Tapering off Xanax due to pregnancy

[betty_elms]

Hi, I have been being treated for a very severe anxiety/panic disorder since August 2004.  I currently take 1 mg of Xanax per day in 4 divided .25 mg doses.  I found out that I am about 5 weeks pregnant and my psychiatrist and I have agreed that I must stop taking Xanax due to the risk of birth defects and problems with withdrawal in the baby after delivery.  My doctor wants me to stop the Xanax by discontinuing one .25 mg dose every five days until I am down to none (in other words, it will take 2 weeks to stop completely - I will remove a dose, wait 5 days, remove another, wait 5 days, remove another, wait 5 and then stop).  I am extremely terrified of the prospect of having bad withdrawal symptoms and seizures.  The Xanax did not even control my anxiety really well, as I still have had panic attacks from time to time and have daily anxiety (primarily focused on obsessions about my health).  Do you think that this tapering schedule is too fast?  Am I risking seizure or terrible withdrawal if I taper this fast?  I know it will be uncomfortable, I just fear having tachycardia and palpitations and seizures from the removal of Xanax.  I did stop .75 mg per day cold turkey over a year ago and wound up in the ER with a heart rate of 150 and in absolute mortal terror - I didn't have a seizure, though.  Should I take a seizure medication to prevent the risk of seizure?  If so, can you recommend one that will not harm my fetus and won't cause cardiovascular side effects like tachycardia and palpitations?  I do take 12.5 mg per day of Toprol XL to control tachycardia from panic attacks - should I up this dose while going through the withdrawal period?  Any help you can give is greatly appreciated as I cannot tell you how scared I am that I am going to have a seizure.  I am 33 years old, in excellent health, low BP, low cholesterol levels, etc. by way of background info.  
Thank you!

[Kevin Pho, MD]

Xanax is not the best medication for controlling anxiety precisely for this reason.  Because it is so short-acting, it does have habit-forming tendencies, making it hard to taper off.

That being said, there is no "right" way to taper off Xanax.  This will be different from patient to patient.  I would work closely with your personal physician - if the Xanax taper is too fast, perhaps a more gradual taper can be instituted.  

The adjustment of the Toprol XL can be considered - but will depend on how you respond to the Xanax taper.

You can discuss these options with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b

[mooreMD]

Unless Xanax is controlling repeated acute panic attacks I would recocmend discontinuing it all at once as soon as possible.  You are on a very low dose and the chances of having withdrawl are relatively slim, and if withdrawl occurs it should be medically mild.  The potential damage to your child is of more immediate concern.  Unless your psychiatrist feels that it is chemically unwise to do so, attempt to stop completely.

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DO NOT SUBSITUTE THIS ADVICE FOR OFFICIAL PROFESISONAL CONSULTATION.  GUIDANCE FROM YOUR PCP IS THE BEST WAY TO ENSURE SOUND MEDICAL CARE.

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B.Moore, MD