Xanax, officially known as Alprazolam, is a medication under the class known as the benzodiazepines that are commonly used to treat panic and anxiety disorders. It is also often misused and abused recreationally for its euphoric and anxiolytic effects.
Within benzodiazepine use in the United States, misuse accounts for 20% of overall usage. It is possible to overdose on Xanax; however, this is relatively uncommon unless taken alongside other drugs in much higher doses.¹
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Benzodiazepines are among the most commonly prescribed pharmacological agents in the United States. Overall, benzodiazepines aim to increase inhibition in the brain by acting on inhibitory GABA receptors.²
This means they result in a sedative-like effect, increasing relaxation and reducing anxiety symptoms. They are also relatively rapid-acting drugs — they quickly absorb into the bloodstream and execute peak effects after 1–2 hours.
Different types of benzodiazepines are used for different conditions, including insomnia, anxiety disorders, and seizure disorders.
There are several types of Xanax pills available. They differ based on strength and dosage — some have different colors to represent the strength of their dosage. Xanax can be obtained in 0.25mg, 0.5mg, 1mg, and 2mg doses. Extended-release tablets are also available in 0.5mg, 1mg, 2mg, and 3mg doses.³
As with other benzodiazepines, it is possible to overdose on Xanax. Xanax is notably more toxic than other benzodiazepines and, therefore, should be avoided in patients who have an increased risk of suicide.
The elderly are more at risk of overdosing on Xanax due to impaired metabolism and increased sensitivity.
Generally, Xanax dosage for anxiety is 0.25–0.5mg tablets taken orally three times daily. It is recommended that the daily dose does not exceed 4mg per day.
The dosage for panic disorder is somewhat higher, with a maximum of 6–10mg daily.
The amount of Xanax that would result in an overdose varies significantly from person to person. It depends on whether you take any other medication and the potential drug interactions. Also, your height, weight, and whether you have any preexisting conditions will influence how your body processes the drug.
However, research has identified that the LD50 (the dose that causes death in 50% of a test animal population) is very high — at around 300–2000mg/kg. Consequently, an overdose of benzodiazepines is quite rare when they are taken in isolation, but it is more common when taken in combination with other substances.
Taking Xanax alongside other nervous system depressants can increase the risk of an overdose.
Opioids are also nervous system depressants that slow brain activity, heart rate, and breathing. They are commonly prescribed for alleviating pain. Individuals who use both benzodiazepines and opioids are at a higher risk of requiring an emergency department visit or having a fatal drug overdose.
This is because of the risk of the combined effects of the drugs resulting in breathing suppression.
Antidepressants are known to interact with Xanax. Alcohol is another nervous system depressant that can have dangerous interactions with Xanax.
Initially, symptoms of a Xanax overdose may resemble the symptoms of more severe side effects of Xanax, which include:
Difficulties speaking or breathing
Loss of balance or coordination
Symptoms of depression
Other symptoms of a Xanax overdose include:
Severe loss of balance or coordination
Severe inability to stay awake
Significantly slowed breathing
Loss of consciousness
Overdosing on Xanax can cause mild to significant side effects, depending on the dose taken.
Because Xanax acts on inhibitory (GABA) signaling, it decreases activity in several parts of the body. It slows your heart rate and lowers your blood pressure. It also slows your cognitive functioning.
In cases of significant overdoses, excessive Xanax can result in coma or death.
Following a benzodiazepine overdose, there is the potential for significant long-term complications. These include brain damage, cardiac complications, and pneumonia. Complications depend on the severity of the dosage, whether other substances were involved, and what treatment protocol was utilized.
In the case of a Xanax overdose, call emergency services immediately. On the way, they may monitor cardiac activity and provide supplemental oxygen. En route, they may also monitor blood glucose levels and administer IV glucose if levels are low.
Flumazenil is an antagonist of benzodiazepines, essentially indicating that it reverses the activity of Xanax. It is commonly administered intravenously to reverse some or all of the sedative effects of benzodiazepines.⁴
They may also administer a dose of activated charcoal, which can be administered up to six hours after ingestion.⁵
At the hospital, a person suffering Xanax overdose may have their stomach pumped to remove any residual benzodiazepine. Doctors will continuously monitor breathing and heart rate as there is a risk of respiration dropping to dangerous levels.
Following the treatment of the overdose, the affected person may be required to have a follow-up to determine whether the cause of the overdose was from interactions with prescription medications or whether it was a consequence of substance abuse.
If substance abuse was involved, the person might be referred to rehabilitation facilities or further psychological assessment to help address the cause.
Only take Xanax if it has been prescribed to you by a medical professional, and always stick to your prescribed dose. Sticking to a set time every day for taking your medication can be useful to ensure you are only taking your prescribed dose.
When prescribed any new medication, always disclose to your doctor any medications you are already taking. Doing so will ensure you get the best help to manage or avoid the risks of using medications in combination while still addressing your health needs.
Generally, individuals with panic disorder have higher rates of suicidal ideation and more suicide attempts than the general population. This means that the prescription of Xanax within this population requires careful consideration.
Prescription of smaller doses or a different benzodiazepine may be recommended if your doctor considers you to be at risk.
Xanax should only be taken as a prescription medication under the guidance of a medical professional. Consuming illicit Xanax or combining Xanax with other substances can be unpredictable and dangerous.
When used as directed, Xanax is a safe and effective medication for anxiety and panic disorder. If you are seeking medication for yourself, talk to your doctor about the potential risks and side effects. If you or anyone you know is experiencing suicidal thoughts, reach out to a crisis helpline to get immediate support and longer-term psychological guidance.
Generally, there is not a set amount of Xanax that is too much. It varies significantly from person to person. As the dosage increases, you can expect more significant side effects. Always follow your doctor’s recommendations on what dose is appropriate for you, and consult them first if you wish to increase or decrease your dose.
After a single therapeutic oral dose of Xanax, it can be detected in your system for up to 36 hours. This varies depending on your metabolism, body composition, age, and sex.
Trends in nonfatal and fatal overdoses involving benzodiazepines — 38 states and the district of Columbia, 2019–2020 | Centers for Disease Control and Prevention
Benzodiazepines and opioids | National Institute on Drug Abuse