Medical Detox from Xanex

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Where protocols are suggested the practioner who treats the patient has sole responsiblity for the decisions involved. The material here is solely suggestions to be considered.

Medical Detox from Xanex

Xanax (alprazolam) is a short half-life, relatively lipid soluble benzo; unaided Xanax withdrawal results in seizures in about a third of cases. In a review of the literature some papers reported on using Xanax itself in decreasing doses (maximally 0.25 mgm per week decrease), and others reported on other benzos. The track record for Klonopin (clonazepam) is more hopeful than most others.

Here is an empirical clinically useful protocol:
For the first 9 mg Xanax per day, substitute 1 mg Klonopin for each 1.5 mg Xanax. For doses beyond 9 mg Xanax (that is, for the next 9 mg and beyond), substitute 1 mg Klonopin for each 3 mg Xanax.

Start with a loading dose of 2-4 mg Klonopin and divide the rest into tid dosing. Reduce gradually over 14 days or so.

So, the pt were taking 15 mg Xanax a day, this would be (6 mg Klonopin for the first 9 mg Xanax) + (2 mg Klonopin for the next 6 mg Xanax) = 8 mg Klonopin. Give Loading dose of 3 mg, then 2 mg, 1 mg, 2 mg the first day, then gradually reduce.

The usual doses of Xanax people are taking are usually modest... 8 or 10 mg a day. If they are enormous doses, try 3 mgm Klonopin tid.

Klonopin is a pretty good anticonvulsant, and is structurally similar to Xanax. Phenobarbital might be an alternative--good anticonvulsant, but won't substitute for symptom control (panic,etc) during withdrawal.

If the pt began the Xanax for panic disorder, or depression, be certain that an alternative tx is started during detox. Some would consider valproic acid as an alternative.