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What’s the Lethal Dosage of Xanax (Bars)?

Xanax OverdoseXanax (alprazolam) is a benzodiazepine, or benzo, that is used to help treat people with anxiety and panic disorders. Benzos are prescription medications that act on GABA receptors to increase inhibitory signaling—essentially “slowing” certain types of brain activity. Such central nervous system (CNS) depressant activity helps to elicit a therapeutic calming effect in those using these drugs.

When this substance is used for short-term benefit under the direction of a doctor, it is generally considered safe. However, it can be harmful when misused, either by taking it without a prescription or taking more than prescribed. 1,2

Taking too much Xanax or taking it with another CNS depressant substance like alcohol can cause a serious, potentially fatal, overdose.1

Signs of a Xanax Overdose

Signs and symptoms of a Xanax overdose include:1,3

  • Impaired coordination.
  • Delayed reflexes.
  • Hypotension.
  • Respiratory depression.
  • Confusion.
  • Extreme drowsiness.
  • Loss of consciousness.
  • Coma.

Though deaths have been reported in association with Xanax use on its own, lethal overdoses are more likely when they involve concurrent use of opioids or other CNS depressants such as alcohol, barbiturates, and other benzodiazepines.1,3,4 Benzodiazepines were involved in over 11,500 overdose deaths in 2017.4

Xanax overdoses may require emergency medical treatment that includes maintenance of adequate blood pressure, airway management, assisted ventilation, and administration of the benzodiazepine receptor antagonist, flumazenil.1

Polydrug Use: A Recipe for Overdose

Polydrug use, or the use of multiple drugs at the same time, is common with benzos like Xanax.4 The majority of deadly benzodiazepine overdoses involve other drugs, with a large percentage of those involving opioids like heroin and prescription painkillers.4

When a person takes other drugs that produce similar effects as Xanax in combination with the drug (such as slowed breathing), certain effects may compound, and it may take a much lower dose for it to be lethal—an alarming fact when you consider that an estimated 80% of all benzo abuse is part of a larger pattern of polydrug abuse.5

Alcohol and benzos are a particularly dangerous combination. Xanax in combination with alcohol may easily result in overdose death.1

Similarly, the combination of Xanax and opioids can be a risk to your health and life. In 2017, there were nearly 10,000 overdose deaths involving opioids and benzos together.4

In reviewing nearly a million benzo-related emergency department visits from 2005 to 2011, the Substance Abuse and Mental Health Services Administration found that combinations of benzodiazepines with opioid pain relievers or alcohol were associated with a 24% to 55% increase in the risk of a more serious outcome (a required hospital admission or death in the emergency department) compared to benzodiazepines used alone.6

How Dangerous Is Xanax?

Although uncommon, using Xanax even as prescribed can result in serious side effects, including:1,3

  • Pronounced mood changes.
  • Depression.
  • Suicidal thoughts.
  • Confusion.
  • Memory problems.
  • Hallucinations.
  • Poor coordination or balance.
  • Problems speaking.
  • Shortness of breath.

Xanax is far more dangerous when misused. Long-term use of Xanax, especially in combination with heavy alcohol use, can cause serious memory impairments including difficulty remembering recent events and the order in which events occurred.5

Using Xanax can also be harmful during pregnancy, since benzos can cross the placenta—potentially leading to fetal dependence and associated neonatal withdrawal.5

Xanax Addiction and Physical Dependence

Xanax Bars

Apart from the risk of overdose, Xanax is also associated with the potential for abuse, physical dependence, and addiction.2,5 

People who are addicted to Xanax have a difficult time controlling their drug use despite experiencing serious negative consequences.2 They may misuse Xanax by using it  in dangerously high doses or by using it in combination with other drugs that make deadly overdose more likely.

Physical dependence is not the same as addiction but is present quite often in individuals who are addicted to benzodiazepines. Dependence involves changes in the body and brain due to Xanax use that lead you to rely on the drug just to feel well. 2 Without the benzodiazepine, or with a much lower dose, you may go through withdrawal.3,7

Xanax dependence can develop quickly, in a matter of weeks.6 Because of the inherent risks of Xanax—including its liability for abuse and dependence—benzodiazepines like Xanax are typically prescribed for short periods of time.2

Once a person has developed significant dependence, it can be very risky to stop taking Xanax abruptly; at this point, cessation of the drug should be done with medical supervision and, potentially, pharmaceutical intervention. Withdrawal symptoms may not only be severely uncomfortable, but potentially dangerous, especially in the case of long-term use or abuse of Xanax.3,4,7

Withdrawal Symptoms

Acute Xanax withdrawal symptoms include:1,3

  • Anxiety.
  • Insomnia.
  • Fatigue.
  • Difficulty concentrating.
  • Loss of appetite.
  • Abdominal pain.
  • Nausea/vomiting.
  • Diarrhea.
  • Increased heart rate.
  • Increased blood pressure.
  • Blurry vision.
  • Sweating.
  • Muscle cramps or twitching.
  • Tremors.
  • Convulsions.
  • Seizures.

Many acute symptoms of Xanax withdrawal typically resolve within 1-4 weeks of stopping.8 However, some protracted or prolonged withdrawal symptoms may persist for several months and may involve anxiety, depressed mood, and insomnia.8

Safely Quitting Xanax

Because of the potential risks of Xanax withdrawal, it may be safest to quit under medical supervision. Medical detoxification programs can help you slowly wean off of benzodiazepines by developing a tapering schedule. While tapering off the drug, a doctor may first prescribe a benzo with a longer half-life or may prescribe the same benzo but reduce the dose over a period of weeks or months. Other medications, such as phenobarbital, anticonvulsants, and sedating antidepressants and anticonvulsants may be beneficial in managing benzodiazepine withdrawal.7

In addition to a tapering schedule and symptomatic management, detox programs will monitor your vital signs and watch for possible signs of medical complications.7 Addiction detox programs also initiate counseling and behavioral therapies, which can help you develop an understanding of addiction and how to prevent relapse.

If you’ve been abusing Xanax, detox alone may only go so far in keeping you sober long-term. Rather than serving as a substitute for more comprehensive treatment, detox and withdrawal management programs simply ready you for a longer program where you’ll learn how to live in recovery.

Inpatient treatment provides an opportunity to temporarily live in a supportive environment while attending intensive group and individual therapy throughout the day. Outpatient treatment allows you to attend a fixed number of therapy sessions each week while living at home or in a recovery residence (e.g., a sober living home). Some people will begin in an inpatient treatment setting and move to outpatient as a step-down treatment.

Because many people who develop benzodiazepine addictions initially start using the drugs as part of a therapeutic regimen, finding alternative ways to cope with an underlying health condition, such as anxiety or panic attacks, is an important step in recovery. This may involve: 9,10

  • Working with a physician or psychiatrist to find appropriate, nonaddictive anti-anxiety medications.
  • Exploring natural coping strategies for anxiety, for example meditation and mindfulness, which have been shown to help people more effectively manage anxiety and cope with cravings for drugs and alcohol.

If you’re finding yourself consistently worrying about whether or not the amount of Xanax you’re taking may be lethal, you may need help for Xanax abuse. Addiction treatment that addresses co-occurring mental health issues such as anxiety and depression can free you from the chains of benzodiazepine addiction and allow you to move forward with a happier, healthier way of life. At Desert Hope, you’ll find the highest-quality care every step of the way from a safe medical detox with 24/7 medical supervision all the way to outpatient and sober living.

References:

  1. Food and Drug Administration. Xanax.
  2. National Institute on Drug Abuse. (2018). Misuse of prescription drugs.
  3. S. National Library of Medicine, Medline Plus. (2019). Alprazolam.
  4. National Institute on Drug Abuse. (2019). Overdose death rates.
  5. Longo, L. P., & Johnson, B. (2000). Addiction: Part I. Benzodiazepines-side effects, abuse risk and alternativesAmerican Family Physician61(7), 2121-2128
  6. Substance Abuse and Mental Health Services Administration. (2014). Benzodiazepines in Combination with Opioid Pain Relievers or Alcohol: Greater Risk of More Serious ED Visit Outcomes. DAWN Report.
  7. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and substance abuse treatment.
  8. (2010). Protracted withdrawal.
  9. Garland, E. L., & Howard, M. O. (2018). Mindfulness-based treatment of addiction: Current state of the field and envisioning the next wave of researchAddiction Science & Clinical Practice13(1), 14.
  10. Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic reviewJournal of Consulting and Clinical Psychology78(2), 169.