What Is Xanax? Purpose, Dosage And Side Effects (2024)

Xanax (also called alprazolam) is one of the most well-known anti-anxiety medications, says Alex Dimitriu, M.D., a double board-certified physician in psychiatry and sleep medicine and founder of Menlo Park Psychiatry & Sleep Medicine and BrainfoodMD. “It’s in the class of drugs called benzodiazepines, also known as muscle relaxants or anxiolytics,” he says. Other common benzodiazepines include Valium and Klonopin.

When the first benzodiazepine was developed in 1955, researchers found it had sedative, muscle relaxant and anticonvulsant effects in animal studies. By the 1970s, there was a major uptick in prescriptions, and benzodiazepines became the most commonly prescribed class of drugs across the globe. “For many years, benzodiazepines were commonly used to treat many anxiety disorders as well as insomnia,” says Ash Nadkarni, M.D., an associate psychiatrist and instructor at Harvard Medical School.

Today, Xanax is prescribed to treat anxiety disorders including panic disorder, which is characterized by sudden episodes of intense fear or worry along with physical symptoms, such as heart palpitations, shortness of breath, chest pain and dizziness. And because Xanax is fast acting—and metabolizes, or leaves the body, quickly—it may be prescribed for anxiety relief for certain events that may cause a person temporary distress, such as public speaking, interviewing for a job or flying.

It may also be prescribed for insomnia, premenstrual syndrome and depression—although these are non-FDA labeled indications of the medication (or what is called “off-label” use).

Benzodiazepines like Xanax are central nervous system depressants that slow down brain activity and relax the muscles. “They achieve this by increasing the effects of GABA [gamma-aminobutyric acid]—one of the main calming or inhibiting neurotransmitters in the brain,” says Dr. Dimitriu.

We all have dozens of neurotransmitters, or chemical messengers, that allow neurons to communicate with each other throughout the body, and the amino acid GABA is one of them. As the primary inhibitory neurotransmitter in the brain—meaning it makes neurons less likely to fire, or send a chemical message—GABA plays a role in several calming functions, including muscle relaxation, the reduction of brain activity and sleep regulation.

Anxiety, life stressors and traumatic experiences “can shift our biological anxiety set point,” explains Dr. Dimitriu. While too little anxiety can make a person feel fatigued and void of care (or less interested and engaged in life), too much anxiety can be debilitating, he says. “Medications like Xanax can help people who are too anxious, and ideally get them back to the sweet spot on the anxiety spectrum.”

It’s important to note that medications like Xanax act more like a symptom Band-Aid rather than a cure-all, adds Dr. Dimitriu. “They help when symptoms arise, but will not affect the background tendency for anxiety or panic to recur,” he says.

Therefore, in order to treat the underlying anxiety symptoms, it’s important to receive evidence-supported psychological treatment, such as cognitive behavioral therapy or somatic experiencing therapy.

Because Xanax is sedating, Dr. Dimitriu says he generally asks patients to try their first dose during an afternoon or evening when being sleepy wouldn’t be problematic. “It’s best to be at home and avoid driving, especially early in the course as people learn how the drug affects them,” he says.

While some people are prescribed extended-release tablets, Dr. Dimitriu reiterates that Xanax is known to be a rapid onset and rapid offset medication, meaning it works quickly—and stops working quickly, too. “For this reason it can become quite addictive. As the medicine’s effects rapidly end, anxiety returns and some people are left wanting more,” he says, advising patients to take as little as they can and to space out doses as much as possible.

Dr. Nardkarni adds that while you do not need to take Xanax with food, it can be taken with a snack or meal to help prevent an upset stomach.

It’s important to avoid driving and operating machinery after first taking Xanax, and to be extra cautious when taking stairs since benzodiazepines can slow reflexes and increase the risk of falling.

And because benzodiazepines can impair coordination and breathing in higher doses or when combined with another sedative, Dr. Dimitriu advises patients to avoid alcohol, anti-seizure drugs, opiates and anticonvulsant medications when taking the medication. Mixing Xanax with opioid medications, for example, can lead to serious side effects like slowed breathing, and can even be fatal.

Since Xanax can interact with a long list of prescription and over-the-counter medications, be sure to disclose to your doctor what medications you are currently taking.

It’s also important to note that benzodiazepines like Xanax are not considered safe for long-term use. The Anxiety and Depression Association of America also does not recommend them for people with severe suicidal or addictive tendencies, or those with a family history of addiction.

Additionally, if you are pregnant or breastfeeding, speak with your health care provider before taking this medication, who can help you weigh the risks versus benefits.

How much Xanax a person takes—and how often they take it—comes down to their specific needs. “The dosing and schedule for Xanax is dependent on the therapeutic needs of the individual,” says Dr. Nadkarni, “but given that it is a short-acting medication, it can be taken more than once a day.”

It’s always best to start with a low dose and gauge how you respond to this medication before consulting with your health care provider to increase your dosage, adds Dr. Dimitriu.

“Start low and go slow with increases is a good mantra to follow for anyone,” he says. This advice is especially important for older individuals who may be at a higher risk for impaired cognition and mobility as well as an increased risk of falls when taking a benzodiazepine.

And for those who take Xanax regularly long-term (which is not recommended), it’s possible to build up a tolerance. “Sometimes people will require higher doses to achieve the same effect when the medicine is taken often,” says Dr. Dimitriu. “If used sparingly, this can be avoided.”

The side effects of taking Xanax often mirror those of drinking too much alcohol, according to Dr. Dimitriu. “People can become slow, wobbly, uncoordinated, sedated and be at an increased risk of falls and even car accidents,” he says.

Additional side effects of Xanax may include:

• Sleepiness
• Dizziness
• Irritability
• Difficulty concentrating
• Dry mouth
• Changes in mood
• Changes in sex drive
• Changes in appetite
• Changes in weight
• Nausea
• Constipation

Withdrawal symptoms of Xanax can include:

• Headaches
• Muscle pain
• Dizziness
• Visual disturbances
• Sleep disturbances
• Delirium
• Nausea
• Anxiety
• Irritability

If you experience symptoms including shortness of breath, seizures, a severe skin rash, yellowing of the skin or eyes, confusion, problems with speech or problems with coordination or balance, reach out to your doctor immediately, as these could be serious.

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And as mentioned above, Xanax and other medications in the benzodiazepine class of drugs are not considered safe for continuous use, which can increase the risk of dependence. Because Xanax is considered such a potent sedative, Dr. Nadkarni says there are concerns related to its nonmedical (recreational) use and its potential role in the drug overdose epidemic.

“Making a comprehensive clinical assessment, consideration of substance use disorders, ensuring proper informed consent and use of non-pharmacological options for treatment are all key components of a careful approach,” she says.