Xanax, also known generically as alprazolam, is a benzodiazepine medication commonly prescribed for the treatment of anxiety and panic disorder 1. More infrequent, off-label uses for Xanax include managing agoraphobia (fear of open spaces) and premenstrual syndrome (PMS) 1.
Xanax works by decreasing pathologically elevated levels of excitation in the brain.1 For people who suffer from extreme anxiety or debilitating panic disorders, Xanax can be a beneficial drug that can improve quality of life. However, due to its rapid delivery of rewarding calming effects, many people chronically abuse this potentially dangerous drug—eventually developing an addiction to Xanax.
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Why Is Xanax Dangerous?
Xanax poses such a serious threat of overdose because the effects of the drug occur quickly after the drug is ingested 2. Compared with many other drugs, Xanax is relatively fast-acting. Shortly after being taken orally, it is absorbed through the GI tract into the bloodstream, then shuttled to the brain where it begins to exert its effects. When too many Xanax tablets are consumed at once, the body may quickly become overwhelmed with the massive dose.
Xanax is a highly addictive drug that users often rely on as the sole means of calming down after a stressful day, when they are feeling anxious, or when they are unable to sleep 2. Because of this, Xanax use and abuse is on the rise around the world 2,3. Some researchers have suggested that Xanax is significantly more toxic—resulting in more severe, complicated cases of overdose—than other benzodiazepines commonly used to treat anxiety 3. As rates of prescribing remain high, drug availability continues to climb. Both those with and without valid Xanax prescriptions have begun to use Xanax at higher rates, which in turn may lead to increased numbers of Xanax addiction and overdose.
Signs and Symptoms of Xanax Overdose
With its quick onset of action, some of the early signs of a Xanax overdose may resemble the side effects of regular Xanax use, which may include 1:
- Changes in appetite.
- Difficulty concentrating.
- Difficulty passing urine.
- Dry mouth.
- Increased salivation.
- Joint pain.
- Changes in sex drive/ability.
- Unusual talkativeness.
While few of these signs and symptoms serve as an accurate gauge for the likelihood of or progression toward an overdose, you should pay close attention to how the person feels for the next several hours following the onset of any of these symptoms. If you experience any of these symptoms, do not take any more Xanax and do not consume any other drugs or alcohol. If the symptoms worsen, seek medical attention immediately.
Some people experience more severe side effects and warning signs of an overdose, including 1:
- Depression symptoms, such as depressed mood or suicidal thoughts or actions.
- Difficulty breathing or labored breathing.
- Difficulty speaking or annunciating.
- Hallucinations (seeing, hearing, or feeling things that are not there).
- Loss of coordination or balance.
- Memory problems.
- Unusual changes in mood or behavior.
- Yellowing of the eyes or skin.
Any of these signs or symptoms can indicate a potential overdose or a serious adverse reaction to the drug. If a person is overdosing from Xanax use, they may have symptoms that include 1,3:
- Profound confusion.
- Severe coordination problems or loss of balance.
- Severe drowsiness and an inability to stay awake.
- Significantly slowed breathing.
- Loss of consciousness.
There are numerous factors that increase an individual’s risk of experiencing a Xanax overdose. One of the most common and lethal factors is polysubstance use, which occurs when an individual consumes more than one drug, or drugs and alcohol, simultaneously. When a person takes Xanax, there are specific drugs that increase the risk of overdose and death.
Combining alcohol, other benzodiazepines, and opiates/opioids is extremely risky 2. All three of these drugs, when taken alone, significantly slow respiration 2. However, when a person consumes Xanax and alcohol together, for instance, the combined effect of both sedative drugs can cause the brain to fail to tell the lungs to breathe 2. The result is that breathing stops altogether and the user essentially suffocates to death 2. This risk of death occurs whenever you consume Xanax in combination with alcohol, other sedatives, opioid pain medications, or illicit opiates, such as heroin.
Another risk factor for Xanax overdose is building a tolerance to the drug. When your body builds up a tolerance to Xanax, it needs more and more of the drug to have the same effect as before 4. If this happens, your doctor may recommend switching to a different medication or abstaining from Xanax use for a while to ensure that your threshold for the effects of Xanax does not reach a dangerous level. When you resume taking Xanax, be sure to take only the prescribed amount and not the amount you have taken in the past. After a period without the drug, your tolerance levels drop, so consuming too much Xanax after a period of abstinence can more easily result in an overdose 4.
Finally, increased age is also associated with a higher risk of Xanax overdose 3. Researchers have found that the Xanax toxicity becomes more pronounced as the body ages 3. While most medical professionals prescribe lower doses for patients over the age of 65, many patients do not follow the doctor’s recommendations or build up a tolerance to the lesser quantities of the drug quickly, which can lead to an overdose caused by Xanax toxicity 3.
What to Do If You Overdose on Xanax
If you or someone you know has overdosed on Xanax, call 911 for emergency help immediately. If possible, provide them with specific information, such as:
- How much Xanax was consumed.
- When it was consumed.
- The person’s height, weight, and age.
Stay with the person and monitor their breathing. If the person is wearing anything around their neck (such as a tie or necklace), carefully remove it. Ensure that the person’s airway is clear and check to make sure they are inhaling and exhaling 4. If their breathing stops, perform mouth-to-mouth resuscitation until medical help arrives.
Once a person has been taken into medical care, a Xanax overdose is usually treated with gastric lavage (stomach pumping) and intravenous fluids to help flush the toxic chemicals from the body 4. In some cases, medical professionals may treat a Xanax overdose with flumazenil, which is a benzodiazepine antidote capable of reversing some of the life-threatening overdose effects. Flumazenil administration will proceed cautiously, since it is itself associated with some health risks (such as seizure), and it will likely be used in combination with other treatments, such as assisted respiration, gastric lavage, and intravenous fluids 4.
Preventing Xanax Overdose
If you have been prescribed Xanax for medical reasons, the best way to avoid a Xanax overdose is to adhere to prescribed orders—closely monitor your dose and the time at which you take your medication 2. Track your Xanax consumption in a notebook or on your phone. If you notice that you are taking a higher dose of the drug, taking the drug more often, or you want to consume more of the drug, talk with your doctor immediately.
If you believe you or someone you care about may have developed a Xanax addiction, and are concerned about your overdose risks, seek professional mental health or drug rehabilitation treatment. You have several options when it comes to addiction treatment, including:
- Individual Counseling: This type of counseling involves seeing a substance abuse counselor for one-on-one sessions in which you discuss your recovery, mental health, and any barriers you encounter while on the road to recovery.
- Group Therapy: This can include group therapy sessions run by a counselor or self-help groups, such as 12-step programs.
- Outpatient Treatment: This type of treatment involves meeting with a counselor or in a group therapy setting 1 to 2 times per week for 1 to 2 hours per meeting.
- Intensive Outpatient Treatment: Meeting with a counselor or in a group therapy setting 3 to 4 times per week for 2 to 4 hours per meeting, this type of treatment is relatively more intense than other forms of outpatient treatment, since you receive more counseling on a daily and weekly basis.
- Partial Hospitalization: This variant on outpatient treatment is generally conducted in a hospital setting for 4 to 6 hours per day on weekdays.
- Inpatient Treatment: Inpatient treatment involves living at a drug rehab center for the duration of treatment, which typically lasts 30 days to 18 months (or more, if needed), depending on the severity of the addiction.
Substance abuse is of great concern to medical and mental health professionals. Decades of scientific research on substance abuse treatment has helped drug rehab facilities develop highly effective therapeutic techniques for helping patients overcome addiction to Xanax and other drugs.
For example, cognitive behavioral therapy is an effective and reliable treatment option in which a trained therapist helps patients identify the unhealthy thoughts and behavior patterns that led to the substance abuse. Therapists then help their patients identify attractive alternative behaviors—such as hobbies, exercise, and enjoyable employment—to use as coping skills for the unpleasant emotions and experiences that once were solved with drugs.
- U.S. National Library of Medicine. (2016). Alprazolam.
- University of New South Wales: Sydney. (2017). Xanax overdoes and related deaths – A podcast.
- Isbister, G. K., O’Regan, L., Sibbritt, D., & Whyte, I. M. (2004). Alprazolam is relatively more toxic than other benzodiazepines in overdose. British Journal of Clinical Pharmacology, 58(1), 88–95.
- Vintage Pharmaceuticals. (2008). Alprazolam Tablets, USP 0.25 mg, 0.5 mg and 1 mg.