Key Takeaways:
- Never stop Xanax suddenly. The FDA warns that stopping too fast can cause withdrawal reactions, including seizures, and those can be life-threatening.
- You can become dependent in days, even taking it exactly as told. The FDA puts the window at several days to weeks. That is how the drug works, not a sign you did something wrong.
- It is the most prescribed benzodiazepine in the country. Of 92 million benzodiazepine prescriptions filled in 2019, alprazolam made up 38 percent.
- Mixing it with opioids or alcohol is what kills people. That combination carries its own boxed warning, and death is far more likely when more than one drug is involved.
- The risk grows the longer you take it. Xanax labeling states plainly that dependence and withdrawal risks rise with longer treatment and higher daily doses.
Maybe a doctor gave you Xanax for panic attacks, and it worked, and now you are wondering why you feel foggy all afternoon. Or you have been taking it for a year and the same dose has stopped doing much, so you looked up Xanax side effects at midnight.
In our guide, we will go through the side effects people actually notice and explain how dependence builds even when you follow the instructions.
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Common Physical Side Effects of Xanax
Xanax is the brand name for alprazolam, which decreases activity in your central nervous system. That is how panic can be swiftly extinguished, and that is why most Xanax side effects can seem like a half-speed walk.
These are the ones that people will see first:
- That drowsiness that persists longer than you expected it to
- Lightheadedness or dizziness from sudden standing up
- The risk of falls due to poor balance and/or coordination
- Dry mouth, headaches, and appetite or weight changes
Drowsiness and Sedation as Primary Reactions
Sedation isn’t really a separate side effect, it’s the main effect turned up too high. The medicine relaxes your nervous system, and at too high a dose that relaxation tips into heavy sedation.
This usually subsides during the first week or two, as the body gets used to it. If it doesn’t, call the person who prescribed it – a lower dose will usually cure it, there is no prize for being pushed through a fog all day!
Dizziness and Coordination Problems
Typically, symptoms associated with dizziness appear early and improve with adaptation. The most important thing is what it does during its time.
You’re not supposed to drive until you know how the medication affects you, and take extra care on stairs. But it’s not a trivial thing for older adults, because falls can indeed result in injuries and, indeed, benzodiazepines are among the more common causes of falls leading to an ER visit.
Cognitive and Behavioral Changes From Alprazolam Use
Most patients don’t realize how common the mental side effects are and how much they seem to frighten patients.
Gaps in memory of events occurring an hour or two after doses may be noticed. Others have difficulties focusing or following a conversation. A smaller group is the opposite of being calm: restless, irritable, or unusually blunt in their reaction, which is worthy of reporting, not ignoring.
Recognizing Dependency Risk and Benzodiazepine Effects
The aspect of dependency risk is the most surprising part. The FDA reports that physical dependence can occur when benzodiazepines are used regularly for several days to weeks, even when used as prescribed – and in 2020, the FDA added a boxed warning to all benzodiazepines due to the potential for abuse, addiction, dependence, and withdrawal.
How Tolerance Develops Over Time
Tolerance occurs the same way with Xanax and it develops fairly rapidly compared to some other drugs. The more the drug is in your body, the more of it you need to get the same effect.
According to the prescribing information for Xanax, there is a greater potential for dependence and withdrawal with higher doses and as doses are increased over time.
Xanax Withdrawal Symptoms and Timeline
This is the part to read twice, as Xanax withdrawal is not similar to the withdrawal from most other drugs.
The FDA states that stopping abruptly, or cutting the dose too quickly, can cause withdrawal reactions, including seizures, and that these can be life-threatening. The Xanax labeling says the same.
Early Withdrawal Signs to Monitor
Because the drug leaves your body fairly quickly, Xanax withdrawal can start within a day. Watch for these:
- Rebound anxiety that feels more intense than what you had before starting the medication.
- Often, the first symptom of getting sick is trouble sleeping.
- Shaking, sweating or rapid beating heart.
- Irritability or edge for no apparent reason.
- Increased sensitivity to light and sound that is disproportionate to the level of light or sound.
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Managing Acute Withdrawal Phases
If you notice any of these after you missed your dose(s) or reduced the amount, call your prescriber during the day. Never wait to determine if it will settle.
Here, a slow, gradual tapering under the supervision of a physician is the answer. The FDA is aware that there is no one-size-fits-all tapering schedule, and it should be customized to you and monitored throughout the process.
It is normal for a good taper to take weeks or months.
Anxiety Medication Trade-offs: Benefits Versus Risks
Xanax is genuinely good at stopping acute panic. It can stop a panic attack almost instantly, which matters enormously to someone in the middle of one.
What it does not do is treat anxiety over the long run. For that, most guidelines suggest that SSRIs or SNRIs, buspirone and cognitive behavioral therapy are the medications to use, but they take longer to work and do not carry the issue of dependence. A sensible plan may be a short-term use of Xanax and then a longer-term plan is put in place.
Getting Professional Support at Silicon Valley Recovery
Another interesting safety factor, which is more important than all the above. The drug mixture that is the leading cause of hospitalizations on Xanax is using the drug in combination with opioids or alcohol: When used in combination, Xanax and opioids or alcohol substantially slow down breathing.
If you are concerned about how much you are using, or have attempted to quit but failed, contact Silicon Valley Recovery and talk to someone. There, the clinicians can provide a safe medically supervised taper and treat the anxiety that is typically the origin of the prescription. In a crisis, call or text 988.
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FAQs
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Can Xanax drowsiness and sedation impair work or driving ability safely?
Yes, and this is one of the more serious everyday risks, because the drug slows reaction time and affects coordination even at normal doses. Do not drive until you know exactly how it affects you, and never drive after drinking while taking it.
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Why does alprazolam tolerance develop and how quickly does it occur?
Your nervous system adapts to the drug being present, so over time the same dose produces less effect and you may notice it wearing off sooner. Xanax labeling notes that dependence and withdrawal risks increase with longer treatment and higher daily doses, which is why short courses are usually preferred.
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Are benzodiazepine withdrawal symptoms dangerous without medical supervision and monitoring?
They can be genuinely dangerous, and the FDA states that stopping abruptly or reducing too fast can cause withdrawal reactions including seizures that may be life-threatening. Always taper with a doctor, and never stop on your own or on advice from the internet.
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What anxiety medication alternatives carry lower dependency risk than Xanax?
SSRIs and SNRIs, buspirone, and certain other non-benzodiazepine options carry far less dependence risk, though they take several weeks to start working properly. Cognitive behavioral therapy also has strong evidence for anxiety and leaves you with skills that stay after treatment ends.
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How long does Xanax dizziness typically last after starting treatment?
For most people it eases within the first week or two as the body adjusts to the medication. If it is still there after that, or it is severe enough to affect your balance, contact your prescriber rather than simply putting up with it.
References
- U.S. Food and Drug Administration. (2020). FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class
- Pfizer. (n.d.). XANAX (alprazolam) prescribing information. https://labeling.pfizer.com/showlabeling.aspx?id=547
