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Xanax: 12 Things You Should Know

Medically reviewed on Mar 16, 2017 by L. Anderson, PharmD.

Xanax Has Been Around for Over 30 Years

Xanax, commonly referred to by its generic name alprazolam, was originally developed by Upjohn Labs in the late 1960's as a sleep aid with muscle relaxant properties, but researchers soon learned it had other properties, too. Xanax, in the class known as benzodiazepines, works to suppress the overreaction of the central nervous system. It was found to be effective for anxiety and panic disorder, and the FDA approved these uses in 1981. Xanax has been one of the most successful, but worrisome, blockbusters in years past due to a serious addiction potential. Patients also develop tolerance, requiring higher and higher doses.

How Xanax Works

When you have anxiety don't you feel like everything is moving faster? Xanax is a benzodiazepine, and like all benzodiazepines, has action as a central nervous system (CNS) depressant. Benzodiazepines increase the neurotransmitter gamma-aminobutryic acid (GABA) in the brain to illicit a calming, sedative effect. But alprazolam can cause drowsiness and affect your ability to react to situations. For these reasons, you should not combine alprazolam with alcohol, other CNS depressant medications like narcotic painkillers, or driving. Your inability to react quickly to an unexpected situation may lead to a car accident. Plus, as reported in a 2017 study published in BMJ, the combination of sedatives like Xanax and narcotic pain killers can be fatal due to suppressed breathing.

I'm Afraid I Don't Know What Anxiety Is

We all worry. But when chronic, unwarranted worry lasts for over 6 months and disrupts our normal lifestyle, this may be diagnosed as Generalized Anxiety Disorder (GAD). GAD affects about 5% of adults in the U.S. The occurrence of at least 3 symptoms below may constitute a diagnosis of GAD:

  • Excess anxiety for at least 6 months, but not due to another condition or substance abuse
  • Sleep disturbances, insomnia
  • Fatigue
  • Restlessness
  • Difficulty concentrating
  • Irritability
  • Muscle tension

Understanding Panic Attacks

A panic attack is not just that dreaded feeling you get when you know you missed your mortgage payment. Panic disorder, or panic attacks are repeated episodes of intense fear which may be expected or unexpected.

Physical symptoms are similar to the body's normal response to danger - the fight or flight phenomenon. Symptoms of a panic attack usually start very quickly and include rapid heartbeat, shortness of breath, dizziness, tingling, and anxiousness. Anxiety medication may be used short-term while other preferred medications, like SSRI antidepressants, kick in for treatment of panic disorder. Psychotherapy, often called talk therapy, may be used, too.

How is Xanax Dosed?

Doses of alprazolam for anxiety or panic typical start low, and go slow. Doses range from 0.25 mg to 0.5 mg tablets, usually given three times day, although your doctor may adjust this based on your individual symptoms. Lower doses are needed in the elderly and with severe liver disease. Slowly stop this medication, too, tapering by no more than 0.5 mg every 3 days.

Alprazolam also comes as Xanax XR, an extended-release form for panic disorder, as an orally-disintegrating tablet called Niravam, and in a liquid. Generics are available for all forms.

Should Grandma Be Taking Xanax?

The elderly are very sensitive to the effects of benzodiazepines, and in general, they should be avoided in those over 65 years of age.The 2015 updated Beers Criteria, an expert opinion-developed guideline addressing safe drug use in the elderly, recommends against the use of this class in the elderly. Older adults have a lowered metabolism (liver break down) of this drug class, which may elevate dangerous side effects like dizziness or falls, excessive sedation, and confusion.

If there is a documented need, physician-monitored low doses and drugs with shorter durations (half-lives) will help to minimize side effects like dizziness, weakness, and falls that may lead to hip fractures.

Learn How to Correctly Stop Taking Xanax

The benzodiazepine class has addictive potential - this is a well-known fact. Abruptly stopping Xanax after you have been regularly taking it, even if only for a short while, can lead to troublesome side effects. You may end up having trouble sleeping, much worsened (rebound) anxiety, restlessness, irritability, weakness, blurred vision, panic attacks, tremors, sweating/flushing, nausea/vomiting, headache, seizures, psychosis, and even hallucinations. In general, benzodiazepines should be discontinued slowly to minimize symptoms. Talk to your doctor how to slowly stop a benzodiazepine like Xanax.

Why the Bad Rap for Grapefruit Juice?

You might think that grapefruit juice interactions with medicines aren't really that important, but you are wrong. Grapefruit and grapefruit juice can affect liver enzymes that are needed to break down (metabolize) Xanax. When you take Xanax with grapefruit, the amount of alprazolam in your blood may increase and boost side effects, like drowsiness, dizziness and confusion.

It may be best if you avoid grapefruit juice while you take alprazolam; but do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor. Luckily, orange juice does not interact with benzodiazepines so you can still get your daily dose of vitamin C.

Avoid These Xanax Drug Interactions

As was mentioned before, liver enzymes are a source of drug interactions for many medicines when used in combination with alprazolam. Two interactions are very important to know about - Xanax should not be used with oral ketoconazole or itraconazole, two antifungal medicines, because these drugs inhibit (block) the 3A4 liver enzymes needed to break down alprazolam for elimination from your body. Using either of these drugs together with Xanax can cause drowsiness, slowed breathing and possible confusion. These reactions can be especially serious in seniors. Always have your pharmacist check for drug interactions with Xanax and you can check them here, too.

What is the Biggest Concern With Xanax Abuse?

The combination of Xanax or other similar sedatives with narcotic (opioid) painkillers and/or alcohol is a real concern. Over 124,000 emergency department (ED) visits due to Xanax abuse were reported by the SAMHSA's Drug Abuse Warning Network in a 2014 publication. During the 7 years from 2005 to 2011, almost one million ED visits involved benzodiazepines alone or in combination with opioid pain relievers or alcohol.

The combination of a benzodiazepine like Xanax with alcohol and/or narcotic painkillers such as Oxycontin, Percocet and Vicodin is particularly dangerous because it can cause individuals to go to sleep and then stop breathing, leading to death.

How to Handle Other More Common Xanax Side Effects

Overall, alprazolam can be a useful drug with low toxicity if used properly and according to doctor directions. Addiction, overdose, and CNS sedation can all be severe effects of Xanax, but alprazolam also has other more common side effects, too.

Irritability and difficulty sleeping (especially when stopping the drug), memory impairment, increased appetite, loss of sexual desire, and confusion may occur. If you experience any side effects due to alprazolam, call your doctor who may adjust your dose to help lessen the side effect. Remember, it's best not to abruptly stop alprazolam, so check with your doctor first if you want to stop the medication.

Generic Xanax is Affordable

If you are prescribed Xanax, you can rest assured it shouldn't cost you too much. The generic for Xanax - alprazolam - is found on many lower cost drug lists at pharmacies; be sure to ask your pharmacist.

Anxiety is often a component of depression, and if you are prescribed an antidepressant, it may take up to 4 weeks for its full effect. In the mean time, you may be prescribed a quick-acting medication like alprazolam to help with those anxious feelings and your sleep. But short-term use -- about 2 to 4 weeks -- of alprazolam treatment is preferred due to its addictive potential.

Finished: Xanax: 12 Things You Should Know

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Sources

  • American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 63:2227–2246, 2015. Accessed March 16, 2017 at http://onlinelibrary.wiley.com/doi/10.1111/jgs.13702/full
  • Opioid Painkillers and Xanax or Valium a Deadly Mix: Study. Drugs.com. Accessed March 16, 2017 at https://www.drugs.com/news/opioid-painkillers-xanax-valium-deadly-mix-study-64838.html
  • Xanax Product Labeling. Pfizer January 2017. Accessed March 16, 2017 at http://labeling.pfizer.com/ShowLabeling.aspx?id=547

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