida, offers different levels of addiction treatment beyond detox, including inpatient, partial hospitalization, and intensive outpatient, so you can continue your care with us and get the skills and support needed to sustain long-term recovery.

We provide evidence-based therapies, treatment medications (as needed and determined by the treatment team), and evaluation and treatment for co-occurring mental health disorders, as well as specialized support for Veterans, first responders, and members of the LGBTQ+ community.

At River Oaks, we try to make paying for rehab as simple as possible and are in-network with many major health insurance plans, so all or a portion of your treatment costs may be covered.

To learn more about using insurance to pay for rehab, contact us at or simply fill out this quick and confidential . Our team is available 24/7 to answer questions and help you start the admissions process today.

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