50 mg of xanax

Typically prescribed as an anti-anxiety medication, Xanax is the most widely prescribed of all benzodiazepines as a method to alleviate anxiety and treat panic disorders. Unfortunately, it has also become one of the most abused recreational drugs on the market, infiltrating homes and communities with little regard to race, age, gender, creed or color.

Today, ”benzos” are the most commonly used anti-anxiety drugs and, among the lot, Xanax is the most popular. A Xanax bar contains two to four times the dose of medicine typically required to treat anxiety.



Alprazolam is a depressant whose effects include anxiety suppression, sedation, disinhibition, and muscle relaxation. Alprazolam has a fast onset of action and symptomatic relief. Ninety percent of peak effects are achieved within the first hour of using in preparation for panic disorder and full peak effects are achieved in 1.5 and 1.6 hours respectively.


Alprazolam is capable of producing strong sedation and can lead to a lethargic state. At higher levels, this causes users to suddenly feel as if they are extremely sleep deprived and need to fight to stay awake. This sleep deprivation increases proportionally to dosage and eventually becomes powerful enough to force the user into a deep state of unconsciousness. This is usually preceded by loss of motor skills and coordination with the effect ranging from motor impairment and difficulty moving at lower doses to complete lethargy or inability to stand up or move at high doses.

When mixed with alcohol, Alprazolam (as with other benzos) usually leads to memory loss or dangerous “blackouts”.

What Color Xanax Bars Are The Strongest?

Xanax, which is the name brand of alprazolam manufactured by Pfizer, comes in several different strengths. The term “Xanax bars” usually refers to the 2-milligram-strength tablets of the drug; these are white and rectangular tablets imprinted with the word “XANAX” on one side and the number “2” on the other side. These pills are scored (indented) in three places, so that one pill can be broken into four 0.25-mg pieces.

The company called Par Pharmaceuticals distributes pale green Xanax bars. These 2-mg rectangular pills are different in that they have the imprint “S 90 3” and have two scores (instead of three) and can be broken into three equal 0.66 doses.

A Yellow version of the drug is manufactured by Actavis Pharma. These particular 2-mg tablets are often referred to a “school buses” on the street.

As is apparent, different manufacturers use different colors for their formulations. The lowest dose of alprazolam is 0.25 mg, and it usually comes as an oblong white pill that is scored down the middle. The highest strength dose of Xanax, however, is a 3-mg extended-release tablet. Unlike others, this pill is triangular (not bar-shaped) and green. Manufacturers often give their medications different shapes and colors in an attempt to make them seem separate or unique.

Familiarizing yourself with the various colors and strengths can be useful in identifying suspected alprazolam addiction in a loved one.

By prescription, alprazolam (Xanax) is available as a:

Green Xanax Bar

Green pills are similar in strength to White and Yellow Xanax bars and typically contain 2 mg of the drug. The effects of the green pills are, therefore, the same as those seen with yellow and white Xanax bars. Green pills are available in rectangular, oval, triangular, and round shapes, usually in doses of 2 mg to 3 mg. In the oval shape, they are known as green football Xanax with a strength of 1 mg. Other street names include green oval Xanax and green monster Xanax. Hulk Xanax is a slow-release form with lower sedation effects. The triangular green pills have a strength of 3 mg and this is the strongest dose available. In general, the green pills are considered stronger than the white ones. The price of green Xanax bars on the street varies according to demand and supply, but typically one bar costs about $6.

Pink Xanax Bar

This is a common dosage form of alprazolam with a maximum strength of 0.5 mg, which is a dose suitable for the treatment of panic and anxiety disorders. These round or oval-shaped pink pills resemble a football. This type of alprazolam is not widely produced. Pink alprazolam is legally available by physician-authorized prescription only, but many people with a benzodiazepine addiction purchase it on the street or obtain it from friends and family members.

White Xanax Bar

These are Rectangular Bars that contain 2 mg of active alprazolam. It is important to note that the maximum dose of alprazolam is 4 mg per day, so white Xanax bars of 2 mg is a very high dose of the drug. This form of the drug produces strong sedation within minutes of being consumed. The bar is typically marked with scores or grooves to make it easy for the user to split into smaller portions. The bar shape of alprazolam in any color (white, yellow, or green) usually contains a 2-mg dose. Because white Xanax bars have such a high strength, it is not advisable to quit them cold turkey because this can produce severe and dangerous withdrawal symptoms. Each manufacturer puts their own unique imprint on the bars (for example, G 372 2 or X ANA X 2). White pills are also available in round, rectangular, oval, and triangular shapes with strength varying from 0.25 mg to 2 mg.

Yellow Xanax Bar

This type of alprazolam pill is the generic form of the drug and sometimes has the number 039 imprinted on it. The strength of yellow Xanax bars is 2 mg and they are similar in effect to the white-colored ones. The difference in color is due to the tablets being manufactured by different companies. The street name for this type of alprazolam is yellow school bus on account of the color and shape. A four-sided 1-mg pill and yellow oval Xanax are the other shapes and strengths that are available. The 2-mg yellow bars typically cost $4.00 each on the street and are considered stronger than the green or white bars.

Blue Xanax Bar

This is a 1-mg strength of alprazolam that is available in an elliptical or oval shape. Users can break the pills in half to consume a 0.5 mg dose. These pills are schedule 4 controlled substances available by prescription only. The round blue Xanax pills of 1 mg strength are imprinted with 031 R by manufacturer Actavis. On the street, the price of 1 mg Xanax is approximately $2.00 per pill.

Peach Xanax Bar

Also known as Orange Xanax, this is a lower dose of the drug and is usually oval or football-shaped. It contains 0.5 mg of active drug and sometimes has the number 257 imprinted on the tablet. Pfizer manufactures elliptical/oval alprazolam in orange-colored pills of 0.5 mg strength. It is widely produced in doses ranging from 0.25 mg to 0.5 mg and is typically prescribed for patients with less severe anxiety symptoms.

Purple Xanax Bar

This is a popular form of the medication manufactured by Pfizer. These round or elongated pills contain 1 mg of alprazolam and have the name of the drug and 1.0 imprinted on them. For anxiety disorders, the commonly prescribed dose is 0.25 or 0.5 mg. The maximum dose corresponds to about 4 purple Xanax footballs.


Since Xanax has a half-life of around 12 hours, most users will have the drug out of their systems after 4 days. A half-life is defined as the amount of time it takes for the concentration of the drug to be reduced by 50% (in other words, after one half-life, the concentration of the drug in the body will be half of the starting dose). Urine tests can detect Xanax for up to 5-7 days after the last use. Saliva tests can detect Xanax for up to 2.5 days after the last use. Blood tests can detect Xanax for up to 1-6 days after the last use.


The 2013 National Survey on Drug Use and Health showed that young adults were the most likely to have ever used alprazolam or the closely related drug lorazepam for non-medical purposes. The rate of abuse for those aged 18-25 (10.3%) was nearly double that for people aged 26 or over (5.7%).

According to the National Institute on Drug Abuse (NIDA), Xanax is currently the tranquilizer drug most commonly used by 12th graders. Additionally, the National Survey on Drug Use and Health showed that young adults were the most likely to have used for non-medical purposes.


Upwards of 47 million prescriptions for Xanax are written every year making it the most popular psychiatric medication in the United States. These numbers contribute to the fact that up to 40% of people who take benzodiazepines like Xanax will develop an addiction to those pills. Treatment for this kind of debilitating addiction has to be two-pronged: physical and psychological.

A medical detox is necessary to circumvent the hazards of benzo withdrawal and remain comfortable and safe as the body becomes accustomed to the absence of Xanax. Rehab, itself, however, is also vital for skill-building and relapse-prevention planning while learning to understand and defy core issues that may have led to addiction in the first place.

If you or a loved one is struggling with Xanax addiction or are addicted to benzos or benzodiazepines, THERE IS A SOLUTION. Please feel free to call us anytime, day or night, at 1-877-837-2393. We’re here to help.

How Much Xanax Is Too Much?

When a dependence forms for Xanax, the dosage must be increased for the drug to provide the same calming effects. Increasing the dosage can lead to a dependence, as the body becomes used to Xanax’s presence to produce enough GABA to achieve a chemical balance. When someone does not take Xanax for a period of time, withdrawal symptoms such as extreme anxiety or nervousness could emerge. Experiencing these effects can result in someone taking too much Xanax, an amount that differs for each person. If this occurs, a Xanax overdose could happen.

Xanax overdose is a problem in the U.S. The Chicago Tribune reported that the use of benzos, a drug class that also includes prescription medications Valium and Ativan, accounted for approximately 7,000 overdose deaths in 2013.

Knowing the Xanax overdose symptoms can help someone determine if they or their loved one needs immediate medical assistance. The common signs of a Xanax overdose are:

  • Abnormal breathing, often changing between fast and slow frequencies
  • Extreme drowsiness
  • Impaired balance and coordination
  • Blurry vision
  • Feeling lightheaded or faint

If you or someone you know has experienced any of these symptoms, seek medical assistance immediately. Taking Xanax has helped many people who struggle with anxiety or panic disorders. However, the medication can be dangerous when misused, or even used as prescribed. The drug can be addictive and many people face a challenge of no longer taking the drug when their prescription ends or sticking with the prescribed amount.

Xanax (Alprazolam) Dosage Levels and the Various Factors Involved

Alprazolam, going by the trade name Xanax, is a prescription drug used in the treatment of anxiety and panic disorders. The Xanax dosage prescribed varies from patient to patient depending on the severity of the condition being treated and age. Generally, alprazolam dosage is determined by a medical professional after evaluation of the patient and other comorbid factors such substance abuse, especially alcohol. If the patient qualifies for a Xanax dose, the medical professional will fill them out a prescription. How often can one take Xanax? In general, it can be taken up to three times a day over a specified time.

Hope Without Commitment

Find the best treatment options.
Call our free and confidential helpline

Most private insurances accepted

Marketing fee may apply

Table of Contents

  • What Are The Basics About Xanax Dosage?
  • What Is The Maximum and The Lowest Dose of Xanax?
  • What Is The Dosage of Xanax by Age and Condition?
  • What Is Alprazolam Dose for Occasional and Preventative Use?

The Basics About Xanax Dosage

The medication is recommended for adults and geriatric patients but contraindicated for those below the age of 18. Patients presenting with anxiety and panic disorders are prescribed the medication starting at the lowest dose of 0.25mg, to a maximum of 2mg per tablet. The average dose of Xanax will depend on whether the prescription contains immediate/rapid release or extended release preparations of the medication.

Xanax Dose Titration

Titration refers to the stepwise process of determining the ideal Xanax bars dosage. As it is possible to over-medicate, it is recommended to start at the lowest possible level. The patient is then monitored for improvement. If the symptoms remain unchanged, the dose is slowly increased at a rate not exceeding 1mg per day every 3-4 days with concomitant monitoring until the appropriate dosage is reached.

Xanax Dose Maintenance

Once the ideal measure is reached, it is recommended that drug administration remains at this level for the duration of the treatment. Clinical studies have, however, shown that the effectiveness of alprazolam is limited to 8 months in panic treatment cases, and 4 months for Xanax dosage for anxiety. After this, in both cases, efficacy starts declining.

Xanax Dose Reduction

When weaning off the drug, it is recommended that the reduction follow a 0.5mg reduction in dosage every 3-5 days. If the medication has been taken over a long time and dependence has formed, there may be withdrawal symptoms including but not limited to drug-related anxiety (dissimilar from the original anxiety being treated), psychosis, and seizures.

Do not wean off the drug by own, only doctor should make a personal plan of proper tapering off medication for each patient.

Maximum and The Lowest Dose of Xanax

Lowest Dose of Xanax

The lowest dose a person can take is that which adequately treats the condition at hand. As most drug preparations start at 0.25mg per tablet, this is the lowest measure available. Low doses are indicated in cases where the person requires long-term relief and where the dose has been titrated to the appropriate level.

Maximum Dose of Xanax

10mg per day is the maximum dose indicated for safe medication. Anything above this level may have paradoxical effects including heightened anxiety, nervousness, and tremors. If after titrating the medication upwards to this maximal level symptoms remain unchanged, the dosage is titrated downwards and consequently discontinued.

Xanax Lethal Dose

A lethal dose of Xanax depends on how much has been taken and whether other drugs are involved. The combination of Xanax and substances, for instance, with alcohol can lead to respiratory arrest and death. Doses that may lead to overdose vary from person to person. However, taking anything above the recommended 10mg per day may be considered an overdose and potentially lead to overdose symptoms.

The Dosage of Xanax by Age and Condition

Xanax Dosage by Age

The average dose of Xanax can be determined by age. Use is contraindicated for those under the age of 18. Adults and geriatric patients may take the medication although at different amounts and frequencies. Adults may take 0.25 to 0.5mg pills administered up to 3 times a day. The maximum measure depends on the condition, varying from 4mg/day up to 10mg/day. Geriatrics may take 0.25mg administered 2-3 times daily. Debilitated patients receive the same dosage as elderly patients.

Xanax Dosage by Condition

In addition to age, the condition being treated also influences the amount prescribed. Treating adults with an anxiety disorder requires 0.25-0.5mg taken orally and given 3 times a day up to a maximum of 4mg. Adult panic disorder cases require 0.5mg orally 3 times daily. Geriatric patients with either an anxiety disorder or a panic disorder will typically be prescribed the same measure of 0.25mg taken orally and administered 2-3 times daily. Generally, in both cases, titration is required to achieve the correct dosage of alprazolam.

Alprazolam Dose for Occasional and Preventative Use

Occasional Xanax Use

Occasional use depends on whether it is under prescription or a recreational setting. Occasional use under prescription may not be harmful especially when administered in low quantities. However, a Xanax recreational dose taken occasionally may lead to tolerance and subsequent dependence.
Other dangers related to occasional use include side effects such as paradoxical anxiety, loss of appetite, and insomnia, and addiction. Because titration is often needed for correct dosage, non-medical settings can also lead to an overdose of Xanax.

Preventative Xanax Use

Taking a Xanax dosage for sleep may be considered a preventative measure especially if insomnia is expected to occur. However, the preemptive administration can lead to dependence if not monitored. A person thus taking the pills chronically may increase the dose beyond healthy levels unknowingly, a dangerous situation that could lead to dire consequences. Preventative use is however recommended in cases where a person experiences certain trigger events that set off a panic or anxiety attack. In such cases, the administration is appropriate but only under medical supervision.

The doctor only can define the correct dose, do not self-medicate as the dangerous consequences may happen.

Correct Xanax Use

In 2010, Xanax was the 12th most prescribed drug in the United States. Easy availability coupled with the mild Xanax side effects make it a popular drug among recreational users. The drug is in some cases used to manage the side effects of other illicit drugs including withdrawal symptoms and comedowns. Xanax addiction has, therefore, become a pandemic in the United States. For persons on the drug or thinking of taking it, understanding its potency and addictive nature provides a basis upon which to take appropriate precautions.

Those with already formed addictions should be aware that treatment options are available that can get them off the drug safely.

Find the best treatment options.
Call our free and confidential helpline

Most private insurances accepted

Marketing fee may apply

View Sources

Alprazolam Dosage

Medically reviewed by Drugs.com. Last updated on Sep 18, 2019.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Tips
  • Interactions
  • More

Applies to the following strengths: 0.25 mg; 0.5 mg; 1 mg; 2 mg; 3 mg; 0.5 mg/5 mL; 1 mg/mL

Usual Adult Dose for:

  • Anxiety
  • Panic Disorder

Usual Geriatric Dose for:

  • Anxiety
  • Panic Disorder

Additional dosage information:

  • Renal Dose Adjustments
  • Liver Dose Adjustments
  • Dose Adjustments
  • Precautions
  • Dialysis
  • Other Comments

Usual Adult Dose for Anxiety

Immediate-release tablets/orally disintegrating tablets (ODT): 0.25 to 0.5 mg orally administered 3 times a day
-Maximum dose: 4 mg/day

-The lowest possible effective dose should be administered and the need for continued treatment reassessed frequently.
-Dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage.
-The daily dosage may be decreased by no more than 0.5 mg every 3 days; however, some patients may require an even slower dosage reduction.
-The dose may be increased at intervals of 3 to 4 days in increments of no more than 1 mg per day.
-The times of administration should be distributed as evenly as possible throughout the waking hours
-Treatment of generalized anxiety disorder
-Management of anxiety disorder or APA DSM-III-R diagnosis of generalized anxiety disorder
-Short-term relief of symptoms of anxiety

Usual Adult Dose for Panic Disorder

Immediate-release tablets/ODTs: 0.5 mg orally administered 3 times a day
-Maximum dose: 10 mg/day
Extended-release tablets:
-Initial dose: 0.5 to 1 mg orally once a day
-Maintenance dose: 3 to 6 mg orally per day, preferably in the morning
-Maximum dose: 10 mg/day

-The lowest possible effective dose should be administered and the need for continued treatment reassessed frequently.
-Dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage.
-The daily dosage may be decreased by no more than 0.5 mg every 3 days; however, some patients may require an even slower dosage reduction.
-The dose of extended-release tablets may be increased at intervals of 3 to 4 days in increments of no more than 1 mg per day.
-The times of administration should be distributed as evenly as possible throughout the waking hours
Use: Treatment of panic disorder, with or without agoraphobia

Usual Geriatric Dose for Anxiety

Elderly or debilitated patients:
Immediate-release tablets/ODTs: 0.25 mg orally administered 2 or 3 times a day

-If side effects develop, the dose may be lowered.
-The lowest possible effective dose should be administered and the need for continued treatment reassessed frequently.
-Dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage.
-Treatment of generalized anxiety disorder
-Management of anxiety disorder
-Short-term relief of symptoms of anxiety

Usual Geriatric Dose for Panic Disorder

Elderly or debilitated patients:
Immediate-release tablets/ODTs:
-Initial dose: 0.25 mg orally administered 2 or 3 times a day
Extended-release tablets:
-Initial dose: 0.5 mg orally once a day

-If side effects develop, the dose may be lowered.
-The lowest possible effective dose should be administered and the need for continued treatment reassessed frequently.
-Dosage should be reduced gradually when discontinuing therapy or when decreasing the daily dosage.
Use: Treatment of panic disorder, with or without agoraphobia

Renal Dose Adjustments

-Impaired renal function: Use with caution

Liver Dose Adjustments

Immediate-release tablets/ODTs:
-Mild to moderate liver dysfunction: Use with caution
-Severe liver dysfunction: 0.25 mg orally 2 or 3 times a day
Extended-release tablets:
-Mild to moderate liver dysfunction: Use with caution
-Severe liver dysfunction: 0.5 mg orally once a day

Dose Adjustments

Patients with debilitating disease (e.g., severe pulmonary disease):
Immediate-release tablets/ODTs:
-Initial dose: 0.25 mg orally 2 or 3 times a day
Extended-release tablets:
-Initial dose: 0.5 mg orally once a day
Switching Between Immediate and Extended-release Formulations:
-Patients who are currently being treated with divided doses of immediate-release tablets, for example 3 to 4 times a day, may be switched to extended-release tablets at the same total daily dose taken once a day.
Dose Reduction:
Immediate-release tablets/ODTs:
-Extended-release tablets: Doses should be decreased gradually, with dose decreases of no more than 0.5 mg every 3 days.


-Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death.
-Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate.
-Limit dosages and durations to the minimum required.
-Follow patients for signs/symptoms of respiratory depression and sedation.
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
US Controlled Substance: Schedule IV


Data not available

Other Comments

Administration advice:
-Extended-release Tablets: Tablets should not be chewed, crushed, or broken.
—Immediately upon opening the blister, using dry hands, remove the tablet and place it on top of the tongue.
—Tablet disintegration occurs rapidly in saliva so it can be easily swallowed with or without water.
Storage requirements:
-ODTs: Protect from light and moisture.
-Oral solution: Protect from light; discard 90 days after opening.
-Tablets: Protect from light.
-This drug is not recommended for the primary treatment of depression and psychotic illness.
-Genitourinary: Periodic urinalysis
-Hematologic: Periodic blood counts during long-term treatment (e.g., longer than 4 weeks)
-Hepatic: Periodic liver function tests during long-term treatment (e.g., longer than 4 weeks)
-Metabolic: Periodic blood chemistry analyses
Patient advice:
-This medicine may increase the risk of suicidal thoughts and behavior. Patients should be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Patients should report any behavior of concern to their healthcare provider as soon as possible.
-This drug may cause drowsiness and dizziness and reduce alertness. Patients should not drive a car or operate dangerous machinery until they know how this drug affects them.
-Patients should avoid drinking alcohol or taking other drugs that may cause sleepiness or dizziness while taking this drug until they talk to their healthcare provider.
-Patients should be told to contact their healthcare provider before increasing/decreasing the dose or discontinuing treatment.
-Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Related questions

  • What does extended release (ER) mean?
  • Ativan vs Xanax – What is the difference?
  • Klonopin vs Xanax – How are they different?
  • How long does Xanax last for and stay in your system?

Medical Disclaimer

More about alprazolam

  • Side Effects
  • During Pregnancy or Breastfeeding
  • Patient Tips
  • Drug Images
  • Drug Interactions
  • Compare Alternatives
  • Support Group
  • Pricing & Coupons
  • En Español
  • 1192 Reviews
  • Drug class: benzodiazepines
  • FDA Alerts (2)

Consumer resources

  • Alprazolam
  • Alprazolam Extended-Release Tablets
  • Alprazolam Orally Disintegrating Tablets
  • Alprazolam Oral Solution
  • Alprazolam Tablets
  • Alprazolam Oral (Advanced Reading)

Other brands: Xanax, Xanax XR, Alprazolam Intensol, Niravam

Professional resources

  • Alprazolam (AHFS Monograph)
  • … +5 more

Related treatment guides

  • Borderline Personality Disorder
  • Dysautonomia
  • Tinnitus
  • Panic Disorder
  • Depression
  • Anxiety

Paradoxical Reaction to Alprazolam in an Elderly Woman with a History of Anxiety, Mood Disorders, and Hypothyroidism


With less than 1% of patients who use benzodiazepines being affected, paradoxical responses to benzodiazepines are rare. In this case report, we outline the course of an 80-year-old female who developed a paradoxical response to benzodiazepines. Significant medical and psychiatric history includes anxiety, mood disorder, hypothyroidism, bilateral mastectomy, goiter removal, and triple bypass. The patient presented with mental status changes, anxiety, motor restlessness, and paranoia. Over time, a temporal relationship between the severity of the patient’s motor agitation and intake of alprazolam was observed. As doses of alprazolam were decreased, her motor agitation became less severe. In addition to motor agitation, the patient also demonstrated increased aggressiveness, a subjective feeling of restlessness, and increased talkativeness. As her dose of alprazolam decreased, many of the patient’s symptoms were observed to decrease. This case report also discusses theories regarding the pathophysiology of paradoxical reactions to benzodiazepines, known risk factors, and appropriate treatment.

1. Introduction

Benzodiazepines are commonly used in the treatment of anxiety, panic attacks, muscle spasms, seizures, agitation, and insomnia. The clinical action of benzodiazepines is mediated by gamma-aminobutyric acid (GABA) type A chloride channels. Benzodiazepines cause increased transmission of chloride ions by increasing the cycling rate of GABA channels. The inhibitory action of benzodiazepines typically causes relaxation, decreases anxiety, and can cause anterograde amnesia. It is estimated that less than 1% of patients experience atypical responses to benzodiazepines . Though rare, the case report literature includes observations of atypical response to nearly every agent in the benzodiazepine family, with intravenous midazolam being the most represented . Interestingly, despite an association between risk factors and advanced age, the authors observed more reports of atypical responses in pediatric populations than in geriatric populations .

Atypical reactions include increased talkativeness, agitation, excessive movement, hostility, psychosis, and feelings of restlessness . The exact cause of paradoxical reactions to benzodiazepines is not well understood; however, several potential mechanisms have been proposed. Benzodiazepines cause cortical inhibition, which may contribute to the violent or agitated behavior experienced in some paradoxical reactions . Benzodiazepines also alter neurotransmitter concentrations, including serotonin . Decreased serotonin transmission in the central nervous system may contribute to agitated behavior .

Risk factors for paradoxical reactions include age (with pediatric and geriatric patients being the most represented), genetics, psychological background, and alcohol use . In a recent randomized controlled trial, Shin et al. found paradoxical responses to benzodiazepines to be most influenced by the patient’s age (with younger patients having more atypical reactions) and the dosage received (with higher doses being more likely to cause a paradoxical response). In a separate randomized controlled trial conducted by Moallemy et al. , an increased infusion rate of midazolam was also positively correlated with the development of paradoxical reactions.

2. Case Presentation

2.1. Background

The patient is an 80-year-old female with a medical history that includes significant anxiety, mood disorders, hypothyroidism, tremor, unsteady gait, coronary artery disease, and hyperlipidemia. Her surgical history was positive for goiter removal, bilateral mastectomy, hysterectomy, and triple bypass cardiac surgery. She was brought to the hospital by her family due to changes in her mental status, significant anxiety, gait disturbance, and motor restlessness. The patient has a significant family history of dementia and Alzheimer’s Disease.

Five years prior to this presentation, the patient had undergone an inpatient course for severe depression and anxiety. As part of this course, she received electroconvulsive therapy (ECT). Her treatment course was very effective and, after a short stay at an assisted living center, she was discharged back home at baseline. Despite the previous success of ECT, the patient and her family decided that they would not give consent for future ECT treatments.

In the week prior to her presentation at the hospital, the patient’s dose of alprazolam was increased from 0.5 mg to 1 mg three times daily. She was also taking quetiapine three times daily and sertraline once daily.

2.2. Presentation

At the time of her presentation, the patient was very fearful, anxious, and paranoid. She also perseverated on ECT, making frequent allegations that hospital physicians or staff would force her to undergo this treatment. She also presented with significant tremulousness, motor activation, and unsteady gait.

On admission, the laboratory results and studies in Table 1 were obtained (only responses outside the reference range are included).

UA Notable results
Blood, UA Small
Leukocyte esterase Trace
RBC, UA 0–2
Bacteria, UA 0–10
CBC Notable results
RBC 3.48
Hemoglobin 11.7
Hematocrit 34.6
CMP Notable results
Glucose 121
GFR MDRD Af Amer 80
GFR MDRD non-Af Amer 69
Other tests Result
EKG Nonspecific T-wave changes
CT head without contrast No evidence of mass or intracranial hemorrhage; mild/moderate ischemic change in white matter; mild/moderate cortical atrophy

Table 1

Based on her presentation in the emergency department, the patient was admitted to a geriatric inpatient psychiatry unit.

Early in her course, the patient’s dosage of alprazolam was increased to 1 mg four times daily. Her symptoms were also noted to be “rapidly worsening.” Due to clinical suspicion of delirium, her mental status was rigorously followed up throughout her inpatient course to detect any change in memory, orientation, or onset of hallucinations. It was also noted that her agitation and inability to sit still were “akathisia-like.” Due to concerns over akathisia, the patient’s dose of quetiapine was decreased. Additionally, benztropine 2 mg (twice daily) was added. Because of her low blood pressure and slow heart rate, the patient could not be started on propranolol at this time.

Due to worsening motor agitation, the care team sought a neurology consult. Because of falling concerns, the patient was started on one-to-one care. Despite her frailty and age, she repeatedly leapt from her bed or chair and was constantly agitated and in motion. Still suspecting akathisia, her dose of quetiapine was further decreased and her benztropine dose was maintained. The care team also sought a pharmacy consult.

As per pharmacy consult, alprazolam 1 mg was decreased from four times daily to three times daily. Benztropine and sertraline were discontinued at this time. In this consult, the pharmacist mentioned the possibility that this patient’s symptoms were the result of a paradoxical response to benzodiazepines.

Due to concerns over signs of psychosis, the patient was briefly started on 0.5 mg of risperidone at bedtime. She continued to be particularly activated, anxious, and restless. Frequently, she would leap out of her chair during conversations. As the patient appeared to be poorly oriented at times, the care team became suspicious of   “agitated delirium.” Previously, Montreal Cognitive Assessment (MOCA) testing and interview had largely shown the patient to have stable mental status and sensorium. Haloperidol 2 mg by mouth was provided as needed due to suspicion of agitated delirium. This addition was observed to improve the patient’s ability to function normally. The care team continued weaning the patient from alprazolam.

On day 16 of the patient’s stay, the laboratory results in Table 2 were obtained (only responses outside the reference range are included).

CMP Notable result
Glucose 123
GFR MDRD Af Amer 78

Table 2

At this time, the dose of alprazolam had been reduced to 0.5 mg twice daily and the patient was experiencing visible “improvement in restless and agitation.” With continued tapering of the alprazolam dose, further improvement in restlessness and agitation was noted by the entire medical team. Significantly, she was able to sit through interviews without demonstrating significant motor agitation. The patient’s anxiety remained marked; however, it translated less and less into motor agitation. Regardless of other improvements, she still complained of a subjective feeling of restlessness.

By the time alprazolam was completely discontinued, the patient reported being much closer to baseline. She was able to sit still during interview and exam. Discharge planning was begun. The patient remained anxious but had substantial relief from symptoms of motor agitation, subjective feelings of restlessness, and excessive talkativeness.

3. Discussion

Benzodiazepines are common pharmacologic agents prescribed for the treatment of generalized anxiety disorders and panic disorders and are given to induce sedation. The patient was prescribed benzodiazepine based on her history of crippling anxiety. Interestingly, although benzodiazepine administration typically precipitates rapid improvement in anxiety-related symptoms, this patient did not appear to improve after receiving her regular doses of alprazolam.

Atypical symptoms of benzodiazepines include excessive talkativeness, excessive movement, increased emotional release, hostility and rage, and even new-onset psychosis . During her course, the patient demonstrated all of these symptoms. While increased motor restlessness was the most distinctive symptom, she also demonstrated increased emotionality, increased speech output, aggressiveness, and psychosis (for which she was treated with a short course of risperidone).

3.1. Pathophysiology

Although the precise pharmacologic mechanism that underlies paradoxical response to benzodiazepines is incompletely understood, researchers have proposed a few possible mechanisms. These mechanisms include altered neurotransmission, suppression of central nervous system (CNS) function, and compensatory responses to benzodiazepine effects.

3.1.1. Altered Neurotransmission

Benzodiazepines are known to act by increasing chloride transmission at GABA receptors. Increased GABA (neuroinhibitory) activity leads to sedation, decreased anxiety, and possible reductions in pain perception. One possible cause of paradoxical responses to benzodiazepines centers around genetic variability in GABA receptors. In fact, multiple allelic forms of the GABA receptor have been identified . Although varied forms of GABA receptors are known to exist, clinically significant differences among different allelic groups have not been definitively established . It is, however, possible that certain allelic forms of GABA receptors respond differently to benzodiazepines. Some studies have also noted a decrease in the concentration of GABA neurotransmitter among those taking benzodiazepines . It is thought that, in response to these agents, total GABA concentrations can become decreased, leading to heightened neural activation . Other studies propose that changes in cholinergic receptors, serotonin, and other neurotransmitters may underlie atypical responses to benzodiazepines .

3.1.2. Suppression of CNS Function

Benzodiazepines suppress neural activity by increasing the effect of GABA (inhibitory) receptors. One theory suggests that increased GABA activity can inhibit the activity of the brain’s frontal lobe . Decreased frontal lobe activity could translate into erratic behavior, decreased inhibition, rage, excitement, impaired judgment, or decreased impulse control. In other words, benzodiazepines may decrease an individual’s ability to control their impulses. Significantly, atypical responses to benzodiazepines have been observed to be more common in those with cortical loss .

3.1.3. Compensatory Response

Some researchers have proposed that paradoxical responses to benzodiazepines may be the result of compensatory reactions within the brain. For example, emergent and rebound withdrawal symptoms have been observed to occur between benzodiazepine doses. Similarly, benzodiazepines have been noted to lose effectiveness due to desensitization of receptors. Downregulation of GABA receptors in response to benzodiazepine use could theoretically explain withdrawal-like symptoms, despite intake of therapeutic doses. Interestingly, receptor desensitization is more likely when high-potency, short-acting benzodiazepines (like alprazolam) are used .

3.2. Risk Factors

While the exact mechanism for paradoxical reactions to benzodiazepines is unknown, certain behaviors and settings are known to be associated with paradoxical reactions. The most significant risk factors for developing an atypical response to benzodiazepines are age, genetic predisposition, significant history of alcohol use, large benzodiazepine doses, and psychiatric or personality disorders . While this patient’s genetic risk factors are unknown, this patient’s advanced age, large doses of benzodiazepines (maximal dose four times per day plus additional doses as needed), and anxiety-rich psychiatric history place her at increased risk of responding poorly to benzodiazepines. Also, of note, the anticholinergic effects of her other medications could be an additional contributing factor .

As mentioned above, cortical thinning and alterations in neurotransmitters are proposed causes of paradoxical reactions . The patient has a significant family history of dementia and Alzheimer’s Disease. Between this family history, her advanced age, and observations of decreased cognitive function, it is likely that she has a thinned cerebral cortex. This clinical observation was radiographically confirmed by a head CT that showed decreased cortical mass. The combination of age-related cortical thinning and benzodiazepine-induced inhibition of cortical function could make an atypical response more likely in this patient. Similarly, paradoxical response to benzodiazepines is linked to altered neurotransmitter levels, including serotonin . As this patient has a diagnosis of mood disorders, specifically major depressive disorder, she is likely to have lower-than-normal serotonin levels. Based on the rationale behind existing theories that explain the pathophysiology of paradoxical response to benzodiazepines, this patient is at a significantly elevated risk. It also bears mention that the proposed mechanisms of atypical benzodiazepine reactions are particularly likely in geriatric populations.

3.3. Management

Treatment of paradoxical response to benzodiazepines may include supportive administration of physostigmine, flumazenil, and haloperidol . Physostigmine is an acetylcholinesterase inhibitor that crosses the blood-brain barrier and acts to reverse central nervous system depression. Regardless of these effects, physostigmine is thought to improve paradoxical response to benzodiazepines via a nonspecific antiepileptic effect . Flumazenil antagonizes the benzodiazepine receptor and has clinical use in reversing benzodiazepine overdose. In pediatric populations, it has been observed to improve the symptoms of atypical responses to benzodiazepines . During her clinical course, the patient was not treated with physostigmine or flumazenil. Haloperidol, a first-generation antipsychotic, is thought to improve atypical responses to benzodiazepines via action at dopamine receptors. This action has a calming effect on atypical responders to benzodiazepines. The patient was observed to receive clinically significant benefit from haloperidol administration during her clinical course.

In this patient’s case, the factor that seems to have been most successful in decreasing motor agitation was a decrease in the dose of alprazolam. The medical record shows a relatively strong temporal relationship between the dose of alprazolam and her motor agitation.

This patient’s paradoxical response to benzodiazepines complicated her clinical course and compromised the care team’s ability to return her speedily to baseline. While cessation of benzodiazepines seems to have decreased her emotionality, restlessness, and motor agitation, she remained anxious and depressed.

In this patient’s case, motor agitation led the care team to investigate a variety of clinical causes that were unrelated to her intake of alprazolam. These alternate diagnoses included akathisia, activated delirium, and anticholinergic side effects of medications. Interestingly, providing the appropriate clinical treatments for akathisia and activated delirium did not durably improve her symptoms; however, decreasing her dose of alprazolam provided visible relief of many of her symptoms.

4. Conclusion

Throughout the course of this patient’s treatment for anxiety, increased motor agitation, and depression, we suspected different causes. At various points in the patient’s care, we suspected exacerbation of anxiety, akathisia, agitated delirium, and anticholinergic reactions as the cause of her symptoms. Given the temporal relationship between her course and her intake of benzodiazepines, her continued anxiety after resolution of motor agitation, and the presence of significant risk factors, we believe paradoxical response to benzodiazepines to be the most likely cause of this patient’s motor agitation, increased aggressiveness, increased talkativeness, and subjective feelings of restlessness. Given that benzodiazepines have the potential to decrease serotonin transmission in the central nervous system, added caution should be exercised when prescribing them for patients with major depressive disorder.

As this paradoxical response to benzodiazepines hindered our ability to achieve our patient’s desired results for the inpatient course, we propose that paradoxical reaction to benzodiazepines be considered in the differential diagnosis of increased motor activity, aggressiveness, and subjective restlessness in the setting of geriatric benzodiazepine use.

Competing Interests

The authors declare that they have no competing interests.

What to Do When Suffering from a Xanax Hangover

Xanax (alprazolam in its generic form) is one of the more commonly prescribed psychotropic medications in America. Primarily dispensed to treat anxiety and panic disorders, Xanax is a benzodiazepine medication and central nervous system depressant.1

When someone struggles with anxiety or a panic disorder, certain types of brain signaling may be hyperactive or over-excitatory—the individual’s response to stress and other environmental events may essentially be more “turned on” than in someone who doesn’t suffer from one of these mental health disorders. When a person feels stressed, the body ramps up its “fight-or-flight” reaction, which speeds up heart rate, respiration rate, and blood pressure while increasing body temperature. Pathologically excitatory brain activity can result in a person being abnormally hyper-focused, alert, and tense.2 Xanax works to reduce this response by increasing the activity of the inhibitory neurotransmitter GABA (gamma-aminobutyric acid,). As a sedative-hypnotic medication, Xanax helps to tamp down abnormally elevated brain activity to lower tension, help promote sleep, and reduce stress and anxiety.3 Though therapeutic for many, some individuals taking Xanax may experience somewhat of a Xanax “hangover” the day after taking the medication. People may be particularly at risk of these after-effects if the medication is misused in large doses.

Xanax Hangover Explained

It may be difficult to get up the next morning after taking Xanax. Xanax hangover effects may be similar to those associated with an alcohol-related hangover, such as:4

  • Fatigue.
  • Lethargy.
  • Lack of motivation.
  • Trouble falling asleep.

People who take high doses of Xanax may be be more likely to struggle with the hangover side effects; side effects may also be more significant in those who take it every day for an extended length of time. The US Food and Drug Administration (FDA) publishes Xanax prescribing information and states that long-term use of Xanax can lead to drug dependence.5 This happens when the brain adapts to the chemical changes that Xanax elicits and starts to rely on the medication’s effects in terms of baseline functioning. When Xanax then wears off, individuals can experience a kind of “rebound” effect as the brain tries to regain natural balance. Levels of some of the chemical messengers that had been suppressed by Xanax may spike while others drop, and the central nervous system can go into overdrive.5

The higher the dosage and the longer a person takes Xanax, the larger the risk of significant drug dependence and withdrawal.

The FDA advises that people taking more than 4 mg of the drug per day for at least three months are more likely to struggle with Xanax dependence and withdrawal than those taking less of it for shorter periods of time.5

The full spectrum of Xanax withdrawal symptoms may include effects that go beyond those that might be associated with a mere hangover, such as:1

  • Difficulties concentrating and thinking clearly.
  • Insomnia.
  • Increased anxiety and/or panic disorder symptoms.
  • Racing heart rate.
  • Increased blood pressure.
  • Rapid breathing.
  • Excessive sweating.
  • Stomach cramps and nausea.
  • Decreased appetite and weight loss.
  • Muscle tension and tremors.

Managing the Side Effects of a Xanax Hangover

Not everyone who takes Xanax will experience a hangover the next day, and some cases will be worse than others. Making sure to get enough sleep while taking Xanax is a great way to minimize the next-day hangover effect. Try and go to bed earlier than normal and plan to sleep for longer than is typical to reduce the hangover when taking Xanax. Sleeping for longer may help make the effects of the hangover the next day less intense.7 Getting enough sleep can help a person to be more balanced mentally and therefore more able to handle potentially stressful situations and feelings as they may arise throughout daily life.

Exercise can help to naturally boost a person’s energy levels, which may be lower while taking Xanax.7 Going for a walk or participating in other types of healthy physical fitness can aid in stress reduction and the release of endorphins, which help promote sleep and relaxation, the Anxiety and Depression Association of America (ADAA) reports.8 Again, the better the body works physically, the better a person feels, the clearer the mind is, and the more stable a person is emotionally.

Eating a balanced and healthy diet can help as well. Xanax is a tablet that is metabolized through the gastrointestinal system. Giving the body proper fuel, high in protein, vitamins, and minerals and low in saturated fats, processed foods, and refined sugars, can help bodily systems to function better.7

Other holistic methods, such as mindfulness meditation, yoga, acupuncture, massage therapy, and chiropractic care, can be beneficial as well. Stress reduction techniques, counseling, and therapies may be tools for keeping doses of Xanax lower, working as adjunctive measures for anxiety and panic disorders. Lower doses of Xanax less frequently can mean less of a hangover.

Be sure take Xanax exactly as prescribed by a medical professional. Don’t drink alcohol and limit caffeine while taking Xanax as it can interfere with the drug’s intended effects and, in the case of alcohol, make the hangover worse.7 Other drugs may also have adverse, potentially dangerous interactions with Xanax, including opioids. If the opioids in question are prescription, their use should be cleared with a doctor before mixing them with Xanax.

Getting Help for Xanax Abuse and Addiction

Benzodiazepines, including Xanax, are commonly abused. Anytime the drug is used without a prescription or otherwise for non-medical purposes (such as in larger-than-prescribed doses), it is considered medication misuse and abuse. The National Institute on Drug Abuse (NIDA) indicates that more than 50 million people in the United States have abused a prescription drug at some point in their lives, and benzodiazepines are one of the most commonly abused drug types.10 The Drug Enforcement Administration (DEA) warns that alprazolam is one of the primary drugs diverted onto the illegal drug market from pharmaceutical channels. Alprazolam is considered a controlled substance by the DEA because of its high rate of diversion and abuse.11

Alprazolam is a DEA scheduled substance with known potential for abuse and dependence.11 It can become more difficult to stop taking Xanax the longer a person takes it, and if the drug is abused, it can be even harder. Even if a person takes it under a doctor’s direction for a valid medical reason, some amount of physiological dependence can form that may lead to withdrawal when the drug is no longer used. In some instances, withdrawal avoidance increases the likelihood of developing compulsive patterns of continued drug use. Withdrawal symptoms from Xanax are physically and emotionally intense. In fact, it may seem easier to just keep taking the drug.

Methods of abuse may include crushing up tablets and then snorting, injecting, or smoking the powder. This puts the drug into the bloodstream in a different way than intended, which can raise the risk for overdose and other potentially dangerous side effects, including increasing the rate and onset of drug dependence and possible addiction.12 According to the National Survey on Drug Use and Health (NSDUH), more than a half-million Americans battled addiction involving a drug like Xanax (or other prescription sedative/tranquilizers) in 2016.13

Xanax is one of those drugs that shouldn’t be stopped “cold turkey,” especially without medical supervision and management. The Xanax withdrawal syndrome can be severe and may need to be managed through a medical detox program.1 These programs may use medications to manage the unpleasant and, in some cases, severe symptoms.

Xanax may need to be weaned off slowly through a tapering schedule during detox.1 Other medications may be used to manage specific withdrawal symptoms. Xanax may also be replaced with a longer-acting benzodiazepine that stays in the body longer and therefore requires fewer doses less often during the taper.6

Depending on the severity of drug dependence and the withdrawal side effects, detox may be done on an outpatient basis or in a residential specialty facility. After detox, specialized substance abuse treatment programs can offer support, supervision, as well as extensive counseling and therapy to help people recover from Xanax addiction. The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that close to 8 million Americans battled co-occurring disorders (e.g., the presence of an anxiety disorder and a substance use disorder) in 2014.14 Behavioral therapies, counseling, medication, relapse prevention skills, and stress reduction tools are all components of a specialized co-occurring disorder or dual diagnosis treatment program that can facilitate and enhance a long and healthy recovery.

It’s Never Too Late to Get Help
Take Action Now

The Side Effects of Xanax Use

At American Addiction Centers, we strive to provide the most up-to-date and accurate medical information on the web so our readers can make informed decisions about their healthcare.

Our reviewers are credentialed medical providers specializing in addiction treatment and behavioral healthcare. We follow strict guidelines when fact-checking information and only use credible sources when citing statistics and medical information. Look for the medically reviewed badge ( Medically Reviewed Badge ) on our articles for the most up-to-date and accurate information.

If you feel that any of our content is inaccurate or out-of-date, please let us know at [email protected]

Table of Contents Authored By American Addiction Centers Editorial Staff Edited By Kindra Sclar, M.A. Reviewed By Sophie Stein, A.P.R.N.

What Is Xanax?

Xanax (generic name: alprazolam) is a powerful benzodiazepine drug that is used to treat anxiety and panic disorders by decreasing abnormal excitement in the brain.1,2 The medication comes in the form of a tablet that quickly dissolves in the mouth, and extended-release tablet, or a concentrated oral solution.1

Benzodiazepines can have therapeutic anti-anxiety, anti-convulsant, muscle relaxing, and sedative effects.3 Xanax is often prescribed for mental health disorders related to anxiety, including:4

  • Generalized anxiety disorder.
  • Panic disorder.

How do you know if you or a loved one is addicted? Find out here.

Treatment Advisors Are On Call 24/7 Who Answers? Thinking About Getting Rehab?

Short-Term Effects

Alprazolam is among the most prescribed benzodiazepine drugs in the U.S. and is among the benzodiazepines most often found in the illegal market, according to the Drug Enforcement Administration.3 The top 5 most prescribed benzodiazepines are:3

When taken as prescribed, the short-term effects of Xanax are beneficial to many individuals. Although it isn’t known exactly how Xanax works, it causes a depression of the central nervous system (CNS).4 CNS depressants cause calming and drowsy effects.2

You don’t have to use it for a long time to begin experiencing some of the negative effects of the medication, however. Side effects of Xanax typically occur when it is first started.4 When you use Xanax in larger quantities, you increase the risk of side effects and overdose.

Side Effects of Xanax

All medications have potential side effects, including Xanax. Even when adhering to prescribed dosing, side effects can still occur—with some being more serious than others. Some of the common side effects of Xanax include:11

  • Drowsiness.
  • Fatigue.
  • Dizziness.
  • Difficulty concentrating.
  • Dry mouth.
  • Changes in sex drive.
  • Increased salivation.
  • Slurred speech.
  • Appetite changes.
  • Memory problems.
  • Decreased coordination.
  • irritability.
  • Confusion.
  • Urinary retention.
  • Changes in menstrual cycle.
  • Low blood pressure.

Some of the serious possible side effects of Xanax include:11

  • Slow and/or shallow breathing.
  • Seizures.
  • Suicidality.
  • Dependency on Xanax.
  • Increased heart rate.
  • Fainting.
  • Swelling.
  • Liver damage.

The risk of side effects can be increased by mixing Xanax with other drugs, especially other depressants like alcohol or opioids.1,3 This can increase the risk of potentially fatal breathing issues, sedation, or coma. Because of this, using alcohol or illegal drugs while taking any benzodiazepine is never recommended, and any other medications should be cleared by a medical provider.1


Overdose can occur when someone takes more than their prescribed dose, takes the prescribed dose more frequently than scheduled, or takes the drug with anotehr drug like alcohol. Signs of alprazolam overdose can include:1,4

  • Sleepiness.
  • Confusion.
  • Problems with coordination.
  • Impaired reflexes.
  • Coma.

When you see the signs of an overdose, don’t wait—call 911 immediately. Learn what to do at our blog, Taking Action: How to Intervene During an Overdose.


Credit: American Addiction Centers

Lasting Health Effects

Chronic use of sedatives is associated with:6

  • Cognitive deficits.
  • Psychomotor impairment.
  • Dependence on the drug.
  • Abuse of the drug.

In a meta-analysis of individuals using benzodazepines on a long-term basis, cognitive impairments were noted despite stopping the benzodiazepines. These include problems with visuospation cognition, attention and concentrating, general intelligence, and psychomotor speed.7

Substance Dependence

People who take benzodiazepines for an extended amount of time may build up a tolerance for some effects of the drugs.5 When tolerance occurs, your body requires a larger dose or an increased frequency of use to achieve the same or similar effect that the substance had on you when you began taking it.2

If you continually use Xanax, especially in larger quantities, you may develop a physical dependency on the medication.3,5 When this happens, your body doesn’t function properly without it.12 Of note, It is possible for someone to become physically dependent on the drug even when used as prescribed.3

If you continually use Xanax, especially in larger quantities, you may develop a physical dependency on the medication. When this happens, your body doesn’t function properly without it. Of note: It is possible for someone to become physically dependent on the drug even when used as prescribed.

You can experience withdrawal symptoms if you suddenly stop using Xanax or suddenly decrease your dose significantly.1 Some users may continue taking it to avoid the onset of these unpleasant, potentially life-threatening withdrawal symptoms.4,9 The dangers of withdrawal from benzodiazepines like Xanax means that a person should not stop taking them without consulting with a medical provider. If they are possibly dependent on the medication, they should be tapered off gradually.1 Many addiction treatment programs offer supervised medical detox to provide a safer experience as you end your Xanax use and begin your recovery.

Withdrawal symptoms, or continuing the drug to avoid or alleviate withdrawal symptoms, is one of many possible signs of a substance use disorderbut it does not indicate that a person has a substance use disorder in and of itself. A substance use disorder is marked by using a substance in a problematic pattern that causes significant impairment or distress.9

Potential for Substance Use Disorder

Due to the reinforcing effects they can cause, benzodiazepines are considered to have misuse liability, particularly in individuals with drug misuse histories. Xanax is considered by many to have a high misuse liability.5 According to the U.S. National Library of Medicine, Xanax can become habit forming and should not be used in large quantities than prescribe or for a longer time period than prescribed.1

Symptoms of having an alprazolam use disorder can include:9

  • Often taking alprazolam more or in larger amounts than intended.
  • Persistently wanting to or unsuccessfully trying to decrease or control alprazolam use.
  • Spending a lot of time getting, using, or recovering from alprazolam.
  • Craving alprazolam.
  • Having problems fulfilling important responsibilities at school, work, or home due to regular alprazolam use.
  • Continuing using alprazolam even though it is causing or worsening trouble with relationships or other social issues.
  • Stopping or decreasing important activities because of alprazolam use.
  • Using alprazolam repeatedly in dangerous situations.
  • Continuing using alprazolam even when knowing that it is likely causing or worsening a physical or psychological problem.
  • Experiencing tolerance and/or withdrawal (unless they occur when taking alprazolam as prescribed).

Withdrawal Symptoms

Suddenly stopping Xanax or suddenly decreasing the dose significantly can lead to withdrawal symptoms.1 These symptoms could be life-threatening. The risk of withdrawal should always be considered before stopping or decreasing Xanax use, especially in those who’ve taken a benzodiazepine for any considerable length of time.4 Individuals should not stop or decrease their benzodiazepine use without consulting a medical provider.

Symptoms of alprazolam withdrawal can include:1,4

  • Insomnia.
  • Headache.
  • Sensitivity to noise or light.
  • Difficulty concentrating.
  • Blurred vision.
  • Muscle cramps.
  • Paresthesia or numbness/tingling in the extremities.
      • Digestive upset.
      • Sweating.
      • Depression.
      • Anxiety.
      • Tremors.
      • Seizures.

If you think you or someone else is going through withdrawal, seek medical help immediately. Call 911 if any severe symptoms are present.

Treatment Programs

When you first arrive at a treatment center, the first step after assessment should be detoxification if you are dependent on the drug. Supervised medical detox is extremely important for Xanax-dependent individuals due to seizure risk and other medical dangers. This can be done in an outpatient or inpatient setting, depending on the individual’s needs. During medical detox, you may be slowly weaned off Xanax over the course of several weeks or even months in order to give your body a chance to readjust slowly, decreasing the risks of withdrawal. Alternatively, you may be switched to another benzodiazepine with a longer half-life and then tapered off that medication.8

For some individuals, an inpatient detox is the best option.8 Hospitals and medical detoxification centers should have trained medical staff on hand to help prevent or reduce withdrawal symptoms through medications and other means. If any complications arise, the staff can intervene and/or get the patient to emergency care as appropriate.

For individuals who do not have polysubstance dependence, whose benzodiazepine doses were generally in the therapeutic range, and who are both dependable and have a dependable support system to help monitor them, outpatient medical detox might be appropriate.8

Detoxification alone is not treatment for a substance use disorder.8 Once the detoxification process is over, if you have a substance use disorder, your treatment should shift to focus on the disorder itself, typically including addressing the reasons behind your use and learning how to prevent relapse. Forms of therapy may include cognitive behavioral therapy, motivational enhancement therapy, twelve-step facilitation, and/or contingency management (which incentivizes positive behaviors).10 Both individual and group counseling are generally a part of treatment, and family therapy may be as well.

Outpatient Treatment

Outpatient treatment programs offer more flexibility than inpatient programs. However, some people need the additional structure that an inpatient program provides. It’s important that you review all of your options and choose a program that’s right for your physical health, mental health, and overall well-being. Any trustworthy program will also evaluate you first to ensure they can safely and appropriately meet your needs.

Outpatient treatment programs, by definition, do not have patients stay overnight at the treatment facility. Depending on the intensity of the program, you may be able to receive treatment while still working or attending school. There is a wide range of options for outpatient treatment including:

      • Individual and/or group therapy. This can help target the underlying factors in your addiction and/or help you learn relapse prevention skills.
      • Nonprofessional/community-based support groups. There are many programs (such as AA and NA) and peer support groups that can be helpful in learning to manage and cope with your disorder and in avoiding relapse.

Inpatient treatment programs require you to live at the facility for the duration of your treatment, often recommending 30, 60, or 90 days. During your stay, your days focus on your recovery. A typical day at a treatment facility could include group therapy sessions, an individual therapy session, recreational activities designed to help you learn how to relax and have fun without drugs, addiction education groups, skills training, and/or relapse prevention education.

      • How to Help a Xanax Addict

To share your story or talk to others who understand, visit our Forum today.


Last updated on November 4, 2019 2019-11-04T16:40:28+00:00 Finding the perfect treatment is only one phone call away!

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *