Xanax (alprazolam) is an anxiolytic (antipanic and antianxiety) benzodiazepine medication classified as a schedule IV controlled substance by the U.S. Drug Enforcement Administration (DEA). According to the DEA, a schedule IV drug has a low potential for abuse and a low risk for dependence. Alprazolam does have the potential for misuse, although some experts claim that the risk is low and similar to that of other benzodiazepine drugs.

This drug possesses antianxiety, sedative, muscle relaxing, and anticonvulsant properties. It slows down the chemical movement within the central nervous system, which results in the reduction of anxiety.

History of Xanax

Dr. Leo Sternbach is credited with the discovery benzodiazepines. Alprazolam was first released by Upjohn Laboratories (now a part of Pfizer) in 1981, as the first approved drug for panic attacks. Within two years, it became a “blockbuster” drug in the United States. Now, this medication is the most prescribed benzodiazepine in America.

Dosage FAQs

  • What is a safe does of this medication?
    This medication comes in immediate and extended release formulas. The following dosage information is for the immediate release version:
    • Anxiety: An initial dose of 0.25 mg to 0.5 mg of Xanax is administered orally, three times a day. The dose can be increased gradually every three to four days up to maximum daily dose of 4 mg in divided doses.
    • Panic: An initial dose of 0.5 mg of Xanax is administered orally, three times a day. This dose can be increased every three to four days. The maintenance dose of Xanax is between 1 mg to 10 mg per day in divided doses (with an average dose ranging between 5 mg to 6 mg per day).
    • Depression: An initial dose of 0.5 mg of Xanax is administered orally three times a day. The dose can be increased by no more than 1 mg every three to four days. An average dose of 3 mg of Xanax daily in divided doses has shown to be most effective. Maximum dose should not exceed 4.5 mg daily in divided doses.
    • For elderly individuals (adults aged 65 years or older) dosage should not exceed 2 mg per day without consent from a doctor because of a greater sensitivity to the effects of benzodiazepines.
       
  • How does my body process this drug?
    Xanax is readily-absorbed from the gastrointestinal tract. It has a rapid onset of action and a bioavailability of 80% to 90%. About 80% of Xanax binds to albumin in the blood. The peak serum concentration is reached in one to two hours for immediate release tablets and nine hours for extended release tablets. The drug is metabolized in the liver and removed from the body in the urine.
     

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    How can I get the most out of my treatment with Xanax?
    This medication is primarily prescribed to treat the debilitating effects of anxiety and panic—two conditions that are treated using various types of psychotherapy. There is a growing body of research that highlights the efficacy of a combined approach to mental health treatment using both medication and therapy. Medication can dull the effects of mental health conditions while finding a therapist to work with may help a person learn more about their experiences, how to develop a self-care routine, and healthy coping strategies for when symptoms arise or become triggered.
     
  • How is this drug structured chemically?
    Xanax is a chemical analog of triazolam differing by the absence of a chlorine atom in the ortho-position of the 6-phenyl ring. Xanax has an average molecular mass of 308.765 and a molecular formula C17H13ClN4. It has a crystalline structure and is soluble in alcohol and insoluble in water.

Adverse Effects of Xanax

Xanax shares the adverse effects of many other benzodiazepines. The follow are some of the common adverse effects at higher doses:

  • Drowsiness
  • Depression
  • Headache
  • Constipation
  • Diarrhea
  • Dry mouth

At low doses this medication can exhibit some adverse effects. Some of these are listed below:

  • Impaired coordination
  • Increased or decreased appetite
  • Fatigue
  • Memory impairment
  • Anxiety and increased heart rate
  • Sleeplessness
  • Headache or lightheadedness
  • Nausea, vomiting, or diarrhea
  • Noticeable changes in sex drive
  • Menstrual irregularities
  • Urinary retention

Drug Interactions of Xanax

Xanax has several drug interactions you should be aware of. If you are prescribed this drug, make sure you cover the following interactions with your doctor and/or pharmacist:

  • Alcohol and Caffeine: Avoid alcohol and excessive caffeine consumption while being treated with this medication.
  • Antidepressants: This medication combined with antidepressants may increase sedation.
  • Sodium Oxybate: Xanax and sodium oxybate, on concomitant administration, increases effects of each other by pharmacodynamic synergism. Never use both in combination.

Additionally, the following medications affect the metabolism, increase or decrease the effects of the drug, and/or increase the toxicity of Xanax:

  • Indinavir
  • Fosamprenavir
  • Etravirine
  • Amprenavir
  • Clarithromycin
  • Cimetidine
  • Erythromycin
  • Mephenytoin
  • Ethotoin
  • Fosphenytoin
  • Phenytoin
  • Ketoconazole
  • Itraconazole
  • Fluconazole
  • Quinupristin
  • Rifampicin
  • Telithromycin
  • Ticlopidine

Disclose all medications, vitamins, and supplements you regularly take with your physician before taking this medication.

Safe Withdrawal from Xanax

Stopping this drug abruptly is hazardous to your safety. In addition to agitation, insomnia, a return of anxiety symptoms, depression, and nervousness, rapid withdrawal from this medication may cause an increase in the risk of seizures. If you need to stop taking this medication, please consult with your physician and develop a safe plan to slowly taper down your dosage. Doing so may reduce the occurrence and severity of debilitating withdrawal symptoms.

References:

  1. Caplan, J. P., Epstein, L. A., Quinn, D. K., Stevens, J. R., & Stern, T. A. (2007). Neuropsychiatric effects of prescription drug abuse. Neuropsychology Review, 17(3), 363-80. doi:http://dx.doi.org/10.1007/s11065-007-9037-7
  2. Glod, Carol A,R.N., M.S.C.S. (1992). Xanax: Pros and cons. Journal of Psychosocial Nursing & Mental Health Services, 30(6), 36-37. Retrieved from http://search.proquest.com/docview/1026707787?accountid=1229
  3. Mui, H. Z., Sales, P., & Murphy, S. (2014). Everybody's doing it: Initiation to prescription drug misuse. Journal of Drug Issues, 44(3), 236-253. Retrieved from http://search.proquest.com/docview/1540952982?accountid=1229
  4. Olin, B. R., PharmD. (2014). The drug book: From arsenic to xanax, 250 milestones in the history of drugs. American Journal of Pharmaceutical Education, 78(5), 1. Retrieved from http://search.proquest.com/docview/1544417081?accountid=1229

Page content reviewed by James Pendleton, ND.