The Side Effects of Xanax Use
What Is Xanax?
[content-overview]Xanax (generic name: alprazolam) is a powerful benzodiazepine drug that is used to treat anxiety and panic disorders by decreasing abnormal excitement in the brain.1,2 The medication comes in the form of a tablet that quickly dissolves in the mouth, and extended-release tablet, or a concentrated oral solution.1 [/content-overview]
Benzodiazepines can have therapeutic anti-anxiety, anti-convulsant, muscle relaxing, and sedative effects.3 Xanax is often prescribed for mental health disorders related to anxiety, including:4
- Generalized anxiety disorder.
- Panic disorder.
How do you know if you or a loved one is addicted? Find out here.
Alprazolam is among the most prescribed benzodiazepine drugs in the U.S. and is among the benzodiazepines most often found in the illegal market, according to the Drug Enforcement Administration.3 The top 5 most prescribed benzodiazepines are:3
- Alprazolam (including Xanax).
- Lorazepam (including Ativan).
- Clonazepam (including Klonopin).
- Diazepam (including Valium).
- Temazepam (including Restoril).
When taken as prescribed, the short-term effects of Xanax are beneficial to many individuals. Although it isn't known exactly how Xanax works, it causes a depression of the central nervous system (CNS).4 CNS depressants cause calming and drowsy effects.2
You don't have to use it for a long time to begin experiencing some of the negative effects of the medication, however. Side effects of Xanax typically occur when it is first started.4 When you use Xanax in larger quantities, you increase the risk of side effects and overdose.
Side Effects of Xanax
All medications have potential side effects, including Xanax. Even when adhering to prescribed dosing, side effects can still occur—with some being more serious than others. Some of the common side effects of Xanax include:11
- Difficulty concentrating.
- Dry mouth.
- Changes in sex drive.
- Increased salivation.
- Slurred speech.
- Appetite changes.
- Memory problems.
- Decreased coordination.
- Urinary retention.
- Changes in menstrual cycle.
- Low blood pressure.
Some of the serious possible side effects of Xanax include:11
- Slow and/or shallow breathing.
- Dependency on Xanax.
- Increased heart rate.
- Liver damage.
The risk of side effects can be increased by mixing Xanax with other drugs, especially other depressants like alcohol or opioids.1,3 This can increase the risk of potentially fatal breathing issues, sedation, or coma. Because of this, using alcohol or illegal drugs while taking any benzodiazepine is never recommended, and any other medications should be cleared by a medical provider.1
Overdose can occur when someone takes more than their prescribed dose, takes the prescribed dose more frequently than scheduled, or takes the drug with anotehr drug like alcohol. Signs of alprazolam overdose can include:1,4
- Problems with coordination.
- Impaired reflexes.
When you see the signs of an overdose, don't wait—call 911 immediately. Learn what to do at our blog, Taking Action: How to Intervene During an Overdose.
Credit: American Addiction Centers
Lasting Health Effects
Chronic use of sedatives is associated with:6
- Cognitive deficits.
- Psychomotor impairment.
- Dependence on the drug.
- Abuse of the drug.
In a meta-analysis of individuals using benzodazepines on a long-term basis, cognitive impairments were noted despite stopping the benzodiazepines. These include problems with visuospation cognition, attention and concentrating, general intelligence, and psychomotor speed.7
People who take benzodiazepines for an extended amount of time may build up a tolerance for some effects of the drugs.5 When tolerance occurs, your body requires a larger dose or an increased frequency of use to achieve the same or similar effect that the substance had on you when you began taking it.2
If you continually use Xanax, especially in larger quantities, you may develop a physical dependency on the medication.3,5 When this happens, your body doesn't function properly without it.12 Of note, It is possible for someone to become physically dependent on the drug even when used as prescribed.3
If you continually use Xanax, especially in larger quantities, you may develop a physical dependency on the medication. When this happens, your body doesn't function properly without it. Of note: It is possible for someone to become physically dependent on the drug even when used as prescribed.
You can experience withdrawal symptoms if you suddenly stop using Xanax or suddenly decrease your dose significantly.1 Some users may continue taking it to avoid the onset of these unpleasant, potentially life-threatening withdrawal symptoms.4,9 The dangers of withdrawal from benzodiazepines like Xanax means that a person should not stop taking them without consulting with a medical provider. If they are possibly dependent on the medication, they should be tapered off gradually.1 Many addiction treatment programs offer supervised medical detox to provide a safer experience as you end your Xanax use and begin your recovery.
Withdrawal symptoms, or continuing the drug to avoid or alleviate withdrawal symptoms, is one of many possible signs of a substance use disorderbut it does not indicate that a person has a substance use disorder in and of itself. A substance use disorder is marked by using a substance in a problematic pattern that causes significant impairment or distress.9
Potential for Substance Use Disorder
Due to the reinforcing effects they can cause, benzodiazepines are considered to have misuse liability, particularly in individuals with drug misuse histories. Xanax is considered by many to have a high misuse liability.5 According to the U.S. National Library of Medicine, Xanax can become habit forming and should not be used in large quantities than prescribe or for a longer time period than prescribed.1
Symptoms of having an alprazolam use disorder can include:9
- Often taking alprazolam more or in larger amounts than intended.
- Persistently wanting to or unsuccessfully trying to decrease or control alprazolam use.
- Spending a lot of time getting, using, or recovering from alprazolam.
- Craving alprazolam.
- Having problems fulfilling important responsibilities at school, work, or home due to regular alprazolam use.
- Continuing using alprazolam even though it is causing or worsening trouble with relationships or other social issues.
- Stopping or decreasing important activities because of alprazolam use.
- Using alprazolam repeatedly in dangerous situations.
- Continuing using alprazolam even when knowing that it is likely causing or worsening a physical or psychological problem.
- Experiencing tolerance and/or withdrawal (unless they occur when taking alprazolam as prescribed).
Suddenly stopping Xanax or suddenly decreasing the dose significantly can lead to withdrawal symptoms.1 These symptoms could be life-threatening. The risk of withdrawal should always be considered before stopping or decreasing Xanax use, especially in those who've taken a benzodiazepine for any considerable length of time.4 Individuals should not stop or decrease their benzodiazepine use without consulting a medical provider.
Symptoms of alprazolam withdrawal can include:1,4
- Sensitivity to noise or light.
- Difficulty concentrating.
- Blurred vision.
- Muscle cramps.
- Paresthesia or numbness/tingling in the extremities.
- Digestive upset.
If you think you or someone else is going through withdrawal, seek medical help immediately. Call 911 if any severe symptoms are present.
When you first arrive at a treatment center, the first step after assessment should be detoxification if you are dependent on the drug. Supervised medical detox is extremely important for Xanax-dependent individuals due to seizure risk and other medical dangers. This can be done in an outpatient or inpatient setting, depending on the individual's needs. During medical detox, you may be slowly weaned off Xanax over the course of several weeks or even months in order to give your body a chance to readjust slowly, decreasing the risks of withdrawal. Alternatively, you may be switched to another benzodiazepine with a longer half-life and then tapered off that medication.8
For some individuals, an inpatient detox is the best option.8 Hospitals and medical detoxification centers should have trained medical staff on hand to help prevent or reduce withdrawal symptoms through medications and other means. If any complications arise, the staff can intervene and/or get the patient to emergency care as appropriate.
For individuals who do not have polysubstance dependence, whose benzodiazepine doses were generally in the therapeutic range, and who are both dependable and have a dependable support system to help monitor them, outpatient medical detox might be appropriate.8
Detoxification alone is not treatment for a substance use disorder.8 Once the detoxification process is over, if you have a substance use disorder, your treatment should shift to focus on the disorder itself, typically including addressing the reasons behind your use and learning how to prevent relapse. Forms of therapy may include cognitive behavioral therapy, motivational enhancement therapy, twelve-step facilitation, and/or contingency management (which incentivizes positive behaviors).10 Both individual and group counseling are generally a part of treatment, and family therapy may be as well.
Outpatient treatment programs offer more flexibility than inpatient programs. However, some people need the additional structure that an inpatient program provides. It's important that you review all of your options and choose a program that's right for your physical health, mental health, and overall well-being. Any trustworthy program will also evaluate you first to ensure they can safely and appropriately meet your needs.
Outpatient treatment programs, by definition, do not have patients stay overnight at the treatment facility. Depending on the intensity of the program, you may be able to receive treatment while still working or attending school. There is a wide range of options for outpatient treatment including:
- Individual and/or group therapy. This can help target the underlying factors in your addiction and/or help you learn relapse prevention skills.
- Nonprofessional/community-based support groups. There are many programs (such as AA and NA) and peer support groups that can be helpful in learning to manage and cope with your disorder and in avoiding relapse.
Inpatient treatment programs require you to live at the facility for the duration of your treatment, often recommending 30, 60, or 90 days. During your stay, your days focus on your recovery. A typical day at a treatment facility could include group therapy sessions, an individual therapy session, recreational activities designed to help you learn how to relax and have fun without drugs, addiction education groups, skills training, and/or relapse prevention education.
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- U.S. National Library of Medicine: MedlinePlus. (2017). Alprazolam.
- National Institute on Drug Abuse. (2018). Prescription CNS Depressants.
- Drug Enforcement Administration. (2013). Benzodiazepines.
- U.S. Food and Drug Administration. (2011). Xanax.
- Ait-Daoud, Nassima., Hamby, Allan Scott., Sharma, Sana., Blevins, Derek. (2018). A Review of Alprazolam Use, Misuse, and Withdrawal.
- Weymann, Deirdre., Gladstone, Emilie J., Smolina, Kate., Morgan, Steven G. (2017). Long-Term Sedative Use Among Community-dwelling Adults: A Population-Based Analysis. CMAJ Open. 5(1): E52–E60.
- Barker, MJ., Greenwood, KM., Jackson, M., Crowe, SF. (2004). Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis. Archives of Clinical Neuropsychology, 19(3), 437-454.
- Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- National Institute on Drug Abuse. (2018). Treatment and Recovery.
- Epocrates. (n.d.). Alprazolam.
- National Institute on Drug Abuse. (2007). The Neurobiology of Drug Addiction.