Xanax: side effects, drug information

Xanax: side effects, drug information

Xanax is a brand name for the drug alprazolam, which belongs to a group of drugs called benzodiazepines.1

Benzodiazepines act on the brain and central nervous system to produce a calming effect.2 Xanax slows down the movement of brain chemicals that may have become unbalanced, resulting in a reduction in nervous tension and anxiety. Xanax works by boosting the effects of a natural chemical made in the brain called gamma-aminobutyric acid (GABA).

GABA is an amino acid C4H9NO2 that is a neurotransmitter, which induces inhibition of postsynaptic neurons - slows down activity of nerve cells in the brain.3

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Here are some key points about Xanax. More detail and supporting information is in the main article.

  • Xanax (alprazolam) is the single most prescribed psychiatric medication in the US
  • Xanax is a member of the benzodiazepine family of drugs and is primarily used to treat anxiety and panic disorders
  • Xanax is dispensed in 0.25 mg, 0.5 mg, 1 mg and 2 mg strengths
  • At the same dosage, the drug is 10-20 times as potent as Valium
  • Xanax works by increasing the amount of the neurotransmitter GABA in the brain to promote calmness and a relaxed feeling
  • The short half-life and its quick acting effect - sometimes within minutes - make Xanax so addictive
  • Abrupt discontinuation of Xanax is never recommended; the early stage of withdrawal symptoms is accompanied by a sense of anxiety and apprehension coupled with tremors and headache
  • Overdoses of Xanax can be mild to severe depending on how much of the drug is taken and if any other medications are involved
  • Combined overdose with antidepressants, alcohol or opiates significantly increases the likelihood for severe toxicity and possible fatality
  • When taken correctly, Xanax is a safe and effective medication.

What is Xanax?

Alprazolam is an anti-anxiety medication in the benzodiazepine family, the same family that includes diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan), flurazepam (Dalmane), and others.9 Xanax works by decreasing abnormal excitement in the brain.11

The FDA approved alprazolam in October 1981.

Commonly used brand names

Brands of alprazolam include:1,11,13

  • Xanax tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg
  • Xanax XR extended release tablets: 0.5 mg, 1 mg, 2 mg, 3 mg
  • Niravam orally disintegrating tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg
  • Alprazolam Intensol liquid (concentrate): 1 mg/ml.

Important information about Xanax

Xanax are dispensed in 0.25 mg, 0.5 mg, 1 mg and 2 mg strengths.

For all users of Xanax:4

To ensure safe and effective use of benzodiazepines, all patients prescribed with Xanax should be provided with the following guidance:

  1. Inform your physician about any alcohol consumption and medicine you are currently taking, including medication you may buy without a prescription. Alcohol should generally not be used during treatment with benzodiazepines
  2. Xanax is not recommended for use in pregnancy. Inform your physician if you are pregnant, if you are planning to have a child, or if you become pregnant while you are taking this medication
  3. Inform your physician if you are nursing
  4. Until you experience how Xanax affects you, do not drive a car or operate potentially dangerous machinery
  5. Do not increase the dose of Xanax even if you think the medication "does not work anymore" without consulting your physician. Benzodiazepines, even when used as recommended, may produce emotional and physical dependence
  6. Do not stop taking Xanax abruptly or decrease the dose without consulting your physician, since withdrawal symptoms can occur.

Inform your doctor if you have asthma or other breathing problems, glaucoma, kidney or liver diseases, history of alcoholism or depression, suicidal thoughts or an addiction to drugs or alcohol.

You should not take Xanax if you:

  • Have narrow-angle glaucoma
  • Are also taking itraconazole (Sporanox) or ketoconazole (Nizoral)
  • Are allergic to alprazolam or to other benzodiazepines, such as chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan) or oxazepam (Serax).

Xanax is a federally controlled substance because it has abuse potential.8

Xanax is often abused for the fast-acting, relaxed "high" it can give to people who take it, including people without a prescription.10

According to the National Institute on Drug Abuse (NIDA), benzodiazepines such as Xanax were responsible for most of the emergency room visits attributed to central-nervous-system depressants in 2009.

Long-term abuse and addiction to Xanax is associated with depression, psychotic experiences, and aggressive or impulsive behavior, as said by the Coalition Against Drug Abuse.

According to the Substance Abuse and Mental Health Services Administration, in 2011, there were over 1.2 million emergency department visits overall related to the nonmedical use of prescription drugs - alprazolam was involved in 10% of those visits.12

Alprazolam was the 13th most commonly sold medication in 2012 and was the psychiatric medication most commonly prescribed in 2011.

The number of emergency department visits involving the non-medical use of the sedative alprazolam doubled from 57,419 to 124,902 during the years 2005 to 2010, and then remained stable at 123,744 in 2011.

The most common drug combinations encountered in ER patients are Xanax and alcohol, and Xanax combined with prescription opiates like hydrocodone and oxycodone.

According to the SAMHSA report, in 81% of cases, alprazolam was mixed with another drug (including alcohol).

What does Xanax treat?

Xanax is indicated for the management of anxiety disorder or the short-term relief of symptoms of anxiety. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic (a type of prescription medication used to treat symptoms of acute anxiety).4

Xanax is used to treat anxiety disorder and alleviate the symptoms of panic disorders.

Generalized anxiety disorder is characterized by unrealistic or excessive anxiety and worry about two or more life circumstances, for a period of 6 months or longer, during which the person has been bothered more days than not by these concerns.4

At least six of the following symptoms are often present in these patients:4

  • Motor tension: trembling, twitching, feeling shaky, muscle tension, aches or soreness, restlessness, easy fatigability
  • Autonomic hyperactivity: shortness of breath or smothering sensations, palpitations or accelerated heart rate, sweating, or cold clammy hands, dry mouth, dizziness or light-headedness, nausea, diarrhea, or other abdominal distress, flushes or chills, frequent urination, trouble swallowing or "lump in throat"
  • Vigilance and scanning: feeling keyed up or on edge, exaggerated startle response, difficulty concentrating or "mind going blank" because of anxiety, trouble falling or staying asleep, irritability.

These symptoms must not be secondary to another psychiatric disorder or caused by some organic factor.4

Xanax is also indicated for the treatment of panic disorder, with or without agoraphobia, and may reduce the number of panic attacks experienced.4,7

Panic disorder (DSM-IV) is characterized by recurrent unexpected panic attacks, i.e., a discrete period of intense fear or discomfort in which four or more of the following symptoms develop abruptly and reach a peak within 10 minutes:4

  • Palpitations, pounding heart or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded or faint
  • Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  • Fear of losing control
  • Fear of dying
  • Paresthesia (numbness or tingling sensations)
  • Chills or hot flushes.

On the next page, we look at how to use Xanax as well as side effects and precautions.

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Section Issues On Medicine: Psychiatry