Xanax: Side effects, addiction, risk factors, drug interactions - Insider

• Xanax can help you feel more calm if you suffer from anxiety but should not be used long-term.
• Xanax is highly addictive and comes with many side effects including dizziness and chest pain.
• Xanax can have a negative interaction with other drugs and should never be consumed with alcohol.
• Visit Insider's Health Reference library for more advice.

Xanax, generic name Alprazolam, can be used to treat short-term anxiety, but due to its highly addictive nature is not recommended for long-term use. 

Its effects kick in relatively quickly, about one to two hours after consumption. But that's also when you may start to feel some of Xanax's many potential side effects like sedation and dizziness. 

Therefore, it's important to know about the potential side effects — what's normal and when to seek medical aid — before starting Xanax.

How Xanax works

Xanax is a sedative and anxiolytic, meaning it calms you down. It is part of a class of medications called benzodiazepines, which work by encouraging the neurotransmitter GABA to attach to nerve endings, essentially blocking the path for other chemicals. 

This is important because — with GABA in place — fewer anxiety-causing chemicals like cortisol can attach to your nerves, resulting in a more relaxed physical and mental state.

"Benzodiazepines, including Xanax, act on the brain to cause relaxation, anxiety reduction, and sleepiness. Sometimes, benzodiazepines are used as muscle relaxants or to control seizures," says Kelly Johnson-Arbor, co-medical director of National Capital Poison Center and medical director of hyperbaric medicine at MedStar Georgetown University Hospital.

However, the same way that GABA blocks anxiety-causing chemicals, it can also block other chemical messengers, which is what causes many of the drug's side effects.

Xanax side effects

Xanax can cause side effects throughout the body, including places like the brain, heart, and muscles. 

Here's a list of side effects ranked from most common to least:

• Brain: drowsiness, headache, dizziness, memory impairment 
• Digestive System: constipation, nausea, changes in appetite
• Heart: rapid heartbeat, chest pain
• Sensory organs: dry mouth, blurry vision, tinnitus (ringing in the ears)
• Muscles: stiffness, tremors, cramps
• Respiratory system: respiratory depression which can lead to slow, shallow breathing and shortness of breath

Xanax can also cause what's called anterograde amnesia, which is when the brain has a harder time forming memories. A small 2016 study found healthy male participants who took Xanax for two weeks scored lower on memory tests that required them to match objects and patterns. Researchers did not, however, look at whether this effect lasted after participants stopped taking Xanax.

Moreover, many people who take Xanax experience mood disorders, which can also affect memory. However, researchers have yet to determine whether the drug's effects on memory are permanent or not.

It's important to note that every person's body is different, so you might experience a lot of side effects from Xanax or none at all. Clinical trials suggest people using Xanax to treat panic disorder are more likely to report side effects than those treating another anxiety disorder.

If your side effects feel severe or don't go away, you may want to check in with your doctor. They may prescribe you an alternative medication.

Xanax addiction

Benzodiazepines like Xanax can be highly addictive because of the high they provide. 

Note: The 2020 National Survey on Drug Use and Health examined drug use in Americans over 12. It found 1.7% of Americans (4.8 million) misused prescription benzodiazepines in 2020. Young adults ages 18 to 25 were the most likely to do so.

This high comes back to how Xanax works: by encouraging GABA neurotransmitters to bind to nerve receptors. Some of that GABA binds to cells that are responsible for limiting the amount of dopamine your brain releases.

Dopamine is a chemical that can boost our motivation and mood. So, when GABA binds to these cells, it inhibits their ability to control your dopamine output. As a result, your brain receives a surge of dopamine, causing you to feel high.

"The strong pleasurable high from Xanax is reinforced every time the user ingests the drug, and can result in addiction," says Aaron Sternlicht, credentialed alcoholism and substance abuse counselor of the private practice Family Addiction Specialist. 

"Another reason for the addictive nature of Xanax is that it is extremely fast-acting, meaning that it does not take long for the user to feel its effects," says Sternlicht. Xanax kicks in about one to two hours after taking it and can remain in your system for well over 11 hours (the drug's half-life for healthy adults).

"Xanax is also widely available via legal and illegal means, leading to easy access which can fuel an addiction."

Who should avoid Xanax 

According to the Food and Drug Administration, Xanax is riskier for certain populations. 

You may want to talk to your doctor if you have:

• Plans to become pregnant or breastfeed: Benzodiazepines like Xanax can move through the placenta and harm your unborn child. The drug can also pass into your breast milk.
• An age of 65 or older: You will probably digest Xanax more slowly than younger adults. You are also more likely to have serious side effects.

• Liver or kidney disease: Your liver and kidneys act as filters for your body. If they don't function well, you can have a harder time metabolizing Xanax.

• Lung disease: Xanax can affect your breathing, which is dangerous for people with poor lung function.

• History of depression: Xanax may cause manic symptoms (irritation, hyperactivity, etc.) in some people with depression.

• History of addiction: You may have a heightened risk of getting addicted to Xanax if you have been addicted to other depressant drugs like opioids or alcohol.

Important: Xanax and alcohol do not mix. Combining the two can increase risk of overdose, liver and kidney damage, psychosis, and in severe cases death. Those who drink heavily are at greater risk, but anyone who consumes alcohol while taking benzodiazepines are playing with fire. Alcohol isn't the only drug interaction to be aware of with Xanax.

Xanax can interact with other drugs including (but not limited to) the following:

• Antibiotics: erythromycin (E.E.S. 400), clarithromycin (Biaxin)

• Antidepressants: fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil)

• Opioids: codeine, fentanyl, hydrocodone, methadone, oxycodone, tramadol

• Some herbs: St. John's wort 

These are not exhaustive lists. Nor are they an outright ban. You may still be able to take Xanax, but your doctor will likely monitor you closely for signs of trouble. 

When discussing a Xanax prescription, it's important to provide your doctor with a complete list of medications and supplements you're taking. 

If you cannot take Xanax, there are alternatives that may be safer for you.

When to see a doctor

In some cases, Xanax may cause serious health issues. The following signs suggest you need immediate medical attention:

• Severe skin rash
• Jaundice (yellowing of the skin or eyes)
• Trouble speaking
• Seizure
• Labored breathing
• Confusion
• Difficulty staying awake

"If someone has difficulty breathing or cannot be awakened after taking Xanax, call 911 immediately. If you or someone you love takes too much Xanax or experiences other unwanted side effects after taking Xanax, contact poison control immediately," says Johnson-Arbor. 

"There are two ways to contact poison control in the United States: go online to www.poison.org or call 800-222-1222. Both options are free to the public, confidential, and available 24 hours a day."

Insider's takeaway

Xanax is a potent medication, but it can cause serious side effects and be highly addictive. You can lower your risk by taking Xanax exactly as instructed and contacting your doctor with any concerns.

Emily Swaim