Sour Armpit Odor: Can Benzodiazepine Tapering or Benzo Withdrawal Cause Sour Armpits?

Can benzo withdrawal cause sour armpit odor?

Plausibly, yes. Sweating is a recognized benzodiazepine withdrawal symptom, and the sweat that comes with stress smells stronger than the sweat that comes with heat. So, a sour armpit odor that shows up during a taper has a reasonable explanation.

The evidence on odor itself is limited, and it is better to say so plainly. The Ashton Manual, written by Professor C. Heather Ashton, lists sweating and unusual smells among withdrawal symptoms, but it does not tie the two together. The rest is ordinary physiology and what patients commonly describe during a taper.

The smell is harmless, it is temporary, and ordinary hygiene manages it. It is never a reason to stop a benzodiazepine abruptly or to rush a taper.

Why does a benzodiazepine taper cause more sweating?

Benzodiazepines strengthen the effect of gamma-aminobutyric acid (GABA), the main calming signal in the brain. Over months or years, the nervous system adapts to that extra calming. When the dose comes down, the parts of the nervous system that were held quiet become overactive for a while.

Table 1 in Chapter III of the Ashton Manual lists flushing, sweating, and palpitations together as withdrawal symptoms. Professor Ashton called them the expression of an overactive autonomic nervous system, the part that runs heart rate, blood vessels, and sweat glands without conscious control. She wrote that they would be accepted as normal in a person running for a bus.

So, the body is acting as if it were running for the bus while sitting on the couch. That is uncomfortable, but on its own it is not dangerous. It is one of many benzodiazepine withdrawal symptoms that a slower taper can ease.

Why does stress sweat smell sour?

The body has two kinds of sweat glands. Eccrine glands cover most of the skin and release a watery sweat that cools the body. Apocrine glands sit mostly in the armpits and the groin, and they answer to stress and adrenaline more than to heat.

Apocrine sweat is thicker, and it carries proteins and fats. It has almost no smell when it reaches the skin. The odor comes afterward, when bacteria living in the warm, damp skin of the armpit break that sweat down into smaller compounds, some of them sharp or sour.

A nervous system on high alert makes more of this stress sweat. More sweat feeds more bacteria. A stronger, sourer smell is the expected result.

Is the smell real, or has the sense of smell changed?

It can be either, and sometimes it is both. The same table in the Ashton Manual lists hypersensitivity to light, sound, touch, taste, and smell. Professor Ashton wrote that several people in withdrawal noticed strange, unpleasant smells that seemed to come from the body, and that usually no one else could detect them.

A sense of smell turned up by withdrawal can make an ordinary amount of odor seem overwhelming. Asking one trusted person for a plain answer settles the question faster than worrying does.

Fortunately, this part passes. Professor Ashton also wrote that these heightened sensations return toward normal as withdrawal progresses.

The smell is not toxins leaving the body.

A common belief is that a person in withdrawal is sweating the drug out. That is the wrong picture. Chapter III of the Ashton Manual describes withdrawal as the nervous system readjusting after it has adapted to the drug. The sweat is a sign of that readjustment, and it is not the medication leaving through the skin.

Professor Ashton addressed the water question in the same chapter. She wrote that there is no need to drink extra fluid during withdrawal to flush out toxins, because the body does that job well without help and surplus water is simply excreted.

The picture of sweating a drug out also belongs to addiction, and it does not fit here. Physical dependence is not addiction. A person who took a benzodiazepine as prescribed, and whose nervous system adapted to it, has a medical condition caused by the medication, and a sour afternoon during a taper says nothing about character or hygiene.

What helps with sour armpit odor during a taper?

Ordinary hygiene does most of the work, and four measures cover it. First, wash the armpits daily with soap or an antibacterial wash and dry the skin fully, because fewer bacteria means less odor. Second, use an antiperspirant, which reduces the sweat itself, where a deodorant mainly covers the smell.

Third, wear breathable fabric such as cotton and change a damp shirt, since synthetic fabric tends to hold both sweat and odor. Fourth, pay attention to food. Garlic, onions, and heavily spiced meals change body odor in some people, and it is reasonable to notice whether they matter.

None of this treats withdrawal. These products work on the skin and do not interact with the medication, and how well each one works varies from person to person.

Is body odor a reason to stop or speed up the taper?

No. A person who is tired of sweating may be tempted to get the taper over with, or to quit outright. Unfortunately, either choice leaves the nervous system more overactive, which means more sweating and more of every other symptom.

The 2020 boxed warning update from the United States Food and Drug Administration (FDA) says that stopping a benzodiazepine abruptly, or reducing the dose too quickly, can cause withdrawal reactions, including seizures, that can be life-threatening. Its instruction is a gradual taper.

Slowing or holding the taper is the real remedy.

Sweating that surges after a dose reduction is information about pace. Often, the cut was larger, or came sooner, than the nervous system could absorb. One answer, worked out with the prescriber, is a short hold at the current dose and then smaller steps. In Dr. Leeds’ experience a week or two is usually enough on a diazepam taper, while a patient on clonazepam or alprazolam who holds and does not settle may do better moving to diazepam or continuing the taper rather than waiting indefinitely, never by stopping suddenly. It is also part of why benzodiazepine tapering needs professional guidance.

In Chapter III, Professor Ashton stressed that withdrawal symptoms can be minimized, and largely avoided, by slow tapering fitted to the individual. The Maudsley Deprescribing Guidelines supply the shape, which is hyperbolic: each reduction gets smaller as the dose gets lower. The pace belongs to the patient. A separate article covers using the Ashton Manual to guide a tapering schedule.

Dr. Mark Leeds, an osteopathic physician and deprescribing specialist in Fort Lauderdale, Florida, builds tapers this way. In his practice, patients are never pushed to taper faster than they can tolerate, and holding at a dose is always an option.

When should a doctor look at sweating or body odor?

Withdrawal is a likely explanation during a taper, but it is not the only one. Drenching night sweats with a fever, or with weight loss that has no explanation, should not be put down to withdrawal. They call for an ordinary medical evaluation, and a separate article covers whether benzodiazepine withdrawal can cause a fever.

A red, painful, or broken-out armpit is a skin problem and deserves a look as well. Other medications can cause sweating too, which is one more reason to mention the symptom to the prescriber.

Sweating with chest pain, fainting, or trouble breathing is an emergency. Call emergency services for a seizure or any medical emergency.

The smell usually fades as the nervous system settles.

A sour smell in the middle of a taper is unpleasant, and it can be embarrassing. Yet, it is one of the least dangerous things a taper can produce. With time, as the nervous system settles at each new dose, the sweating tends to ease and the smell goes with it.

Dr. Leeds’ practice in Fort Lauderdale offers medically supervised benzodiazepine and z-drug tapering for patients in Florida. It is a concierge practice with one physician, and each taper is gradual, built for the individual, and paced by the patient. Contact the office to ask about a medically 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.