Suggest Ways To Wean Off Alprazolam

Posted on Fri, 13 Mar 2015

Question: I am 70 years old--male--retired teacher--and have been on Alprazolam 0.5mg for the past 8 years since my by-pass heart surgery. I was prescribed to take 3 a day but never did so-- only one at night for sleep. The current problem is that if I don't tale one at night I cannot sleep--I lay in my bed for hours looking at the ceiling. Another wrinkle in the situation is that I like my 5pm happy hour-- 2 Vodka martinis. It is usually 4 hours before I go to bed and I often get acid reflex. I feel a real need to get off this drug and have been off it now for 4 nights and haven't sleep more than 3-4 hours a night. I am concerned about the side effects and want to know if this addiction will go away? What other safer drug would you suggest for sleep that is less evasive? Please give me your advice. Sincerely, XXXX

Answered by Dr. Ronald Schubert (27 minutes later)

Brief Answer:
Alprazolam addiction

Detailed Answer:
Thanks for contacting HCM with your health care concerns.

I am also worried about your use of alprazolam. As you know alprazolam is an anxiety medication that can be addictive. I am glad to see that you have limited your use of the alprazolam to use before sleeping only. This will make the weaning easier. You have already stopped taking the alprazolam but you are experiencing insomnia. This is not unusual. In my practice I usually try using an antidepressant to help with insomnia. The most common is trazodone which is dosed 50-100mg 30 minutes before going to sleep. The other is mirtazapine 15-30mg 30 minutes prior to sleep. Both make you sleepy and allow for natural sleep. If you can't get to a doctor and need sleep you can use Benadryl OTC also but sometimes is may cause drowsiness the following day.

If you can I also recommend not drinking the vodka martinis. That is because alcohol can interfere with sleep too.

In summary
1. Stop alprazolam
2. Try Benadryl OTC to help sleep
3. See doctor for possible Trazodone or mirtazapine to help sleep
4. Stop alcohol

I hope this answers your question. Please contact HCM or me again for your health care concerns or questions

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Ronald Schubert (22 hours later)

XXXXXXX Schubert: I stopped alprazolam--took a 25 mg antihistamine. Last night I started to feel better-- slept most of the night. I thought I'would continue the antihistamine. A local pharmacist advised me to continue the alprazolam in halves for a week and then the next week a still smaller dose. She said sudden withdrawal is too hard on the body. Please advise! I am feeling mood shifts- depression and a slight balance problem. Looking forward to your reply as I don't have a local doctor here in Hallandale FL as I live in Michigan the other half year. XXXX

Answered by Dr. Ronald Schubert (23 minutes later)

Brief Answer:
Weaning from alprazolam

Detailed Answer:
I am glad to hear that you had a better night's sleep. I think taking the antihistamine will help your sleep.

I also agree with the pharmacist about weaning the dose of alprazolam I think you can just do 1 week of 1/2 tablet and then quit. The dose is already at the smallest dose prescribed and just cutting it in half should be enough to wean from.
By weaning your anxiety and mood shifts will be much less. To further help reduce the depression and mood swings I would highly recommend that you see someone about getting started on mirtazapine as it will help with sleep and reduce the risk of anxiety and depression.

I hope that answers your question. Return to HCM with any further comment or questions you may have.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj