Xanax
Learn about Xanax, the commonly prescribed anti-anxiety benzodiazepine.
Overview
Common Nicknames
Xanny, alprazolam
Drug Class
Benzodiazepine, Anxiolytic, Tranquiliser
Drug Form
Pills
Route of Administration
Ingestion
What is the science of Xanax?
Xanax is a benzodiazepine, similar to diazepam (Valium), however it is about 10 times stronger causing heavy sedation and relaxation. It is prescribed as an anti-anxiety or anti-panic drug or to treat seizures caused by epilepsy. Xanax acts at GABA-A receptors in the brain. Your GABA receptors are inhibitory and so targeting them will cause sedation and the drug will act as an anxiolytic (anxiety reducing).
What are the risks?
The main risk when taking any benzodiazepine is mixing it with alcohol, which can cause respiratory depression. Xanax, being so potent, can also cause drowsiness, dizziness, insomnia, memory problems, poor balance, slurred speech, vomiting, appetite changes, muscle weakness, worsening depression, hypomania, and decreased libido. You should not drive whilst under the influence of Xanax or perform any activity where optimal attention is required.
How might the drug make you feel?
Xanax mediates a reduction in anxiety and aggression, an induction of sleep, reduction in muscle tone, anticonvulsant effects, and anterograde amnesia. It is a powerful and potent drug and using it to self-medicate for anxiety can lead to harm due to heavy sedation and disinhibition whilst under the influence.
Is Xanax addictive, and what are the long-term effects?
Yes, long term use can lead to physical dependence, and it is recommended that you taper off the dose of the drug to avoid harsh withdrawal symptoms. Using Xanax often will also cause tolerance as users need higher doses to get symptom relief. You can become addicted to Xanax to get relief from anxiety symptoms, or from the sedative effects of the drug.
Long term use can lead to physical dependence and it is recommended that you taper off the dose of the drug to avoid harsh withdrawal symptoms.
Harm Reduction and Drug-Drug Interactions
Short term use or use as per a doctor’s guidance is unlikely to cause any harm. However, Xanax has dangerous effects when mixed with alcohol or other depressant drugs. Additionally, taking Xanax often can lead to addiction and the withdrawal effects from the drug can be very severe, leading to seizures, rebound anxiety, and hallucinations. It is also possible to overdose from Xanax. If you think someone is overdosing from Xanax, put them in the recovery position, call 999, and do not leave them on their own. Monitor their breathing, and when a medical team arrives let them know what they have taken if you know. They might need flumazenil, an antidote for Xanax which reverses the activity at GABA receptors.
You should never mix Xanax with alcohol as this can have life threatening side effects. Xanax is metabolised by an enzyme called CYP3A4, and therefore it is affected by drugs which inhibit or induce this enzyme because this can potentiate the effects of the drug or lead to toxic accumulations in the body. Examples of these drugs are antifungals, anti-depressants, St Johns Wort, seizure medications, antihistamines, and muscle relaxants.
Medical Uses
Medically, Xanax is the most commonly prescribed psychotropic medication in the United States. It is prescribed for generalised anxiety disorder, and panic disorders. Off-label it is prescribed for insomnia, premenstrual syndrome, and depression.
Myths and Misconceptions
Xanax is not addictive
Xanax is highly addictive, one of the most addictive prescription drugs available and is therefore only recommended for short term use.
Xanax will turn you into a ‘drooling zombie’
Taking Xanax as per your doctors’ instructions, or at low doses, should allow normal functioning. High doses can cause extreme tiredness or agitation, but when used for anxiety, user most often retain focus and function.
You can quit cold turkey on your own
Abruptly stopping Xanax can be life threatening. Xanax causes physical addiction, and withdrawal can be severe, causing symptoms such as seizures and cardiac issues. Medical help to taper down the dose is essential to safely discontinue the medication.
History
The first benzodiazepine, chlordiazepoxide, was synthesised by accident in 1961, and its unusual 7 membered ring was the result of a reaction gone wrong. Thankfully, its unexpected pharmacological activity was discovered, and benzos became a more favourable alternative to barbiturates, eventually becoming the most widely prescribed drugs in the pharmacopoeia. Later, around the 1970s their abuse potential was discovered.