Xanax is a prescription benzodiazepine that was approved by the U.S. Food and Drug Administration (FDA) under this brand name in 1981. More recently, it was approved as generic alprazolam.
The National Institute on Drug Abuse (NIDA) defines tolerance to drugs as a process by which the brain becomes used to a specific dose of a substance, like Xanax. It does not cause the same effects, like relaxation or euphoria, as it once did. You can develop a tolerance to any substance, whether it is a prescription drug or a recreational substance.
Typically, if you develop a tolerance to a prescription medication like Xanax, your doctor will work with you to adjust the dose or move on to another medication. Your body may quickly stop responding to a lower dose of a benzodiazepine if you take it often, and for anti-anxiety medication, this can indicate that you should work with different medications to treat your anxiety. For example, many psychiatrists favor antidepressants as a routine medication to manage anxiety symptoms since antidepressants manage serotonin, which can ease anxiety symptoms.
It is also important that you work with a psychologist, counselor, or therapist to manage anxiety symptoms alongside medications.
Counseling can treat behaviors associated with mental health, while medication treats the emotions.
If you find that you are taking Xanax in larger doses than you have been prescribed, more often than what your doctor considers “as needed” because you enjoy the feeling of being on Xanax, because you cannot control your compulsion to take it, or because you experience withdrawal symptoms when you do not take it, you may have developed an addiction or a pattern of substance abuse.
This can lead to taking “too much” of the drug, which puts you at risk of being too sedated or even overdosing on the drug.
Even if you take Xanax as prescribed, you may experience some side effects. However, if you misuse or abuse Xanax, you are more likely to experience negative side effects that can affect your physical coordination, ability to concentrate, and mood, among many other issues.
Side effects typically include the following:
Additionally, if you begin to crave Xanax and take it compulsively, or take more just to feel high, you are taking too much. Abusing Xanax increases your risk of becoming addicted to the substance.
Xanax tablets come in 0.25, 0.5, 1 and 2 mg sizes. Each one is scored so it can be divided into a lower dose.
The specific dose that works best for you will be determined by your psychiatrist or general practitioner. It will be based on your height, weight or body mass index (BMI), age, gender, and anxiety or panic symptoms.
Peak concentration of the drug occurs 1 to 2 hours after it is consumed, and the drug lasts anywhere from 6 to 26 hours in the blood. The average half-life for alprazolam is reported as 11.2 hours.
Studies reported by the FDA found that doses ranging from 4 mg to 6 mg per day were safe for up to one month, but study participants developed tolerance to the substances quickly during that period. Xanax was superior to the placebo in each study, leading to zero panic attacks during the trial period, along with reduced instances of phobia. However, reports suggest that taking more than 4 mg for more than 12 weeks leads to tolerance and dependence on the drug.
With the help of doctors, people taking Xanax as prescribed have successfully tapered down their dose until they no longer needed it to feel normal. However, if they took more than 4 mg, withdrawal symptoms became more intense and difficult to control. Therefore, taking more than 4 mg of Xanax in a day can lead to greater discomfort during withdrawal or detox from the medication.
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Benzodiazepines are a class of sedative drugs prescribed to treat anxiety, panic attacks, insomnia, and, in some cases, epilepsy or seizure disorders. This group of medications works by binding to the gamma-aminobutyric acid (GABA) receptors in the brain so that more of the calming GABA neurotransmitter is available to manage communication between neurons. If someone has low levels of GABA in their brain, neurons fire rapidly, which can feel like panic and can trigger seizures in extreme instances.
With a prescription drug like Xanax binding to the GABA receptor sites, more of the neurotransmitter can remain bioavailable, allowing a sense of calm and relaxation.
Like other benzodiazepines, Xanax is a sedative drug, meaning it relaxes the central nervous system (CNS). Each type of benzodiazepine is designed to reach the brain at different times and to remain in the body for different lengths of time.
Xanax is a short-acting benzodiazepine, meaning it binds quickly to neurons and also rapidly metabolizes out of the body. Although the primary sedating effects occur and disperse fast, Xanax’s metabolites remain in the body for longer. The drug’s full action lasts 11 to 20 hours, depending on the size of the dose and if it is formulated to be extended-release (XR).
Unfortunately, the body can quickly develop a tolerance to benzodiazepines, so you may feel like you need more Xanax to calm yourself down just a few days or weeks after receiving the prescription. Xanax is not recommended as a consistent treatment for anxiety or panic. Instead, it should be taken as needed, which reduces the risk of tolerance. This also reduces the risk of taking more of the drug than prescribed.
In addition to tolerance and dependence, misusing or abusing Xanax can cause increased levels of sedation, trouble with memory and thinking, physical risks, and a risk of overdose.
Overdosing on benzodiazepines like Xanax by themselves is rare, but it can happen. Most people who abuse Xanax also take other substances like opioids and alcohol, which greatly increases the risk of overdose, hospitalization, and death.
Symptoms of a benzodiazepine overdose, without other intoxicating substances, may include the following:
Taking more Xanax than prescribed puts you at risk of addiction and overdose. If you receive a prescription for more than 4 mg of Xanax per day, be sure to discuss the risks with your doctor, and let them know about any other drugs — either prescription or recreational — that you may consume.
If you find that you are taking more Xanax than you have been prescribed, get help from an evidence-based detox program immediately.
(March 2011). Xanax: Alprazolam Tablets, USP. U.S. Food and Drug Administration (FDA). Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/018276s044,021434s006lbl.pdf
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(January 2007). The Neurobiology of Drug Addiction, 6: Definition of Tolerance. National Institute on Drug Abuse (NIDA). Retrieved from https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/6-definition-tolerance
(March 2014). Benzodiazepines (and the Alternatives). Harvard Health Publishing, Harvard Medical School. Retrieved from https://www.health.harvard.edu/newsletter_article/Benzodiazepines_and_the_alternatives
(August 1, 2007). Risk Versus Benefit of Benzodiazepines. Psychiatric Times. Retrieved from https://www.psychiatrictimes.com/geriatric-psychiatry/risk-versus-benefit-benzodiazepines
(February 20, 2018). Can You Overdose on Xanax? Healthline. Retrieved from https://www.healthline.com/health/can-you-overdose-on-xanax#overdose-symptoms