Xanax Usage and Effects: A Comprehensive Guide

According to the National Institute for Mental Health, 31% of U.S. adults will experience an anxiety disorder in their lifetime. Anxiety disorders include numerous mental health disorders, such as generalized anxiety disorder, social anxiety disorder, phobias, and panic disorder. Understanding the treatment of these disorders with medications like Xanax is imperative for the healing journey and overall well-being.

Understanding Xanax: uses and overview

Xanax (alprazolam) is a benzodiazepine medication used for anxiety disorder and panic disorder in adults. Xanax binds to the benzodiazepine site on the gamma-aminobutyric acid (GABA) type-A receptors in the brain. This enhances the effects of GABA. GABA is an inhibitory neurotransmitter, meaning it decreases and blocks the chemical messages in the brain, calming the nerves in the brain. This promotes relaxation and calmness.

Anxiety is the way your body handles stress. Some anxiety is normal; however, with anxiety disorders, there is intense fear and worry. This constant worrying can cause issues with daily living and can affect relationships, school, or work. It can cause avoidance of situations known to cause anxiety.

General symptoms of anxiety include:

  • Trouble sleeping
  • Easily irritated
  • Easily fatigued
  • Trouble concentrating
  • Muscle aches
  • Restlessness

Panic disorder is a type of anxiety where you have recurrent episodes of intense fear. These attacks cause physical as well as psychological symptoms.

These symptoms include:

  • Chest pain or pounding/racing heart
  • Sweating or chills
  • Difficulty breathing
  • Stomach pain
  • Dizzines
  • Feeling like they are in danger
  • Weakness
  • Feeling out of control
  • Fear of death

The American Psychiatric Association estimates that approximately 2–3% of adults in the United States have panic disorder.

How long does it take to work?

Xanax is an intermediate-onset benzodiazepine and reaches its maximum concentration in the body within 1–2 hours. Most people start to feel the effects within an hour, some sooner.

Xanax can lead to tolerance, where more medication is needed to feel the same effect.

How does Xanax make you feel?

As with all medications, Xanax can cause mild and severe side effects.

Common but mild side effects include:

  • Drowsiness and fatigue
  • Irritability
  • Impaired memory
  • Impaired coordination
  • Lightheadedness
  • Dry mouth
  • Changes in appetite
  • Changes in weight
  • Low blood pressure
  • Changes in libido
  • Slurred speech

Serious side effects include:

  • Seizures
  • Hallucinations
  • Risk of dependence, overdose, or withdrawal
  • Respiratory depression

Xanax can worsen depression. Anxiety and panic disorders are often associated with other mental health disorders, such as depression. While taking Xanax, patients should be monitored for changes in mood, worsening depression, and suicidal thoughts.

How long does Xanax last?

Xanax is considered a short-acting benzodiazepine. Its effects usually last about 6 hours.

How long does Xanax stay in the body?

Xanax has a half-life of about 11 hours in healthy individuals. This means it takes about 11 hours for half of the medication to leave your body. The time frame can be extended based on the length of time you have taken Xanax, the frequency, and the dosage.

Other factors that can affect how long it stays in your system include:

  • Liver disease
  • Kidney disease or impairment
  • Obesity
  • Being elderly
  • Being of Asian descent
  • Smoking

Xanax and drug tests

Xanax can be detected by various drug tests for differing amounts of time. These include blood, urine, and saliva samples and hair follicles. The amount of time it can be detected can vary depending on age, comorbidities, smoking status, and length of use.

Average detection times by method:

Blood: 1 day
Saliva: 2.5 days
Urine: 4 days; up to a week for heavy users
Hair: 1 month

What is the dosage of Xanax?

Xanax comes as an immediate-release tablet and extended-release tablet, oral disintegrating tablet, and solution.

Immediate-release tablet, oral disintegrating tablet, and solution

For general anxiety disorder (GAD), typical starting doses in healthy adults are 0.25 mg or 0.5 mg three times a day. The dose can be adjusted every 3–4 days until a proper response is seen. Total daily dosages should not exceed 4 mg.

For panic disorder, Xanax is typically started at 0.5 mg three times a day and adjusted every 3–4 days. Normal dosages for panic disorder range from 1 mg to 10 mg daily.

Extended-release tablets

Xanax XR is only indicated for panic disorder. Typical starting doses in healthy adults are 0.5 mg to 1 mg once daily. The dosage can be adjusted every 3–4 days until a proper response is seen. Most patients are adequately maintained at dosages of 3 mg to 6 mg per day. Total daily dosages should not exceed 10 mg.

Patients who are over 65 and those with liver disease or impairment will require dosage reductions, as they are more sensitive to the effects of Xanax.

The lowest effective dose should be used and frequently reevaluated. Some patients may be prescribed an antidepressant medication along with Xanax to help control symptoms. Benzodiazepines such as Xanax work quickly, whereas antidepressants do not. Xanax can help relieve symptoms until other medications start to work.

When stopping or decreasing Xanax, it should be tapered or decreased gradually. Suddenly stopping can increase withdrawal symptoms. It is recommended to decrease the dosage by up to 0.5 mg every 3 days under the supervision of a healthcare provider. It is important to consult with your healthcare provider as they can provide personalized care and dosage recommendations tailored to your needs.

What drugs and substances interact with Xanax?

Xanax has many interactions that increase the risk of serious side effects, including death. Xanax should be avoided with other central nervous system (CNS) depressants, as it can cause respiratory depression, excess sedation, and low blood pressure.

CNS depressants include:

  • Alcohol
  • Opioids
  • Street drugs
  • Sleeping medications
  • Benzodiazepines
  • Muscle relaxers

Xanax is processed in the liver by specific enzymes. Medications that are metabolized in the liver by the same enzyme pathway can increase or decrease the effect of Xanax and lead to serious side effects.

Common medications include:

  • Some antidepressants such as fluoxetine, fluvoxamine, nefazodone, and trazodone
  • Seizure medications such as carbamazepine and phenytoin
  • Antihistamines such as diphenhydramine, doxylamine, and meclizine
  • Macrolide antibiotics such as clarithromycin
  • Azole antifungals such as ketoconazole and itraconazole
  • St. John’s wort
  • Rifampin
  • Cimetidine
  • Ritonavir

The risks of excessive Xanax use

Xanax is a schedule IV controlled substance because it has the potential for abuse and psychological dependence. The risk is lower with schedule IV medication compared to schedule II medication. Taking more than prescribed and taking with other medications or alcohol can increase the risk of fatal side effects.

Xanax use increases the levels of dopamine in the brain. Dopamine elicits feelings of pleasure. Excess dopamine can result in a euphoric mood, which may cause some to take more medication than prescribed. This can lead to abuse and overdose.

Symptoms of overdose include:

  • Excessive sedation
  • Breathing difficulties
  • Low blood pressure
  • Slowed heart rate
  • Slurred speech
  • Cognitive impairment

Anyone experiencing overdose symptoms should be treated at the nearest emergency room immediately. Alternatively, you can visit FindTreatment for more information.

Risks of dependence and withdrawal

Using Xanax, even as prescribed and for short periods, can cause dependency. Dependency is when the medication is needed for normal functioning. Stopping or decreasing usually results in withdrawal symptoms.

It is recommended to slowly lower the dose to avoid unwanted withdrawal effects. Withdrawal symptoms usually start within 1–4 days after stopping or lowering the dose of Xanax.

Common withdrawal effects include:

  • Insomnia
  • Irritability
  • Increased anxiety
  • Tremors
  • Sweating
  • Nausea and vomiting
  • Heart palpitations
  • Muscle pain
  • Headaches
  • Trouble concentrating

At high doses, withdrawal can cause hallucinations, delusions, and seizures.

Your prescriber can help you manage withdrawal effects. It is best to slowly taper off Xanax to avoid unwanted effects. A dose reduction should be done with proper consultation and support from a healthcare professional. In severe cases, an inpatient detoxification center may be the best option.

How is Xanax prescribed?

Xanax is only available by prescription and must be authorized by a healthcare provider. It is against the law to share or give away your prescription to another person. For more information, speak with your pharmacist or healthcare provider.

Anxiety and panic disorders are debilitating conditions. Xanax is an effective medication for the short-term relief of anxiety symptoms. It should be prescribed at the lowest effective dose and should be frequently reevaluated as it has serious side effects and risks.

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