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Xanax Dosages

Xanax Dosages, Interactions, Overdose, Addiction, & Treatment Options

What is Xanax?

Xanax is a powerful sedative. It depresses the Central Nervous System (CNS) and slows down the brain, creating a calming effect in the person taking it. It is a brand name for alprazolam[1]. It is a prescription drug used for anxiety treatment. Xanax is also sometimes prescribed for panic attack treatment. Xanax use can lead to physical dependence and addiction, which is why it is only recommended for use for up to six weeks.

Withdrawal is one of the most common Xanax side effects. It is commonly experienced when someone reduces or stops using this prescription drug, which can lead to complications such as panic attacks, insomnia, and seizures. Withdrawing from Xanax under an inpatient drug rehab specializing in Xanax detox and Xanax addiction treatment reduces the risk of complications and helps the individual experience a safer, more comfortable recovery.

Xanax Dosages
Someone with a Xanax addiction may take up to 20 or 30 pills per day. If the user decides to stop the Xanax dosages, they may experience withdrawal effects 

Some individuals who are dependent on this prescription drug never abused drugs before. They were suffering from anxiety and looking to the medical field for support and relief. They began using Xanax and felt a vast improvement in anxiety symptoms. Some then assumed more of the drug would produce an even greater effect, so they misused Xanax in larger doses. Others just use Xanax for too long, and often with a doctor’s permission. They don’t realize they’re addicted to it until it’s too late.

Many individuals who take Xanax without a prescription or recreationally describe the feeling as calming or sedating. Unlike some drugs, such as cocaine, that produce a “high” or euphoric feeling, Xanax users describe feeling more relaxed, quiet, and tired. These feelings may lead to falling asleep or passing out for a few hours. Mixing cocaine and Xanax, and Xanax and alcohol is pretty common which can lead to a coma, potential paralysis, or even overdose death.

What Does Xanax Do? 

When taken as prescribed, Xanax (alprazolam) use can help stop episodes of irrational and intense anxiety or fear when they begin to occur. Both the regular and the extended-release form of Xanax take effect quickly on the central nervous system, calming the nerves and the brain by increasing levels of the neurotransmitter GABA (gamma-aminobutyric acid) in the brain [2]. Xanax is a central nervous system (CNS) depressant, which means that it also slows down vital functions like breathing and heartbeat. Therefore Xanax use without a doctor’s prescription or taking the medication recreationally can result in over-sedation, Xanax overdose, and death.

Dosage of Xanax 

Dosage of Xanax for Generalized Anxiety Disorder (GAD)

The recommended starting oral dosage of Xanax for the acute treatment of patients with GAD is 0.25 mg to 0.5 mg administered three times daily. Depending upon the response, the dosage of Xanax may be adjusted at intervals of every 3 to 4 days. The maximum recommended dosage is 4 mg daily (in divided doses).

Generalized Anxiety Disorders

The most common use for Xanax is the management of anxiety disorders. Anxiety affects over 18 percent of American adults, and approximately 22 percent of these individuals suffer from severe anxiety symptoms, such as the following:

  • Persistent feelings of fear that are not based on reality
  • Sweating
  • Frequent periods of restlessness or nervousness
  • Heart palpitations
  • Difficulty concentrating
  • Sleep disturbances
  • Shortness of breath
  • Sensations of tightness in the throat or chest

Anxiety can be a disabling condition, interfering with jobs, school, relationships, or social activities. When prescribed for anxiety, Xanax is usually recommended for short-term use to prevent abuse or addiction.

Xanax Dosages
Once an individual becomes psychologically or physically addicted to Xanax, the safest way to stop using the drug is to enter a medically managed detox program.

Dosage of Xanax for Panic Disorder

The recommended starting oral dosage of Xanax for the treatment of panic disorder is 0.5 mg three times daily. Depending on the response, the dosage of Xanax may be increased at intervals of every 3 to 4 days in increments of no more than 1 mg per day.

For patients receiving doses greater than 4 mg per day, periodic reassessment and consideration of dosage reduction are advised. In a controlled dose-response study, patients treated with doses of Xanax greater than 4 mg per day for 3 months were able to taper to 50% of their total maintenance dose without apparent loss of clinical benefit.

Panic Disorder

Individuals with panic disorder can experience crippling attacks of anxiety, especially in public places. In fact, the fear of having a panic attack in front of other people usually triggers further panic attacks and can lead to depression and social isolation.  Panic attack symptoms like the following can be so terrifying that the individual may fear that they are about to die.

  • An overwhelming sense of dread or doom
  • Heavy sweating
  • Pain or pressure in the chest
  • A feeling of choking or suffocating
  • Dizziness and light-headedness
  • Irregular or rapid heartbeat
  • Nausea and vomiting
  • Tremors and shaking
  • A sense of being detached from reality

This drug has been proven effective at relieving panic symptoms when they start to happen, allowing millions of people to handle situations that might otherwise trigger severe anxiety successfully.

Xanax Drug Interactions 

As is the case with any other medication, there may be some instances where Xanax interactions can occur. In such cases, use is not recommended, or dosage will have to be adjusted in order to prevent or reduce the risk of negative interactions occurring from other drugs, medical conditions, or even food and drink.

According to the FDA, drugs that may interact with Xanax (alprazolam) include the following.

  • Ketoconazole (Nizoral)
  • Itraconazole (Sporanox)
  • Desipramine (Norpramin)
  • Fluoxetine (Prozac)
  • Propoxyphene (Darvon)
  • CYP3a inhibitors
  • Opioids, such as oxycodone (OxyContin) and hydrocodone (Vicodin)
  • Other CNS depressants like barbiturates [e.g., butabarbital (Butisol)]
  • Oral contraceptives (aka hormonal birth control; patients should explore non-hormonal birth control methods)

Xanax and Tylenol

There is no indication that Xanax interacts with Tylenol (acetaminophen), and no warnings about taking them together. One should always consult a healthcare provider before mixing medications, though.

Xanax and Tylenol PM

Taking Xanax with Tylenol PM (acetaminophen plus diphenhydramine) might increase the side effects of both medications, including sleepiness, dizziness, and confusion. 

Xanax and Lisinopril

Lisinopril (Qbrelis, Zestril, Prinivil) is an ACE inhibitor that lowers blood pressure. Combining it with Xanax may make blood pressure extremely low, leading to dizziness, headache, fainting, and changes in heart rate. These side effects are more likely to occur when first taking Xanax or lisinopril together or when the dosage changes. 

Xanax and Melatonin

There are some indications that combining alprazolam and melatonin may increase the sedative effect. 

Xanax and Buspirone

Both buspirone (Buspar) and Xanax are for the treatment of anxiety disorders. There is no clear indication of interaction between them, though. That said, one should only combine these medications at the recommendation of a healthcare provider. 

Xanax and Metoprolol

Metoprolol (Toprol XL, Lopressor) treats high blood pressure and chest pain from poor blood flow to the heart. Both metoprolol and Xanax lower blood pressure, so taking them together might have unexpected consequences. These consequences include dizziness, headache, fainting, and a change in heart rate.  

Xanax and Methadone

Methadone (Diskets, Methadone Intensol, Methadose) and Xanax are both central nervous system depressants. Taking them together will intensify the effects. It may increase the risk of overdose, as well. 

xanax dosages
Withdrawal from Xanax shares many of the same symptoms as that of alcohol withdrawal

Xanax and Alcohol

Using Xanax and alcohol together can be extremely dangerous since both substances can suppress the normal functioning of the central nervous system. Mixing Xanax with alcohol increases the risk of serious, even fatal complications such as respiratory depression. Some people who previously took Xanax and miss the feelings they experienced can turn to alcohol as a substitute drug, even if they did not consume alcohol while taking Xanax. 

In order to achieve the same effects, people tend to consume a larger amount of alcohol and eventually become alcoholics. In some cases, their dependency on Xanax is so strong they could also attempt to purchase the drug illegally.

If you are taking Xanax, you should not drink alcohol while taking this drug because of the dangers to your health and well-being. If you feel you have developed a dependency on either Xanax or alcohol, or are using both drugs simultaneously, it is important to seek help.

Xanax Overdose 

A Xanax overdose can be life-threatening, especially if the prescription drug is taken with alcohol. Alcohol is particularly dangerous when mixed with Xanax because they are both depressants; combining the two can lead to an overdose and respiratory failure.

Overdose deaths involving benzodiazepines (including Xanax) increased from 0.58 per 100,000 adults in 1996 to 3.07 in 2010. Moreover, data shows that 11,537 overdose deaths involving benzodiazepines occurred in 2017. This is according to the Centers for Disease Control and Prevention (CDC) [2].

Xanax should never be combined with other benzodiazepines like Valium, Klonopin, or Ativan. The effects of each drug can “stack” and increase the chance of overdose. Xanax overdose can also happen if the pills are chewed or crushed, as the drug is designed to be time-released into the system. Xanax overdose symptoms include:

  • Fainting
  • Slowed heart rate
  • Confusion
  • Extreme drowsiness
  • Difficulty breathing
  • Shallow breathing 
  • Muscle weakness
  • Loss of balance
  • Blue lips or nails 
  • Unconsciousness 
  • Coma

How Much Xanax Does It Take to Overdose?

The amount of Xanax needed to overdose can vary, especially when the drug is mixed with other substances. Most Xanax overdoses happen when Xanax is taken alongside CNS drugs like opioids or alcohol. Xanax bought on the street can also be counterfeit or cut with the opioid fentanyl, which can increase the risk of Xanax overdose.

When combined with the sedative properties of benzos, alcohol and opioids can create a lethal suppression of a person’s breathing or circulatory system. The FDA has a Black Box Warning about mixing benzodiazepines with opioids for this reason. Using Xanax can also be harmful during pregnancy since benzos can cross the placenta—potentially leading to fetal dependence and associated neonatal withdrawal.

How Long Does Xanax Last?

Xanax is a short-acting benzodiazepine. The quick answer to “how long does Xanax last” is four hours. However, that number may vary depending on your physical makeup, the dosage of Xanax, and how long you’ve been taking Xanax.

xanax dosages
Serious Xanax side effects due to withdrawal symptoms include psychosis, seizures, and hallucinations.

Xanax is taken by mouth and quickly absorbed into the bloodstream. Effects should be noticed within an hour and the medicine reaches peak concentrations in the body after one to two hours. People who take Xanax regularly can build up a tolerance to it and effects, such as a feeling of calm or sedation, may take longer to develop or not be felt as strongly as before.

Studies have shown that the half-life of Xanax ranges from 6.3 to 26.9 hours. It is important to realize that half-life is a figure that is an estimate of the time it takes for the concentration or amount in the body of that drug to be reduced by exactly one-half (50%).

After four to five half-lives, 97% of a drug has cleared from the body, and the drug is no longer considered to be having any effect. However, this does not mean that it won’t be detectable by a drug test, as this depends on how specific and sensitive the drug test is.

Xanax Addiction 

Some people who are dependent on Xanax never abused any kind of drugs before. They were people struggling with anxiety and looking to the medical field for relief and support. They started taking Xanax and felt a huge improvement in symptoms. Some of them thought that using more Xanax would provide an even greater result, so they misused it in larger doses. Others just use it for too long, and often with a doctor’s permission. They don’t realize they’re addicted to it until it’s too late.

Some people may attempt to reduce their dose resulting in withdrawal symptoms that copy their initial anxiety. They assume they cannot cope without the drug and keep abusing it. Sometimes the anxiety symptoms that resurface are caused by substance-induced symptoms that would otherwise dissipate if the drug abuse stopped.

Some people combine Xanax with other downer substances like alcohol or opiates in order to increase pleasurable feelings. This can dangerously lead to negative health consequences such as coma, respiratory arrest, and death. Other people use Xanax to control unwanted side effects of stimulant abuse. This combination of uppers and downers can lead to heart complications such as myocardial infarction.

With prolonged usage, people may become dependent on Xanax. This can mean that they rely on the drug both psychologically and physically. In Xanax, many users have found a pleasant escape from everyday stressors and must relearn how to have a productive, enjoyable life without taking this drug. Sober living skills often take time to develop as the person addicted to the prescription drug may feel life without Xanax is unbearable. Many users, in fact, take Xanax to feel normal and function in everyday life, as they may have come to believe that they cannot function without it. These individuals will require drug rehab before embarking on a new, sober life.

Polysubstance Abuse Treatment 

There is a strong link between mental health and substance abuse. Individuals who struggle with mood disorders like depression and anxiety are more susceptible to developing an addiction to drugs or alcohol, often to self-medicate symptoms of their underlying mental health condition. These co-occurring disorders can make each other worse without proper treatment.

To determine the most effective ways to treat Xanax and alcohol addiction, it’s crucial to first get an accurate assessment of all the symptoms. When the symptoms have been evaluated by a mental health professional, it may be determined that another form of mental condition is present and needs a particular type of treatment. Very often, some combination of psychotherapy, medication, and/or lifestyle changes are effective for coping with functional.

Medically-Assisted Detox

Detox is often considered the first stage of treatment. It will help you navigate the complicated process of withdrawal, but it doesn’t address patterns of thought and behavior that contribute to drug abuse. Various treatment approaches and settings can help provide the ongoing support necessary to maintain long-term sobriety after you complete detox.

Cravings are very common during detox and can be challenging to overcome. This often leads to relapse. Constant medical care provided during inpatient treatment helps prevent relapse. Clinicians can provide necessary medication and medical expertise to lessen cravings and the effects of withdrawals.

Psychotherapy for Depression and Anxiety

Several different modalities of psychotherapy have been used in the treatment of depression including:

  • Cognitive Behavioral Therapy (CBT) – is an effective treatment that involves making changes in both the patterns of negative thoughts and the behavioral routines which are affecting the daily life of the depressed person for various forms of depression.
  • Dialectical Behavioral Therapy – is a comprehensive mental health and substance abuse treatment program whose ultimate goal is to aid patients in their efforts to build a life worth living. The main goal of DBT is to help a person develop what is referred to as a “clear mind.” 
  • Person-Centered Therapy – is a strategy that allows and encourages clients to understand and resolve their concerns in a safe, supportive environment.
  • Solution Focused Therapy – is an approach interested in solutions that can be quickly implemented with a simple first step leading to further positive consequences.

Dual Diagnosis Treatment

Substance abuse and mental health disorders often co-occur. In many cases, traumatic experiences can result in a mental health disorder and substance abuse. Dual diagnosis rehabilitation treats both of these issues together. The best approach for the treatment of dual diagnosis is an integrated system. In this strategy, both the substance abuse problem and the mental disorder are treated simultaneously. Regardless of which diagnosis (mental health or substance abuse problem) came first, long-term recovery will depend largely on the treatment for both disorders done by the same team or provider.

Medication-Assisted Treatments

Medication-Assisted Treatments (MAT) for substance use disorders and mental health disorders are commonly used in conjunction with one another. This includes the use of medications and other medical procedures. During your rehab, the staff from your treatment facility will help you identify what caused your addiction and teach you skills that will help you change your behavior patterns and challenge the negative thoughts that led to your addiction. Sometimes, the pressures and problems in your life lead you to rely on substances to help you forget about them momentarily.

Someone with a Xanax addiction may take up to 20 or 30 pills per day. If the user decides to stop the Xanax dosages, they may experience withdrawal effects such as anxiety, restlessness, insomnia, and tremors. The development of tolerance and withdrawal are indications of addiction. If you or a loved one are struggling with long-term Xanax and alcohol addiction and a co-occurring mental health condition such as anxiety and depression, contact one of our helpful treatment specialists today. We Level Up can provide information on dual diagnosis and detox programs that may fit your specific needs.

Xanax dosages
Recovering from Xanax addiction may be challenging but we’re here to help and want to see you get back to living a happier and healthier life of sobriety.
Sources

[1] NCBI – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846112/

[2] CDC – https://www.cdc.gov/nchs/data/nhsr/nhsr137-508.pdf