Alprazolam (Xanax) is one of the most commonly prescribed anti-anxiety (anxiolytic) drugs in the U.S. Belonging to the benzodiazepine class of anxiolytics, alprazolam medicine is primarily used to treat generalized anxiety disorder, panic disorder and insomnia caused by anxiety. Although alprazolam is FDA-approved for reducing anxiety and panic disorder, it is also prescribed off-label to treat alcohol withdrawal syndrome (AWS), nausea associated with chemotherapy, and muscle spasticity.
Pharmacology: Understanding How Alprazolam Affects the Brain and Body
Xanax causes gamma-aminobutyric acid (GABA), a neurochemical that slows down brain cell activity to surge in the brain. GABA also functions to:
- Moderate stress, fear, and anxiety: Low GABA levels have been implicated in generalized anxiety disorder, depressive disorder, insomnia, and schizophrenia.
- Regulate muscle tone and motor control: Low GABA reduces the activity of nerve cells that control muscle movement. Unless enough GABA reaches these nerve cells, muscles may become overly active and spastic.
Although dietary GABA supplements are available, it is not known whether taking GABA supplements may reduce anxiety. A few animal studies indicate GABA supplements may inhibit brain cell overactivity, but more research involving humans is needed to validate the benefits of GABA supplements.
Alprazolam Dosage Recommendations
Before prescribing Xanax, doctors consider the age and medical history of the patient, the severity of the patient’s mental health issue, and if the patient is taking other medications. Xanax dosages are not increased or decreased due to a person’s weight.
Xanax tablet colors correspond to milligrams:
- White, oval tablets–0.25 mg
- Peach, oval tablets–0.5 mg
- Blue, oval tablets–1 mg
- White, rectangular tablets with rounded corners–2 mg
Xanax XR (extended-release tablets) is primarily prescribed to treat panic disorder:
- White, pentagon-shaped Xanax XR–0.5 mg
- Yellow, square Xanax XR–1 mg
- Blue, round Xanax XR–2 mg
- Green, triangular XR–3 mg
While regular Xanax tablets provide anxiety relief for up to four hours, Xanax XR continues working for up to 10 hours.
Common Alprazolam Side Effects
Xanax is available in oral form. Once taken, the drug rapidly crosses the blood-brain barrier. Most people will feel less anxious and relaxed within 10 to 15 minutes of ingestion. However, the effects of Xanax last only about two to four hours. Factors determining how long users feel sedated and slightly euphoric include their age, metabolic rate, current health condition, and whether they are combining alprazolam with other drugs.
Uncommon Side Effects of Taking Alprazolam
If a person experiences one or more of the following side effects, they should stop taking Xanax and call their doctor immediately:
- Difficulty breathing
- Fainting
- Heart palpitations/irregular heartbeat
- Hives/skin rash
- Abdominal pain
- Nausea/vomiting
- Visual or audio hallucinations
- Rare “paradoxical” reactions to Xanax include seizures, aggressive behavior, and severe muscle spasticity.
Contraindications for Alprazolam
Pregnant women in their third trimester should avoid taking Xanax since all benzodiazepines cross the placenta and can affect the fetus. In addition, alprazolam and other benzodiazepines are excreted in breast milk. Nursing mothers should not take alprazolam medicine.
Infants born with Xanax in their system often suffer from respiratory depression, lethargy, restlessness, uncontrollable movements, and tremors at birth. Infants addicted to Xanax may have neonatal withdrawal symptoms that require intensive care and lengthy hospital stays.
Xanax is also contraindicated in people who are using azole antifungal medications and other CYP3a inhibitors. Combining alprazolam and CYP3A inhibitors will heighten the risk of adverse reactions by increasing the concentration of alprazolam in the brain and bloodstream.
If you plan to ask your doctor about taking Xanax, make sure to tell your doctor if you have a history of:
- Mental illness
- Drug or alcohol addiction
- Kidney or liver disease
- Asthma
- Previous allergic reactions to benzodiazepines, including alprazolam
Xanax and Addiction
The U.S. DEA classifies alprazolam as a Schedule IV Controlled Substance, due to its “low potential for abuse and low risk for addiction.” Other Schedule IV drugs include Valium, Darvon, Darvocet, Ambien, and Soma.
Physical dependence on Xanax can occur within one month, if the drug is taken daily. Suddenly stopping Xanax may cause withdrawal symptoms, such as joint pain, nausea, sweating, heart palpitations, and chills. Physicians trying to wean patients off Xanax will gradually decrease the dosage to reduce the risk of withdrawal symptoms.
Xanax addiction begins when the person develops a tolerance for the drug. Like other addictive substances, alprazolam disrupts the brain’s reward system, which leads to dependence and cravings. The rapid relief Xanax provides for users with severe panic and anxiety disorders often encourages users to take higher doses to achieve the same therapeutic effects they experienced when they first started taking the drug.
Risks of Long-Term Use of Alprazolam Medicine
When they are unable to obtain a prescription, Xanax addicts often turn to drug dealers to buy Xanax. They may also combine Xanax with alcohol to intensify the effects of alprazolam as their tolerance builds and withdrawal symptoms worsen.
Misusing Xanax may also lead to conditions associated with repeated withdrawal and relapsing episodes:
- Leukopenia (abnormally low white blood cell count)
- Pancytopenia (low white and red blood cell counts)
- Thrombocytopenia (low platelet count)
- Gastrointestinal hemorrhage
- Cognitive deficits (especially processing speed and working and recent memory)
One study found that the non-overdose mortality risk for individuals using hypnotic and anti-anxiety drugs is higher when compared to non-users. Researchers associate this risk with the adverse effects of anxiolytics and hypnotics on movement, perception, and cognition. Being under the influence of alprazolam medicine reduces your ability to walk, judge distance and depth, and engage in rational thinking.
Further research indicates that using benzodiazepines to manage depression and anxiety could heighten the risk of suicide. Specifically, some studies reveal that individuals who start and stop taking alprazolam within a two-week timeframe report poor sleep quality, insomnia, and thoughts of suicide. This suggests a connection between benzodiazepine use, significant sleep disruptions, and increased suicide risk. However, researchers are still unclear about why alprazolam is associated with these effects.
Getting Help for a Xanax Addiction
Alprazolam medicine can provide quick relief from anxiety and panic attacks. If you are prescribed Xanax for daily use, your doctor will likely limit your prescription to two but not more than three weeks. For those taking Xanax once every few days, doctors generally limit prescriptions to around four or five weeks. Taking Xanax infrequently, such as only when you feel a panic attack coming, can help reduce the risk of dependency and addiction.
Because of the risk of seizures during withdrawal, recovery from Xanax should begin with a medically supervised detox, followed by treatment. Treatment typically consists of therapies that address the roots of a Xanax addiction and impart healthy coping tools for stress and stress-induced cravings. With the help of these and other supports such as 12-step groups, many patients have gone on to find freedom from Xanax addiction.
