How does Xanax (alprazolam) work?

Drugs

Xanax, the brand name for the drug alprazolam, is a medication used to treat generalized anxiety disorder and panic disorder. It belongs to a group of drugs called benzodiazepines.  Generally speaking, these medicines relax the nervous system and slow down thinking and other brain processes. For this reason, benzodiazepines are sometimes helpful for managing mental health disorders such as anxiety. Some benzodiazepines are prescribed for alternative purposes as well, including convulsive disorders and pre-surgical sedation.

How does Xanax Work?

Xanax, as with others in this group of medications, works by attaching to the GABA-A receptors that are located in the brain. By binding to these receptors, Xanax works to increase the activity of the chemical signaling molecule – GABA. The role of GABA in the brain is to reduce the activity of the neurons (brain cells).

How long does it take for Xanax to work?

Xanax is absorbed very quickly, reaching the highest concentration in around one to two hours. Compared to other benzodiazepines, Xanax has a shorter half-life and is highly potent. Xanax does not talk long to work, and the effects of Xanax can be felt quickly, which can include muscle relaxation, overall body relaxation, and drowsiness. Some side effects can include headaches, fatigue, loss of memory, and depression. Sedative effects and anterograde amnesia are also side effects associated with the use of this medication. 

A study of otherwise healthy men taking Xanax reported significant effects on memory retention compared with men who were not taking the medication. However, the study reported no effects on attention in the men who were taking Xanax.

Side effects of Xanax

Some of the more common side effects associated with taking Xanax include drowsiness, dizziness, memory or sleep problems, irritability, diarrhea or constipation, headache, nausea and vomiting, and blurred vision.

Xanax can be addictive, particularly when used long-term or at higher doses.

Misuse and withdrawal

According to national statistics, there were 25.5 million prescriptions of Xanax in the United States in 2017. Ten percent of the Canadian population uses some kind of benzodiazepine once per year and 1 in 10 persistently use it for more than a year. Xanax is an extremely addictive drug. Fatality is commonly caused by an overdose or a combination of Xanax with other drugs and medications.

Substances such as opioids, antidepressants, and alcohol  when mixed with Xanax, can greatly increase the risk of death. Grapefruit products also contribute to toxicity. This is because grapefruit contains furanocoumarins, molecules that indirectly cause blood concentration levels of Xanax to rise, which can lead to an overdose.

Withdrawal effects connected with the discontinuation of Xanax include increased heart rate and blood pressure, gastrointestinal problems, sensory hypersensitivity, and insomnia. More serious symptoms can include delirium tremens (confusion or hallucination) and seizures.  Withdrawal symptoms from discontinuing the use of Xanax can be life-threatening.

Xanax and pregnancy

Xanax, as with other benzodiazepines, are labelled class D teratogens, which means that they pose a significantly high risk to a developing embryo or fetus. It is reported that these medications may also be found in breastmilk. Due to the severe risks of this kind of medication, women should keep their doctor informed and discuss the potential to become pregnant or intention to become pregnant while taking these medications.

Talk to your doctor

It is important to exercise caution and speak to your healthcare professionals about proper medical advice regarding Xanax use and its long-term effects on your health. Seeking professional help for mental health concerns is important. Talking to your doctor for any changes to medications or supplements is also essential.

References:

Ait-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018). A Review of Alprazolam Use, Misuse, and Withdrawal. Journal of addiction medicine12(1), 4–10. https://doi.org/10.1097/ADM.0000000000000350

Brands B, Spraule B, Marshman J. (Eds.) Drugs and Drug Abuse. Third edition. Toronto: Addiction Research Foundation; 1998.

Chowdhury, Z. S., Morshed, M. M., Shahriar, M., Bhuiyan, M. A., Islam, S. M., & Bin Sayeed, M. S. (2016). The Effect of Chronic Alprazolam Intake on Memory, Attention, and Psychomotor Performance in Healthy Human Male Volunteers. Behavioural neurology, 2016, 3730940. https://doi.org/10.1155/2016/3730940

George TT, Tripp J. Alprazolam. [Updated 2020 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538165/

Isbister, G. K., O’Regan, L., Sibbritt, D., & Whyte, I. M. (2004). Alprazolam is relatively more toxic than other benzodiazepines in overdose. British journal of clinical pharmacology58(1), 88–95. https://doi.org/10.1111/j.1365-2125.2004.02089.x

Longo, L., & Johnson, B. (2000, April 01). Addiction: Part I. Benzodiazepines-Side Effects, Abuse Risk and Alternatives. Retrieved January 14, 2021, from https://www.aafp.org/afp/2000/0401/p2121.html

Olsen RW, DeLorey TM. GABA Receptor Physiology and Pharmacology. In: Siegel GJ, Agranoff BW, Albers RW, et al., editors. Basic Neurochemistry: Molecular, Cellular and Medical Aspects. 6th edition. Philadelphia: Lippincott-Raven; 1999. Available from: https://www.ncbi.nlm.nih.gov/books/NBK28090/

Tan, K. R., Rudolph, U., & Lüscher, C. (2011). Hooked on benzodiazepines: GABAA receptor subtypes and addiction. Trends in neurosciences34(4), 188–197. https://doi.org/10.1016/j.tins.2011.01.004

Statista: Number of alprazolam prescriptions in the U.S. from 2004 to 2017 https://www.statista.com/statistics/781816/alprazolam-sodium-prescriptions-number-in-the-us/

Image by Gordon Johnson from Pixabay 

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