What is Xanax?
Xanax—the brand name of the generic medication alprazolam—is used to treat generalized anxiety disorder and panic disorder (with or without agoraphobia). Xanax is a type of medication called a benzodiazepine. Like other benzodiazepines, Xanax is sometimes also prescribed for “off-label” use to treat sleep problems. Off-label use is when a medication is taken for a condition it has not been approved by the Food and Drug Administration (FDA) to treat. This is a common and acceptable medical practice.
Benzodiazepines work by slowing down selected areas of your brain’s activity by attaching to gamma-aminobutyric (GABA) neuroreceptors in your brain. GABA is a neurotransmitter (a type of small molecule in your brain) that relays messages from one nerve to another. Benzodiazepines help you feel calm and/or drowsy by slowing down your brain’s activity at its GABA receptors.
There are a few things to keep in mind when considering and discussing any benzodiazepine medication with your prescribing doctor, nurse practitioner, or Minded psychiatry provider. Benzodiazepines (including Xanax) are typically prescribed for short-term use—usually several weeks or possibly months. You may have heard that taking benzodiazepines comes with a risk of developing a physical and/or psychological dependence—or addiction—to these medications. The risk of abuse or dependence is typically greater in people with a previous history of substance use disorder. The Drug Enforcement Agency (DEA) classified benzodiazepines as controlled substances.
Xanax is available in multiple forms and doses:
- 0.25 mg
- 0.5 mg
- 1 mg
- 2 mg
Xanax XR (extended release) tablet
- 0.5 mg
- 1 mg
- 2 mg
- 3 mg
The Xanax dosage you take typically depends on what you are taking it for. If you are taking Xanax for anxiety, you may take it in multiple doses (as prescribed) throughout the day. If you are taking Xanax for sleep, you may take it once a day (as prescribed) before going to bed.
A typical starting dose of Xanax for generalized anxiety disorder is 0.25 taken 3 times per day. If your starting dose does not ease your symptoms, your prescribing doctor, nurse practitioner, or Minded psychiatry provider may increase the dose every 3 to 4 days. The maximum recommended daily dose is 4 mg, taken as divided doses.
For panic disorder, a typical starting dose of Xanax is 0.5 mg, taken 3 times daily. If this dose is not enough to ease your symptoms, your healthcare professional may increase the dose every 3 to 4 days, usually by no more than 1 mg per day. While the average dose of Xanax for panic disorder in controlled trials was up to 5 mg to 6 mg daily, some people needed as much as 10 mg per day to ease their symptoms.
Because elderly people may be more sensitive to the side effects of Xanax (and benzodiazepines generally), their recommended starting dose is lower—0.25 mg, taken 2 or 3 times daily.
Xanax may be taken daily at regularly scheduled times or on an as-needed basis. Your prescribing doctor, nurse practitioner, or Minded psychiatry provider will give you instructions that include when and how often to take this medication—and the maximum amount that can be taken in a day.
You can take Xanax with or without food, but if you develop an upset stomach after taking it without food, you may want to take it with food going forward.
If you accidentally miss a dose of Xanax you will want to either take the missed dose as soon as you remember, or if it is close to when you would take your next dose, just go ahead and take the next dose.
Xanax side effects, warnings, and interactions
Xanax side effects
Common side effects of Xanax include:
- Difficulty saying words (dysarthria)
- Low blood pressure (hypotension)
- Reduced sex drive
- Trouble with coordination
- Impaired memory
- Impaired concentration
Side effects like these may decrease during the first few weeks of taking Xanax.
Always let your provider know if you experience these (or any other) side effects.
Rare or serious side effects of Xanax include:
- Extreme tiredness or dizziness
- Increased heart rate
- Passing out (fainting)
- Severe allergic reaction and facial swelling, which can occur even on the first dose
- Respiratory depression
- Thoughts of self-harm or suicide
In some cases, people who take benzodiazepines to help with sleep engage in activities—such as driving, eating, or making phone calls—while they are either asleep or not completely awake. They do not remember having done these things once they are awake.
Seek medical attention right away if you experience these—or any other—serious or worsening side effects while you are taking Xanax.
As with other benzodiazepines, Xanax comes with an FDA “Black Box” warning. This means that the FDA has identified serious safety risks that could occur from taking this medication. These safety warnings are serious—though the actual risk may be low.
The Black Box warning for Xanax states that:
- Taking benzodiazepines (such as Xanax) in addition to opioids may lead to serious, possibly fatal, interactions
- Using benzodiazepines comes with a risk of abuse, misuse, and/or addiction
- Continuing to use benzodiazepines may lead to physical dependence on them and/or cause withdrawal, potentially life-threatening, if these medications are discontinued abruptly
Xanax and pregnancy
It is important to discuss your treatment plan with your prescribing doctor, nurse practitioner, or Minded psychiatry provider if you are planning on becoming pregnant and/or breastfeeding. This is because taking Xanax while pregnant may harm your baby. Xanax may also be passed to your baby through breast milk.
Xanax withdrawal symptoms
Xanax can cause withdrawal symptoms if stopped suddenly. If you need to stop taking Xanax, discuss a plan to do so carefully and safely with your healthcare provider.
Xanax withdrawal symptoms can be life-threatening and include:
- Difficulty concentrating
- Difficulty sleeping
- Feeling discouraged, sad, or empty
- Feeling irritable
- Lack of interest or pleasure
- Loss of appetite
- Nausea or vomiting
- Seizures or tremors
- Stomach or muscle cramps
- Suicidal thoughts
- Unusual behaviors
Tell your prescribing doctor, nurse practitioner, or Minded psychiatry provider about any other medications or supplements you may be taking to determine if Xanax might have any negative interactions with them.
Xanax may interact with:
- Antihistamines, such as Benadryl (diphenhydramine)
- Antipsychotic medications
- Luvox (fluvoxamine)
- Narcotic pain medications, such as morphine, OxyContin (oxycodone), Lortab (hydrocodone), or Vicodin (hydrocodone)
- Nizoral (ketoconazole)
- Opioid cough medications, such as codeine cough syrup
- Other anti-anxiety medications
- Other benzodiazepines
- Serzone (nefazodone)
- Sleep medications, such as Ambien (zolpidem)
- Some antiepileptic medications, such as Dilantin (phenytoin), Luminal (phenobarbital), or Tegretol (carbamazepine)
- Sporanox (itraconazole)
- Tagamet (cimetidine)
- Tricyclic antidepressants, such as Elavil (amitriptyline)
Xanax and alcohol
You should not drink alcohol while you are taking Xanax. Not only can alcohol decrease the benefits of medications such as Xanax, but it can also increase their negative side effects—such as sedation. Because alcohol can impair judgment and memory, drinking might also increase your risk of unintentionally overdosing on Xanax by taking a higher dose than prescribed.
Symptoms of a Xanax overdose include:
- Decreased coordination
- Slowed reflexes
An overdose of Xanax can be fatal—seek immediate medical attention if you are experiencing any overdose symptoms.