What to Know About Xanax (Alprazolam)

An antianxiety medication should be part of a comprehensive treatment plan

In This Article

Xanax (alprazolam) is an oral prescription medication used for the treatment of anxiety and panic disorder. It comes in tablet form with immediate release and extended release (XR) formulations. Xanax is also prescribed off-label for treatment of several conditions, including insomnia.

Xanax can cause side effects, such as extreme tiredness or confusion, and an overdose can be life-threatening. This medication can be addictive and, in addition to its indicated uses, Xanax is also sometimes a drug of abuse.

Xanax treats anxiety and panic disorder
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Uses

Xanax is prescribed to relieve and prevent symptoms of anxiety. It should be used as part of a comprehensive plan to manage anxiety that can include strategies like psychotherapy and counseling. 

Xanax approved for: 

  • Managing anxiety disorder
  • Short-term relief of symptoms of anxiety
  • Panic disorder

Xanax is indicated for treating conditions that are diagnosed as anxiety disorders based on medical criteria. It is not meant to be prescribed for coping with stress or dealing with tension that occurs in response to external situations. 

Xanax is a benzodiazepine, which is a category of prescription medications that bind to the gamma aminobutyric acid (GABA) receptor in the brain. GABA is an inhibitory neurotransmitter and it is believed that Xanax prevents overactivity of the nervous system by mediating inhibition of GABA activity.

Off-Label Uses 

In addition to its approved uses, Xanax is also prescribed for several off-label indications. 

The most common off-label uses for Xanax are: 

In research studies, Xanax has been used as a treatment for certain types of seizures. Xanax has also been investigated as a possible treatment for essential tremor, with promising results. 

Before Taking

Xanax can be harmful in certain situations. If you have had any type of adverse reaction to Xanax or any benzodiazepine, you may not be able to take Xanax, or you would need to take it with extreme caution. 

Xanax is not approved for use in children under age 18. It can cause adverse effects if you are pregnant or nursing. 

When you start taking Xanax, you should avoid driving or using heavy or dangerous equipment.

Xanax can be addictive and may lead to dependence. If you have a history of substance abuse or addiction, be sure to discuss this with your doctor prior to taking Xanax.

Alprazolam is a controlled substance under the Controlled Substance Act by the Drug Enforcement Administration and Xanax Tablets have been assigned to Schedule IV.

Precautions and Contraindications 

You should use Xanax with caution if you have any condition that predisposes you to severe adverse effects.

Xanax can be dangerous if you have:

  • Acute narrow angle glaucoma: Xanax can worsen this condition, but you can use it if you have open angle glaucoma.
  • Epilepsy: If you have epilepsy, discontinuing or skipping your doses of Xanax can predispose you to having a seizure.

Other Benzodiazepines

Xanax is a brand version of alprazolam. The generic version, alprazolam, is also available in immediate-release tablets, extended-release tablets, and as a liquid formulation.

Other benzodiazepines include Valium (diazepam) and Ativan (lorazepam).

Dosage

Immediate-release Xanax tablets are generally prescribed to be taken three times per day, and Xanax XR is prescribed as a once per day dose to be taken in the morning. 

The immediate-release formulation is used for treating anxiety disorder and panic disorder, and the XR formulation is used for treating panic disorder.

Immediate-release Xanax tablets are available in 0.25 milligram (mg), 0.5 mg, 1 mg or 2 mg strengths. The 2 mg tablets are scored in fourths so they can be divided. Xanax XR tablets are available in 0.5 mg, 1 mg, 2 mg, and 3 mg strengths.

According to the manufacturer, the recommended doses of Xanax are:

  • Immediate-release tablets should be started at 0.5 mg three times per day. The total daily dose can be increased by 1 mg per day every three to four days, as necessary.
  • The Xanax XR tablets should be started at a dose of 0.5 mg or 1 mg per day. The daily dose can be increased by 1 mg per day every three to four days if that is needed to control symptoms. According to the manufacturer, the suggested daily dose of Xanax XR ranges between 3 to 6 mg per day.

It is recommended that you take the lowest dose of Xanax that is effective for controlling your symptoms. Do not increase or decrease your dose without checking with your doctor. Increases and decreases should be made gradually, according to a schedule and with consideration of any other medications that you are taking.

Modifications 

You might need to take a lower than usual dose if you are elderly or have kidney or liver failure. These conditions can increase the concentration of Xanax in your body and make you more sensitive to it.

In addition to starting at a lower dose, your doctor would increase your dose at a slower than usual rate if you have these conditions.

How to Take and Store 

Xanax should be taken whole, and you shouldn’t chew, crush, or break your tablets except to cut them where they are scored.

Xanax tablets should be stored at a temperature of 20 to 25 C (68 to 77 F). 

Side Effects

Xanax can cause side effects. When you first start to use it, you may experience some mild side effects. Some side effects, like drowsiness, might continue even after you get used to the medication.

If you continue to experience issues like drowsiness, you need to avoid driving or other activities in which drowsiness can be problematic. Serious adverse effects can be harmful, and you need to get urgent medical attention if you start to have signs of severe side effects.

Common 

The most common side effects of Xanax can be more noticeable within a few hours after you take your tablet.

Common side effects of Xanax include:

Severe

Severe side effects of Xanax can be life-threatening. You can experience these side effects due to a regular dose, an overdose, or the combination of Xanax with other drugs.

Severe side effects of Xanax include:

  • Loss of consciousness
  • Seizures
  • Mania 
  • Hallucinations
  • Suicidal thoughts
  • Coma or death

Get emergency help if you or someone else is beginning to have serious adverse effects of Xanax.

Warnings and Interactions

Abruptly stopping Xanax can be dangerous. Suddenly decreasing or stopping this medication can trigger withdrawal seizures, severe anxiety, or severe depression. Be sure to talk to your doctor if you want to stop taking Xanax so you can follow a schedule to gradually decrease your medication. 

Xanax interacts with several substances and medications. Your doctor or pharmacist can check if any other medications that you take interact with Xanax.

Taking Xanax with alcohol, illegal drugs, or opioids can be life threatening.

Medications that interact with Xanax include:

  • Opioids
  • Desipramine and imipramine (antidepressants) have increased concentrations in the body when taken with Xanax.
  • Fluoxetine (an antidepressant) increases the concentration of Xanax in the body.
  • Oral contraceptives increase the concentration of Xanax in the body.
  • Propoxyphene (a narcotic pain reliever) decreases the concentration of Xanax in the body.
  • Cimetidine (an antacid) increases the concentration of Xanax in the body.
  • Ketoconazole and itraconazole (anti-fungal medications) should not be taken with Xanax.
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Article Sources
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