AboutDr Alan Galbraith Expertise I can answer most questions on drugs, both medical and "recreational". Answers can be given in either technical or layperson terminology. My main areas of interest are psychiatric, gastrointestinal and cardiovascular drugs.
Experience I have been a university lecturer/head of department for almost thirty years, but am now retired. My research interests were alcohol, smoking and cardiovascular disease.
Organizations Institute of Biology, London.
Publications Principal author of "Fundamentals of Pharmacology" 4th Edition published in November 2003 by Pearson Education, Australia.
Expert: Dr Alan Galbraith Date: 3/30/2007 Subject: xanax withdrawal with vestibular migraine
Question My husband has had severe oscillopsia (thing appear to move) that is debilitating and has been diagnosised with vestibular migraine. He does have numerous vestibular symptoms, 2 neurologist even suspected M.S. and all test proved negative. He has been on Xanax (alprazolam) 4mg for almost a year. The vision problem started after taking Xanax for about 6 months and just 3 weeks ago stoppped the Xanax and started taking klonepin .5mg twice daily. His vision problem has increased from things appearing to move side to side a few inches to now appearing to move a few feet. Just walking down the hall is extremely rough. Our Neurontologist has said alot of it is the Xanax withdrawal but he has to come off it for the migraine prevention meds to work. 2 days ago he stopped the klonepin and topiramate (3 week trial for migraine) and now is on promethazine 12.5mg twice daily and gabapentin 180mg 3 times.
We need to know what kind of problems the xanax withdrawal can cause and can the vision problems be related?
Answer Dear Jeanine
Benzodiazepine withdrawal can cause hosts of problems and I have appended a list below, but be cautioned only a few of these occur in any particular individual. Some of the problems or related to vision eg double vision but I think that his vestibular problems may be more related than the benzodiazepine withdrawal. Maybe the promethazine will help here. It can take a long time though for symptoms of benzodiazepine withdrawal to cease completely so he may have to be patient. Please do not be alarmed at the next section , these are just possibilities.
Regards
Dr Alan Galbraith
The use of benzodiazepines may lead to dependence as defined by the presence of a withdrawal syndrome on discontinuation of the drug. Tolerance, as defined by a need to increase the dose in order to achieve the same therapeutic effect, seldom occurs in patients receiving the recommended dose under medical supervision. Tolerance to sedation may occur with benzodiazepines, especially in those patients with drug seeking behaviour.
The result of withdrawal symptoms is a direct consequence of physical dependence to Xanax tablets. Signs and symptoms of withdrawal are similar in character to those noted with barbiturates and alcohol and are more prominent after a rapid decrease of dosage or abrupt discontinuation. These symptoms range from insomnia, anxiety, dysphoria, palpitations, panic attacks, vertigo, myoclonus, akinesia, hypersensitivity to light, sound and touch, abnormal body sensations (e.g. feelings of motion, metallic taste), depersonalisation, derealisation, delusional beliefs, hyperreflexia and loss of short-term memory, to a major syndrome which may include convulsions, tremor, abdominal and muscle cramps, confusional state, delirium, hallucinations, hyperthermia, psychosis, vomiting and sweating. Such manifestations of withdrawal, especially the more serious ones, are more common in patients who have received excessive doses over a prolonged period. However, withdrawal symptoms have been reported following abrupt discontinuation of benzodiazepines taken continuously at therapeutic levels.
Signs and symptoms of withdrawal are more prominent after a rapid decrease of dosage or abrupt discontinuation of benzodiazepines. Hence, abrupt discontinuation of therapy with alprazolam should be avoided. It is recommended that all patients on Xanax tablets who require a dosage reduction be gradually tapered under close supervision (see Dosage and Administration, Discontinuation therapy) to minimise the incidence or severity of withdrawal problems. It is important to advise patients not to increase the dose of, or abruptly discontinue, their medication without first consulting a doctor.
The discontinuation of therapy with Xanax tablets may not only result in withdrawal symptoms, but also in relapse of the anxiety and panic symptoms of the original disorder and a rebound effect. The term relapse refers to the return of symptoms characteristic of the original disorder, at levels approximately equal to those seen at baseline before active treatment was initiated. Rebound phenomena refer to the return of symptoms characteristic of the original disorder at levels greater than originally seen at baseline.
In general, rebound phenomena reflect the re-emergence of pre-existing conditions combined with withdrawal symptoms described earlier. Withdrawal/ rebound phenomena may follow high doses of benzodiazepines for relatively short periods of time.
In a large database comprising both controlled and uncontrolled studies in which 641 patients received Xanax tablets for the treatment of panic disorder, discontinuation emergent symptoms which occurred at a rate of over 5% in patients treated with Xanax tablets and at a greater rate than the placebo treated group were as shown in Table 1.
From the studies cited, it has not been determined whether these symptoms are clearly related to the dose and duration of therapy with Xanax tablets in patients with panic disorder.
These discontinuation emergent symptoms do not appear to differ from those associated with other benzodiazepines.
In two controlled trials of six to eight weeks duration, in which the ability of patients to discontinue medication was measured, 71 to 93% of Xanax treated patients tapered completely off therapy compared to 89 to 96% of placebo treated patients. In a controlled clinical trial of 3 to 12 months duration involving 144 patients, in which the ability of patients to discontinue medication was measured, it was found that the majority of Xanax treated patients (66.9%) were able to taper dose to zero. A minority of patients were unable to successfully stop alprazolam after long-term therapy.
