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Xanax (Alprazolam)

Risk factors, physical effects, and why treatment works

Xanax, a brand name of alprazolam, is a widely prescribed benzodiazepine usually given for generalized anxiety and panic attack disorder. It is also approved to treat depression, certain phobias, and severe premenstrual syndrome.

Alprazolam provides a sedative effect that can feel calming and relaxing. But as with other benzodiazepines, taking the drug for extended periods of time can lead to needing higher doses to get the same effect once achieved with lower doses. This can be a sign of dependency. When you use alprazolam in combination with alcohol or an opioid like fentanyl, which are also sedatives, you can put yourself at serious risk of physical injury, overdose, or death.

Recovery starts by recognizing the signs of a problem.

1. Signs of a problem

When taken as prescribed, alprazolam is effective as a short-term treatment for the anxiety or panic that you may experience in certain situations. Taking the medication as prescribed relieves your symptoms temporarily, which may allow you to attend an appointment or engage in a social activity that might otherwise cause anxiety. A typical dosage may last three or four hours.

Like other benzodiazepines, though, misuse of alprazolam can lead to your becoming reliant on it. And compared with other types of commonly prescribed benzodiazepines, studies show that alprazolam may be associated with a higher potential for misuse, and may land people in the emergency room more often.

All benzodiazepines work by decelerating the central nervous systems. When misused, these depressants can cause serious risk to your health through slowed breathing, which can result in a coma or even death. Even if you taper the use of alprazolam as directed, you could experience withdrawal symptoms that are more complex than those caused by other benzodiazepines. These withdrawal symptoms may arise shortly after the effects of the drug wear off.

In every case, you should use only the medications that you are prescribed and take only the amount required. Read the label explaining how the drug interacts with other substances. Due to the higher potential for misuse of alprazolam compared with other psychoactive drugs, consider alternative therapies for anxiety or panic disorder before opting for a prescription.

Do you think you or someone you know has overdosed on alprazolam? Call 911 immediately.

2. Alprazolam withdrawal

The onset and intensity of withdrawal symptoms from alprazolam depend on several factors, including how long you’ve taken the drug, the dosage, and whether you have routinely taken it with other substances. Medical experts recommend withdrawing from alprazolam slowly, rather than halting its use suddenly.

However, alprazolam withdrawal symptoms may occur even after shorter periods of use; some people experience feelings of withdrawal after even one week of use. And overall symptoms of withdrawal might be more severe than those that occur when quitting other types of benzodiazepines.

Certain patients report experiencing something researchers call “alprazolam withdrawal syndrome.” This refers to symptoms of severe withdrawal, even when usage is slowed according to guidelines. Across different studies, reported withdrawal symptoms specific to alprazolam include a return of panic and anxiety disorders, dizziness, malaise, tachycardia (fast heart rate), weakness, severe sleep disturbance, delirium, and psychosis.

Alprazolam and the brain. Alprazolam acts on our brain to relax us, and so it can have a calming effect to prevent an anxiety or panic attack. However, it sedates large regions of the brain, making it hard to control our ability to breathe, move, and speak.[iii] Even though the drug’s effects wear off in four hours or less, and it’s out of the system in about eight hours, our brain tissue quickly absorbs the medication. This can lead to our craving more of it and our experiencing acute withdrawal symptoms. Long-term use causes side effects that include psychological and physical dependence.

3. Getting alprazolam treatment

Do you recognize the signs of alprazolam misuse or withdrawal in yourself or someone you know? Consult with a licensed medical professional, who can reduce your dosage slowly and carefully. A licensed mental health professional can introduce you to cognitive and other behavioral therapies to relieve the effects of withdrawal symptoms and address causes of anxiety and panic.

  • Medication: There are limited treatments for alprazolam-related withdrawal symptoms. Because it lasts longer, diazepam (brand name Valium) is sometimes used to help manage withdrawal from the shorter-acting Xanax. For overdose situations, Flumazenil, an intravenous solution typically given to patients in health care settings to reverse the postoperative effects of anesthesia, can reverse alprazolam overdose — but it can also cause serious side effects, especially for patients withdrawing from misuse of sedatives. Similarly, naloxone — used to reverse the effects of opioids overdose — is effective in treating alprazolam overdose, but can be used only by professionals in health care settings.
  • Therapy: Recovery from misuse of alprazolam is possible using nonpharmaceutical therapies. Licensed medical and mental health professionals can manage your treatment program and provide behavioral therapies and counseling.
  • Recovery and symptom relief: Physical exercises such as yoga, tai chi, and walking can lower your blood pressure, improve your ability to sleep, and relieve stress — thus benefiting your recovery. Meditation, mindfulness, and other techniques also may relieve symptoms.

Making a recovery plan

Recovery is possible with the guidance of a licensed medical professional to lower your dosage and a mental health professional to provide therapy and nonpharmaceutical options to relieve symptoms. Manage your progress with periodic guidance from your medical and mental health team and friends, family members, and others who can provide support to you in your recovery.

Sources:

A Review of Alprazolam Use, Misuse, and Withdrawal, Journal of Addiction Medicine Jan-Feb 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846112

Alprazolam, MedlinePlus, May 15, 2021

Benzodiazepines and Opioids, National Institute on Drug Abuse, February 3, 2021

What is fentanyl?, National Institute on Drug Abuse, June 2021

This is what happens to your brain when you take Xanax, Business Insider YouTube Post, March 22, 2017

A Review of Alprazolam Use, Misuse, and Withdrawal, Journal of Addiction Medicine Jan-Feb 2018

Alprazolam and diazepam: Addiction potential, Journal of Substance Abuse Treatment, January 1, 1991

Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives, Journal of Clinical Medicine, January 30, 2018

This is what happens to your brain when you take Xanax, Business Insider YouTube Post, March 22, 2017

Alprazolam is relatively more toxic than other benzodiazepines in overdose, British Journal of Clinical Pharmacology, July 2004

Mind and Body Approaches for Stress and Anxiety, National Center for Complementary and Integrative Health, National Institutes of Health, April 2020