Xanax Overdose: Risks, Symptoms and Treatment
By The Recovery Village
Medical Reviewer Dr. Jessica Pyhtila, PharmD | Editor Jonathan Strum
Last Updated: May 16, 2023
Editorial Policy | Research Policy
A Xanax overdose can be fatal, especially if it’s taken with another drug. Seek emergency help immediately if you suspect one is happening.
In 2020 alone, more than half of fatal benzodiazepine overdoses were due to a single drug: Xanax (alprazolam). As the most commonly prescribed benzodiazepine in the United States, Xanax is taken by millions of Americans every year. Nonetheless, it is a controlled substance that carries a risk of abuse, addiction and overdose. As such, it is important to be aware of the risk factors for a Xanax overdose and know what to do if you suspect an overdose.
What Does Xanax Do?
Xanax is a benzodiazepine, commonly known as a “benzo.” The drug works by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain. GABA is the brain’s main inhibitory neurotransmitter, meaning that it helps reduce activity in the brain. Because Xanax helps calm down the brain and body, it is often prescribed to treat conditions like:
- Anxiety disorders
- Panic disorder
- Nausea and vomiting due to chemotherapy
Is Xanax Safe?
As an FDA-approved medication, Xanax is safe and effective when taken exactly as prescribed by a doctor. However, as a Schedule IV controlled substance, it can increase the risk of abuse, addiction and dependence, especially if not taken as prescribed. Taking more Xanax than prescribed or taking it more often than prescribed can increase your risk of Xanax addiction and overdose.
There are also some safety issues that can arise if someone takes Xanax for an extended period. These include an increased risk of:
- Cognitive impairment
- Motor vehicle crashes
- Hip fractures
Related Topic: Xanax Side Effects
Brand-name Xanax and its generic version alprazolam both come in different dosage forms and doses:
- Oral concentrate: As 1 mg alprazolam inside every 1 mL of liquid
- Orally disintegrating tablets: In strengths of 0.25 mg, 0.5 mg, 1 mg, 2 mg
- Short-acting tablets: In strengths of 0.25 mg, 0.5 mg, 1 mg, 2 mg
- Long-acting tablets: In strengths of 0.5 mg, 1 mg, 2 mg, 3 mg
How Often Can You Take Xanax?
You should only take Xanax as often as prescribed by your doctor. Short-acting Xanax can be taken up to three times daily, while long-acting Xanax is usually taken once daily. Taking Xanax more often than prescribed can increase your risk of overdose.
What Is the Highest Dose of Xanax?
Short-acting Xanax comes in strengths as high as 2 mg, and long-acting Xanax can be as high as 3 mg. However, the highest recommended dose of Xanax depends on why you are taking it. For example, the highest recommended total daily dose for anxiety is 4 mg; for panic disorder, it is 10 mg.
Can You Overdose on Xanax?
It is common to overdose on Xanax if you take it with other substances, such as opioids, or take more Xanax than prescribed. A Xanax overdose can be deadly. In 2020 alone, there were more than 1,200 fatal Xanax overdoses. In 2019, about 16% of opioid overdose deaths also included the presence of a benzo like Xanax.
What Happens When You Overdose on Xanax?
When you overdose on Xanax, there is an excessive impact on neurotransmitters in your brain, specifically GABA. Xanax causes GABA to work more effectively in your brain. Since GABA slows down brain activity, this means that taking too much Xanax excessively slows your brain.
Most people who seek help for a Xanax overdose will be very sedated but have near-normal breathing, heart rate and blood pressure unless they have taken Xanax with another substance. Unfortunately, most Xanax overdoses involve taking multiple substances, which makes a Xanax overdose very dangerous.
Xanax Overdose Symptoms
If you or someone you love takes Xanax, it is important to be able to quickly identify overdose symptoms. Xanax overdose symptoms include:
- Mental status changes, including drowsiness and slurred speech
- Slow or shallow breathing, which is more likely to occur if Xanax has been taken with another substance, such as an opioid
- Balance and coordination problems
A Xanax overdose can be fatal, especially if a person has taken Xanax with another drug. If someone is experiencing any signs of a Xanax overdose, seek help immediately by calling 911 or the National Capital Poison Center.
How Much Xanax Is Too Much?
How much Xanax it takes to overdose can vary, especially when you mix Xanax with other substances. Most Xanax overdoses occur when Xanax is taken with other depressants, including alcohol or opioids. Illicit Xanax may be counterfeit and is sometimes cut with opioids like fentanyl, further increasing your overdose risk.
How Much Xanax Does It Take To Overdose?
There is no one set amount of Xanax that can cause an overdose. Multiple factors can influence how much Xanax it takes to overdose, including whether your body is used to (or tolerant of) Xanax and whether you have taken other substances. To avoid a Xanax overdose, never take Xanax in higher or more frequent amounts than prescribed.
How Much Xanax Can Kill You?
Different amounts of Xanax can be fatal in different people. Factors that can affect this include taking other substances besides Xanax, especially opioids. The amount can also depend on whether your body is used to the presence of Xanax.
Xanax Overdose Risk Factors
A Xanax overdose can be deadly. Fortunately, there are many risk factors that can help identify who is most at risk for a Xanax overdose. Knowing that you or someone you love has risk factors can help you remain vigilant against taking too much Xanax. In addition, risk factors can signal that it may be time to seek help for Xanax use.
Some risk factors include:
- Xanax addiction
- Taking Xanax with alcohol or other substances, especially opioids
- Having other health conditions, including mental health problems
As a Schedule IV controlled substance, Xanax carries a risk of abuse, addiction and dependence. For this reason, doctors and pharmacies must closely monitor benzodiazepine prescriptions and ensure people are not taking too much Xanax or taking it more often than prescribed.
A common reason that people take more Xanax than they should is to try to self-treat sleep or anxiety problems. However, other medications that are less addictive can treat these conditions, so it is important to talk to your doctor if you are tempted to take more Xanax than instructed.
Xanax Addiction Rate
Xanax is the most commonly prescribed benzo, with more than 17 million prescriptions dispensed in the U.S. in 2019 alone. Although there is little data available specifically on Xanax addiction rates, experts know that about 2% of people prescribed benzos have benzodiazepine use disorders. This means that around 340,000 Americans likely have an addiction to Xanax.
Xanax and Alcohol
You should avoid drinking while taking Xanax. This is because both Xanax and alcohol are central nervous system depressants that can slow activity in your brain and may have an additive effect. Mixing the two substances can increase the risk of overdose as well as side effects like:
- Problems concentrating
- Impaired thinking and judgment
How Long After Taking Xanax Can I Drink?
It is important to avoid alcohol until your body has metabolized Xanax. Although short-acting Xanax only lasts for a few hours in most people, it can last much longer in others, especially those who have liver problems or are on medications that interact with Xanax. As such, you should talk to your doctor before drinking if you take Xanax. Based on your medical history and medications, your doctor will be able to give you the safest time frame for when you can have a drink.
Other Drug Interactions
Taking Xanax with other central nervous system depressants can increase the risk of overdose. This is especially true of opioids, which is why the FDA has a Boxed Warning on benzodiazepines like Xanax that warns against combining with opioids. More than 93% of fatal benzo overdoses in 2020 involved people who had also taken an opioid.
Interactions with Xanax are not limited to opioids. For example, certain antidepressants, especially fluvoxamine, have a drug interaction with Xanax that may increase the risk of an overdose. If you take Xanax and are started on fluvoxamine, you may need a Xanax dose decrease.
The presence of mental health concerns like depression can increase the risk of a Xanax overdose. Unfortunately, some people may intentionally overdose on Xanax by taking a large amount of the drug or combining it with other drugs.
Some medical conditions, such as liver or breathing problems, can increase the risk of an accidental Xanax overdose. For this reason, it’s very important to only take Xanax that has been prescribed to you by a doctor.
Age, race and gender are additional risk factors for Xanax overdose. More than 51% of Xanax overdoses in 2020 were in women, and 81% of fatal benzo overdose victims were white. Although overdose can occur in anyone at any age, benzo overdose rates are highest among those aged 25 to 34 as of 2020.
Xanax Overdose Treatment
Due to its life-threatening risks, a Xanax overdose should only be treated in a medical setting. A Xanax overdose can cause slow breathing, low blood pressure and slow pulse, so doctors will often address these issues first while waiting for Xanax to wear off. In rare cases, doctors may prescribe flumazenil, a benzodiazepine reversal drug. However, flumazenil can carry health risks like seizures and heart rhythm abnormalities, so it is not widely used.
Xanax Addiction Treatment
Fortunately, help is available for Xanax abuse and addiction. A medical detox program can wean you off Xanax in a safe environment to help you avoid withdrawal symptoms. This is followed by a rehab program that helps ensure you stay off Xanax for good.
At The Recovery Village Cherry Hill at Cooper, we offer an evidence-based medical detox program and a comprehensive list of rehab options to suit your needs. These include inpatient rehab, outpatient rehab, partial hospitalization programs and long-term aftercare.
Our 90-bed, nationally accredited treatment facility also has amenities to help keep both your body and mind healthy while you recover from Xanax. These include:
- Fully-equipped gym
- Indoor basketball half-court
- Outdoor volleyball court
- Yoga room
- Game room
- Entertainment lounges
- Outdoor bocce ball
- Outdoor shuffleboard
If you or someone you love is struggling with Xanax, our addiction experts can help. Contact us today to learn more about Xanax addiction treatment programs that can work well for your situation.
Our Recovery Advocates are ready to answer your questions about addiction treatment and help you start your recovery.
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