Can Benzodiazepine Withdrawal Cause a Fever?

Can benzodiazepine withdrawal cause a fever?

Benzodiazepine withdrawal can make a person feel feverish. Flushing, sweating, chills, and an aching, flu-like feeling are all described in withdrawal. A true fever, the kind that shows on a thermometer, is not an expected part of a gradual taper.

The Ashton Manual, written by Professor C. Heather Ashton, lists withdrawal symptoms in Table 1 of Chapter III. The table includes “influenza-like symptoms” along with flushing and sweating, and the same chapter describes “sensations of hot and cold.” Fever is not on the list.

So, a measured fever during a taper should be treated as what it most likely is, an infection or another illness. It deserves to be checked. It is not one more withdrawal symptom to push through.

Feeling feverish is not the same as having a fever.

The difference is a number. A fever is usually defined as a temperature of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher. Patients in withdrawal often describe feeling burning hot, sweating through the night, and shivering an hour later, all with a normal reading.

Why does withdrawal feel this way? The likely reason is that the nervous system is overactive while it adjusts to a lower dose, including the part that runs sweating, blood flow to the skin, and the sense of hot and cold. The sensations are real, even when the body’s temperature has not changed.

Withdrawal is a smoke alarm that can go off without a fire, and the thermometer is how to check for the fire. So, before deciding what a hot, shaky night means, take a temperature. When the reading is normal and the problem is aches, chills, and exhaustion, the article on coping with benzo flu covers that ground.

Why would a real fever show up during a taper?

People who are tapering still catch what everyone else catches. Professor Ashton gave a section of Chapter III to a question her patients kept asking, which was why they caught so many infections. Colds, sinusitis, ear infections, cystitis, and influenza were on her list, although she wrote that it was not clear whether infections are truly more common during withdrawal.

A careful taper takes months, sometimes longer, and ordinary illnesses will happen along the way. Unfortunately, a person who already feels hot, achy, and worn out most days can easily miss the start of one.

Whoever evaluates the fever needs to know about the benzodiazepine and the taper. Some patients hesitate to mention it, because they have been labeled for it before.

Physical dependence on a prescribed medication is a medical condition, and dependence is not addiction. A taper belongs on the medication list like any other prescription, and the article on why the labels are wrong explains the difference.

What should a person do with a fever during a taper?

First, measure it, and write down the reading and the time. A record of real numbers helps a clinician far more than a memory of feeling hot.

Rest and fluids come next, because fever and sweating both pull water out of the body, one reason staying hydrated matters throughout a taper. As for fever reducers such as acetaminophen or ibuprofen, Professor Ashton wrote in Chapter III that there is no need to avoid ordinary painkillers for everyday aches and pains during withdrawal. Still, the prescriber or a pharmacist should confirm the choice, because a person’s other medications and health conditions matter.

The next step is a call to a primary care doctor or a visit to urgent care, the same as for anyone with a fever. That matters most when the fever lasts more than two or three days, keeps coming back, or arrives with a cough, a sore throat, or painful urination.

Do not speed up or stop the taper because of a fever. Skipping doses, stopping, or cutting faster while sick only adds withdrawal to an illness. Holding at the current dose until the illness passes is reasonable, and any change to the dose itself is a conversation to have with the physician who manages the taper.

When is a fever an emergency?

Call 911 or go to the nearest emergency room when a fever comes with any of the following:

• a seizure
• confusion, hallucinations, or unusual drowsiness
• a stiff neck or a severe headache
• a new rash
• trouble breathing or chest pain
• a temperature above 103 degrees Fahrenheit (39.4 degrees Celsius)

The United States Food and Drug Administration (FDA), in its 2020 boxed-warning update for benzodiazepines, cautioned that stopping abruptly or reducing the dose too quickly can cause withdrawal reactions, including seizures, that can be life-threatening. Severe withdrawal after an abrupt stop or a rapid cut is different from a gradual taper, and a high temperature in that setting is an emergency as well. Anyone having thoughts of suicide can call or text 988, the Suicide and Crisis Lifeline, at any hour.

How does Dr. Mark Leeds handle a new symptom during a taper?

Dr. Leeds is an osteopathic physician and deprescribing specialist in Fort Lauderdale, Florida. During a supervised taper, he evaluates each new symptom instead of assuming that it is withdrawal. A symptom that does not fit the pattern, such as a measured fever, is a reason to have another cause looked for, not to wait.

The taper itself stays gradual and patient-directed. Fortunately, an illness does not have to derail it, because the next reduction can wait until the patient feels ready.

Dr. Leeds’ practice provides medically supervised benzodiazepine tapering for patients in Florida, and a new symptom is part of what that supervision is for. Contact the office to ask about a supervised taper.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.