Xanax is a brand name for the drug alprazolam, which belongs to a group of drugs called benzodiazepines. Xanax is used to treat anxiety and panic disorders and is the single most prescribed psychiatric medication in the United States.
In this article, we will explain why Xanax is used, potential side effects, and relevant warnings.
Fast facts on Xanax:
- Xanax (alprazolam) is the single most prescribed psychiatric medication in the U.S.
- Xanax is a member of the benzodiazepine family of drugs and is primarily used to treat anxiety and panic disorders.
- Xanax works by increasing the amount of the neurotransmitter GABA in the brain to promote calmness and a relaxed feeling.
- When taken correctly, Xanax is a safe and effective medication.
Xanax (alprazolam) is an anti-anxiety medication in the benzodiazepine family, the same family that includes diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan), flurazepam (Dalmane), and others.
Xanax works by decreasing abnormal excitement in the brain and was approved by the FDA in October 1981.
Benzodiazepines act on the brain and central nervous system to produce a calming effect.
Xanax slows down the movement of brain chemicals that may have become unbalanced, resulting in a reduction in nervous tension and anxiety. Xanax works by boosting the effects of a natural chemical made in the brain called gamma-aminobutyric acid (GABA).
For all users of Xanax:
To ensure safe and effective use of benzodiazepines, all patients prescribed with Xanax will be provided with the following guidance:
- Inform your doctor about any alcohol consumption and medicine you are currently taking, including over-the-counter (OTC) medication. Alcohol should generally not be used during treatment with benzodiazepines.
- Xanax is not recommended for use in pregnancy. Inform your doctor if you are pregnant, if you are planning to have a child, or if you become pregnant while you are taking this medication.
- Inform your doctor if you are breast-feeding.
- Until you experience how Xanax affects you, do not drive a car or operate heavy or dangerous machinery.
- Do not increase the dose of Xanax without speaking with a doctor, even if you think the medication “does not work anymore.” Benzodiazepines, even when used as recommended, may produce emotional and physical dependence.
- Do not stop taking Xanax abruptly or decrease the dose without consulting your doctor because withdrawal symptoms can occur.
Inform your doctor if you have asthma or other breathing problems, glaucoma, kidney, or liver diseases, history of alcoholism or depression, suicidal thoughts, or an addiction to drugs or alcohol.
You should not take Xanax if you:
- Have narrow-angle glaucoma.
- Are also taking itraconazole (Sporanox) or ketoconazole (Nizoral).
- Are allergic to Xanax or other benzodiazepines, such as chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax).
In certain individuals, the body handles Xanax differently, these include:
- people with alcoholism
- individuals with alcoholic liver disease
- individuals with impaired hepatic function
- individuals with impaired renal function
- older adults
- people who are obese
Do not use Xanax if you are allergic to alprazolam or other benzodiazepines such as chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax).
Do not drink alcohol while taking Xanax. Xanax can increase the effects of alcohol.
Do not use Xanax if you are pregnant. Benzodiazepines can potentially cause harm to the fetus. Xanax increases the risk of congenital abnormalities when given to a pregnant woman during the first trimester.
Use of Xanax during the first trimester of pregnancy should usually be avoided.
Patients should be advised that if they become pregnant during therapy or intend to become pregnant, they should tell their doctor.
A child born of a mother who is taking benzodiazepines may be at risk of withdrawal symptoms from the drug. Also, respiratory problems have been reported in children born to mothers who have been taking benzodiazepines.
It is thought that Xanax is excreted in human milk. As a general rule, mothers who must use Xanax should not breast-feed.
Xanax has not been studied in children.
Gender does not effect the body’s response to Xanax.
Older adults may be more sensitive to the effects of benzodiazepines. The sedative effects of Xanax may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking Xanax.
Xanax may affect Asian populations more than white populations.
Xanax concentrations may be reduced up to 50 percent in smokers, compared with nonsmokers.
As with other psychotropic medications, there are precautions when giving the drug to severely depressed patients or those who may have suicidal thoughts.
Episodes of hypomania and mania have been reported in association with the use of Xanax in patients with depression.
Xanax is often abused for the fast-acting, relaxed “high” it can give to people who take it, including people without a prescription.
According to the Treatment Episode Data Set, the number of individuals seeking treatment for benzodiazepine abuse almost tripled from 1998-2008. Long-term abuse and addiction to Xanax are associated with depression, psychotic experiences, and aggressive or impulsive behavior.
According to the Substance Abuse and Mental Health Services Administration, in 2011, there were over 1.2 million emergency department (ER) visits overall related to the nonmedical use of prescription drugs – Xanax was involved in 10 percent of those visits.
The number of emergency department visits involving the non-medical use of the sedative Xanax doubled from 57,419 to 124,902 during the years 2005 to 2010 and then remained stable at 123,744 in 2011.
The most common drug combinations encountered in ER patients are Xanax and alcohol, and Xanax combined with prescription opiates like hydrocodone and oxycodone.
Xanax is used to manage anxiety disorder or the short-term relief of symptoms of anxiety. Anxiety or tension associated with the stress of everyday life usually does not require treatment.
Generalized anxiety disorder is characterized by unrealistic or excessive anxiety and worry about two or more life circumstances, for a period of 6 months or longer, during which the person has been bothered more days than not by these concerns.
At least six of the following symptoms are often present in these patients:
- Motor tension: trembling, twitching, feeling shaky, muscle tension, aches or soreness, restlessness, easily tired.
- Autonomic hyperactivity: shortness of breath or smothering sensations, palpitations or accelerated heart rate, sweating, or cold, clammy hands, dry mouth, dizziness or light-headedness, nausea, diarrhea, or other abdominal distress, flushes or chills, frequent urination, trouble swallowing or a “lump in the throat.”
- Vigilance and scanning: feeling keyed up or on edge, exaggerated startle response, difficulty concentrating or “mind going blank” because of anxiety, trouble falling or staying asleep, irritability.
Panic disorder is characterized by regular panic attacks. Panic attacks are relatively short periods of intense fear or discomfort where four or more of the following symptoms develop all of a sudden and reach a peak within 10 minutes:
- Palpitations, pounding heart, or accelerated heart rate.
- Trembling or shaking.
- Sensations of shortness of breath or smothering.
- Feeling of choking.
- Chest pain or discomfort.
- Nausea or abdominal distress.
- Feeling dizzy, unsteady, lightheaded, or faint.
- Derealization (feelings of unreality) or depersonalization (being detached from oneself).
- Fear of losing control.
- Fear of dying.
- Paresthesia (numbness or tingling sensations).
- Chills or hot flushes.
Side effects are often observed at the beginning of therapy and usually disappear upon continued use of medication. Possible side effects of Xanax include:
- low energy
- impaired coordination
- memory impairment
- abnormal involuntary movement
- decreased libido
- confusional state
- muscle twitching and cramps
- increased libido
- dry mouth or increased saliva
- constipation or diarrhea
- inflammation of the skin caused by allergy
- chest pain
- nasal congestion
- blurred vision
- menstrual disorders
- upper respiratory infection
- dream abnormalities
- increased or decreased appetite and weight gain or loss
- slurred speech
The above is not a complete list of side effects and others may occur. Call a doctor for medical advice about side effects. Side effects can be reported to the FDA at 1-800-FDA-1088.
Seek emergency medical help if you have any of these signs of an allergic reaction to Xanax: hives, difficulty breathing, and swelling of the face, lips, tongue, or throat.
Call your doctor at once if you have a serious side effect such as:
- Depressed mood, thoughts of suicide or hurting yourself, unusual risk-taking behavior, decreased inhibitions, or no fear of danger.
- Confusion, hyperactivity, agitation, hostility, hallucinations.
- Feeling like you might pass out.
- Urinating less than usual or not at all.
- Chest pain, pounding heartbeats, or fluttering in the chest.
- Uncontrolled muscle movements, tremor, seizure (convulsions).
- Jaundice (yellowing of the skin or eyes).
Xanax comes as a tablet, an extended-release tablet, an orally disintegrating tablet (tablet that dissolves quickly in the mouth), and a concentrated solution (liquid) to take by mouth.
Xanax should be taken by mouth as directed by a doctor. Dosage is based on the following factors:
- why it is being taken
- the patient’s age
- how they respond to treatment
The dosage of Xanax may be increased gradually until the drug works effectively for the patient. The instructions of a doctor should be closely followed to reduce the risk of side effects.
If this medication has regularly been used for a long time or in high doses, withdrawal symptoms (such as seizures) can occur if usage is suddenly stopped. To prevent these reactions, the doctor may reduce the dosage of Xanax gradually.
Xanax is available in doses of:
- 0.25 milligram – white, oval, scored, imprinted “XANAX 0.25”
- 0.5 milligram – peach, oval, scored, imprinted “XANAX 0.5”
- 1 milligram – blue, oval, scored, imprinted “XANAX 1.0”
- 2 milligram – white, oblong, multi-scored, imprinted “XANAX” on one side and “2” on the reverse side.
Do not crush, chew, or break a Xanax extended-release tablet. Swallow the tablet whole. It is specially made to release medicine slowly in the body. Breaking the tablet would cause too much of the drug to be released at one time.
Do not share your medicine with other people. It may not be suitable for them and may harm them.
What happens if I miss a dose?
If you miss a dose of Xanax, take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Symptoms of a Xanax overdose include tiredness, confusion, impaired coordination, diminished reflexes, and coma. Death has been reported in association with overdoses of Xanax by itself, as it has with other benzodiazepines.
If an overdose of Xanax occurs, call your doctor or 911. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Xanax should be stored at controlled room temperature 20-25°C.
The following drugs may increase the effects of Xanax:
- Cimetidine (Tagamet)
- HIV protease inhibitors, such as ritonavir
Benzodiazepines, including Xanax, produce extra depressant effects on the central nervous system (CNS) when taken with:
- other psychotropic medications
- other drugs that produce CNS depression
Other possible negative drug interactions include:
- Digoxin – in people aged 65 or over.
- Imipramine and desipramine.
- Birth control pills.
Studies of benzodiazepines other than Xanax suggest a possible drug interaction with the following drugs:
- some antibiotics
- grapefruit juice
- ergotamine (Cafergot, Ergomar, Migergot)
- Cyclosporine (Gengraf, Neoral, Sandimmune)
- Some heart or blood pressure medications
- Dexamethasone (Cortastat, Dexasone, Solurex, DexPak)
- imatinib (Gleevec)
- St. John’s wort
- antifungal medication – such as miconazole (Oravig) or voriconazole (Vfend)
- antidepressants – such as fluoxetine (Prozac, Sarafem, Symbyax) or nefazodone
- some barbiturates
- some seizure medications
This list is not complete, and other drugs may interact with Xanax. Tell your doctor about all medications you use. This includes prescription, OTC, vitamin, and herbal products.
Do not start a new medication without telling your doctor.
It is important to taper off Xanax gradually; otherwise, there is a risk of benzodiazepine withdrawal syndrome.
Withdrawal from Xanax
To discontinue treatment of Xanax, the dosage should be reduced and tapered slowly. It is suggested that the daily dosage of Xanax be decreased by no more than 0.5 milligrams every 3 days. Reported withdrawal symptoms include:
- fatigue and tiredness
- abnormal involuntary movement
- weight loss
- decreased appetite
- decreased salivation
- cognitive disorder
- blurred vision
- muscular twitching
- impaired coordination
- muscle tone disorders
- memory impairment
Xanax is a safe and effective medication when used as directed.