Xanax: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on Aug 29, 2023.

1. How it works

• Xanax is a brand (trade) name for alprazolam. Alprazolam may be used in the treatment of anxiety and other mood-type disorders. It may also be given for its calming and sedative properties.
• Experts aren't sure exactly how Xanax works to stabilize mood but experts suggest it may enhance the activity of GABA (gamma-aminobutyric acid), an inhibitory neurotransmitter, in the brain. This produces hypnosis (a trancelike state).
• Xanax belongs to the class of medicines known as benzodiazepines.

2. Upsides

• May be used to help manage the symptoms of generalized anxiety disorder or for the short-term relief of symptoms of anxiety. May help the symptoms of anxiety associated with depression.
• May be used for the treatment of panic disorder, with or without agoraphobia (agoraphobia is a fear of places or situations that might cause panic, helplessness, or embarrassment).
• Xanax is available as an immediate-release tablet and an extended-release tablet.
• Available in four strengths: 0.25mg, 0.5mg, 1mg, and 2mg.
• Xanax is available as a generic under the name alprazolam.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Drowsiness and unsteadiness upon standing, increasing the risk of falls.
• May impair reaction skills and affect a person's ability to drive or operate machinery. Avoid alcohol.
• Blood pressure-lowering, heart palpitations, constipation, nausea, dry mouth, headache, and a decrease in libido are also commonly reported side effects.
• Xanax is potentially addictive and may cause emotional or physical dependence that may lead to overdose or death. Before prescribing Xanax assess a person's risk for abuse, misuse, and addiction.
• Withdrawal symptoms (including convulsions, tremors, cramps, vomiting, sweating, or insomnia) may occur with abrupt discontinuation; taper off slowly over several months under a doctor's supervision.
• Smokers may have less of a response to Xanax. The dosage of Xanax may need to be reduced in those with liver disease.
• Although Xanax has been used off-label (not an FDA-approved use but still a common use) in the past to aid sleep, it should not be promoted for this purpose unless there is no other alternative. Benzodiazepines such as Xanax reduce the duration of deep or slow-wave sleep, (which correlates to how refreshed you feel in the morning) and are also associated with addiction, dependence, and tolerances (where progressively larger dosages of the same drug are needed to obtain the same effect). Abrupt discontinuation of Xanax, when used for sleep, has been associated with rebound insomnia that may be worse than the initial sleeping problem.
• Avoid combining Xanax with other benzodiazepines (such as diazepam) or opioids such as oxycodone or hydrocodone. Profound sedation, respiratory depression (abnormally slow and shallow breathing), coma, and death may result. May also interact with several other drugs including those that induce or inhibit CYP 3A hepatic enzymes. Do not use it in people taking strong CYP3A inhibitors such as ketoconazole or itraconazole. There have been reports of death in people with severe pulmonary disease given Xanax.
• May worsen depression in some people. Monitor.
• Needs to be given several times a day. The recommended initial dosage is 0.5mg three times daily.
• May not be suitable for people with significant liver or kidney disease, lung disease or breathing problems, and certain psychiatric disorders.
• If Xanax is given to pregnant women during the later stages of pregnancy, sedation, respiratory depression, lethargy, hypotonia, and withdrawal symptoms may occur in the newborn. Avoid unless the benefits outweigh the risks and observe the infant when born.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Xanax may be used for the treatment of anxiety or panic disorder; however, it is addictive, and withdrawal symptoms can be severe. Can interact with several drugs including those that cause drowsiness or induce or inhibit CYP 3A hepatic enzymes. May not be suitable for people with severe pulmonary disease.

5. Tips

• Xanax may be taken with or without food.
• Avoid operating machinery, driving, or performing tasks that require mental alertness while taking Xanax.
• Avoid alcohol while taking this medicine.
• The lowest effective dose of Xanax should be used for the shortest time possible.
• Extended-release tablets should be taken in the morning, swallowed whole, and not crushed or chewed.
• Withdrawal symptoms (blurred vision, insomnia, sweating, and rarely seizures) may occur if long-term Xanax is stopped abruptly; discontinue slowly on a doctor's advice.
• Not for use if you have acute narrow-angle glaucoma.
• Do not take Xanax with itraconazole (Sporanox) or ketoconazole (Nizoral) or take it with any other medications until you have checked with your doctor that they are compatible with Xanax.
• Keep out of reach of children and pets.
• Do not start or discontinue Xanax during pregnancy without speaking to your provider first.
• Do not use during pregnancy except on a doctor's advice and women should not breastfeed their baby while receiving Xanax.
• Talk to your doctor or pharmacist before taking other medications with Xanax to check that they are compatible with them.

6. Response and effectiveness

• Peak concentrations of Xanax occur 1-2 hours following administration of immediate-release tablets, and up to 12 hours following administration of extended-release forms.
• The duration of the effect of Xanax varies between individuals and formulations (anywhere from 6 to 27 hours).

7. Interactions

Medicines that interact with Xanax may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with Xanax. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Xanax include:

• anti-anxiety medications, including other benzodiazepines, such as lorazepam and oxazepam
• anticonvulsants such as valproate
• antidepressants, such as amitriptyline, imipramine, nortriptyline
• antifungals such as voriconazole
• antihistamines that cause sedation, such as diphenhydramine
• barbiturates
• duloxetine
• HIV medications such as ritonavir (reduce the dosage of Xanax to half of that recommended, then increase to the target dosage after 10 to 14 days)
• monoamine oxidase inhibitors, such as selegiline, isocarboxazid, or phenelzine
• opioid analgesics such as alfentanil, codeine, oxycodone and morphine
• oral contraceptives
• muscle relaxants such as baclofen and cyclobenzaprine
• probenecid
• scopolamine
• sleeping pills, such as zolpidem
• some medications used to treat mental illness, such as clozapine and thioridazine
• strong CYP3A inhibitors, such as ketoconazole and itraconazole (do not use together)
• Other CYP3A inhibitors, such as ritonavir, nefazodone, fluvoxamine, or cimetidine (consider dosage reduction of Xanax)
• theophylline.

Alcohol may worsen the side effects of Xanax such as drowsiness and dizziness.

Note that this list is not all-inclusive and includes only common medications that may interact with Xanax. You should refer to the prescribing information for Xanax for a complete list of interactions.

References

• Xanax (alprazolam) [Package Insert]. Revised 01/2023. Pharmacia and Upjohn Company LLC. https://www.drugs.com/pro/xanax.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Xanax only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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