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HomeXanax Overdose
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Edited & medically reviewed by COGNIFUL Team
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Xanax, a prescription medication used to manage stress, anxiety, and panic disorders, offers significant relief to those struggling with anxiety and panic attacks. However, due to its potency and effects on the central nervous system, the risk of overdose remains a serious concern.

As a benzodiazepine, Xanax depresses brain activity, which helps control symptoms of anxiety,, but is also dangerous when taken in a higher-than-prescribed dosage or used with other substances. Understanding the symptoms, causes, and possible risks of a Xanax overdose is necessary for its safe usage and risk prevention. This article examines the dangers linked to Xanax overdose, including its signs, contributing factors, and strategies to minimize the likelihood of having a life-threatening event.

Xanax decreases anxiety and induces a soothing effect on the brain by affecting specific receptors and neurotransmitters in the nervous system. However, the very mechanism that makes it effective can also create conditions that raise the chances of an overdose. To understand how Xanax works and can lead to an overdose, consider the following:

Slowing Brain Function

According to research, Xanax works by enhancing the effects of specific inhibitory neurotransmitters that control neural activity. Under typical doses, Xanax enhances the calming effects of the neurotransmitters and slows down brain communication to alleviate anxiety. However, higher doses intensify this impact, causing the brain function to slow down significantly, often to a level that negatively affects critical functions crucial for survival. [1]

Relaxing the Body

As a benzodiazepine, Xanax acts as a central nervous system depressant to calm the mind and simultaneously slow down physical responses in the body. In therapeutic use, the CNS impact of this drug can aid in anxiety relief and the promotion of relaxation. However, when overdosed, these depressant effects become dangerous, resulting in several potentially life-threatening issues.

High Risks

Studies show Xanax has a narrow medical index, which means the difference between a safe dose and a possibly harmful one is small. As a result, even a slight increase in the prescribed dose can enhance its depressant effects on the brain and body. The small margin causes a higher risk for overdose, particularly in cases of accidental misuse or an off-label dose increase. [2]

An overdose of Xanax can occur due to various risk factors that contribute to the likelihood of taking a dangerously high dose. Some of these risks include the following:

Mixing Xanax with Other Substances

One of the most common and known contributors to Xanax overdose is combining it with other central nervous system depressants. [3] Some of the substances that can enhance Xanax’s impact and elevate the risk of overdose include the following:

  • Alcohol: Drinking alcohol while taking Xanax significantly increases sedation and respiratory depression, as both substances suppress CNS activity.
  • Opioids: Opioid painkillers, like fentanyl, are also CNS depressants. When taken with Xanax, the combined effect on the respiratory system can be life-threatening.
  • Sleep Aids and Antihistamines: Over-the-counter or prescription sleep medicines and some antihistamines can enhance the sedative effects of Xanax, raising overdose chances.

Developing Tolerance and Increasing Dosage

When used for an extensive period, it is possible to develop a tolerance to Xanax. [4] The tolerance can quickly worsen, leading to dangerous dosing patterns, which include:

  • Rapid Dosage Increases: As tolerance develops, individuals may take more than the prescribed amount frequently, increasing the likelihood of overdose.
  • Self-medication: Some people may increase their dose without consulting their healthcare providers, either to manage anxiety or to overcome the underlying tolerance. Regardless of the reason, self-medication with a controlled drug like Xanax can increase the chances of an overdose. 

Taking High Doses in Short Periods

An overdose can also occur if someone takes many doses of Xanax within a short period, specifically if they are not familiar with the drug’s effects. This usually happens in the following scenarios:

  • Binge Usage: Some individuals may take many tablets in a brief period, either for recreational use or underestimating how long the impact lasts, which significantly raises overdose risks.
  • Immediate and Extended-Release: Xanax is available in immediate and extended-release types. Taking multiple immediate-release doses together in a short span can lead to overwhelming effects on the body.

Accidental Misuse in Certain Individuals

Some groups are more prone to the adverse effects of Xanax and have a higher risk of accidental overdose. These individuals include:

  • Elderly Individuals: Older adults usually metabolize medications comparatively slowly. When taking Xanax, they are more likely to experience drug accumulation and overdose, even when taking standard doses.
  • Individuals with Mental Health Conditions: Those with anxiety, depression, or substance use disorder are more likely to misuse Xanax in an attempt to soothe themselves, which adds to overdose risk.
  • First-Time Users: New users may be unaware of Xanax’s potency and inadvertently take more than they can manage, resulting in overdose.

Lack of Medical Guidance

Using Xanax without medical supervision can result in misuse and overdose, particularly in ways like:

  • Not Consulting a Healthcare Professional: Individuals who use Xanax without regular check-ins with a healthcare professional are at a higher risk, as they may not receive necessary guidance on safe use.
  • Illicit Use: Obtaining Xanax without a prescription, especially its counterfeit versions, is more likely to lead to overdose because of unknown dosages and purity.

Xanax overdose primarily affects the central nervous system, causing symptoms that can be mild or severe. The degree of Xanax overdose symptoms depends on the amount taken and whether other substances were used simultaneously. Generally, the following signs of Xanax overdose may commonly appear:

Extreme Sedation and Drowsiness

One of the initial signs of a Xanax overdose is extreme drowsiness and sedation. Unlike the typical soothing effects of the drug at prescribed doses, an overdose causes intense lethargy, making it challenging for the individual to stay awake or alert. The severe drowsiness can also interfere with awareness and responsiveness, progressing to more dangerous symptoms if left untreated.

Mental Confusion and Disorientation

As more time passes, Xanax overdose may impair cognitive function. As a result, individuals may experience confusion and difficulty processing information, recognizing familiar surroundings, or recalling recent events. Disorientation is also expected and is accompanied by issues with focusing or thinking clearly. The confusion can make it hard for the individual to understand their situation or get help, increasing the chances of further complications.

Loss of Coordination and Balance

An overdose of Xanax can also affect motor skills, leading to a loss of coordination and balance. Sometimes, simple actions such as standing or holding objects may become challenging. Loss of physical control increases the risk of falling or getting injured, particularly if the individual moves in a sedated state.

Slurred Speech and Impaired Reflexes

As the overdose progresses, the impact on the nervous system intensifies, causing slurred speech and slow reflexes. Impaired reflexes make everyday functioning difficult, further adding to the chances of accidents and injuries.

Respiratory Depression

In severe cases, a Xanax overdose can cause respiratory depression, where breathing slows down to a dangerous point. Reducing respiratory rate is harmful, as it lowers oxygen levels in the brain and body. If this continues to happen, the individual can slip into respiratory failure, a potentially fatal condition requiring immediate medical attention.

An untreated Xanax overdose can quickly worsen, leading to severe complications. Without medical intervention, the depressant effects of Xanax on the central nervous system worsen and can lead to the following life-threatening issues:

Cardiac Complications

Untreated overdose can significantly impact the cardiovascular system. Decreased oxygen levels and slowed brain function due to high Xanax use can lead to irregular heart rhythms or arrhythmias. This poor oxygenation can also elevate the risk of cardiac arrest, where the heart stops beating. 

Brain Damage Due to Hypoxia

When breathing is slowed significantly, oxygen deprivation, also known as hypoxia, may set inside the brain. Even a few minutes of low oxygen can result in long-term brain damage, impacting memory, cognitive health, and motor functions. Severe hypoxia can also cause permanent impairment or brain death in some cases.

High Risk of Organ Failure

As the Xanax overdose worsens, essential organs like the liver and kidneys may suffer because of a lack of oxygen and proper blood flow. The stress on the organs can pave the way for organ failure, specifically in cases of prolonged overdose. Organ failure due to Xanax can also complicate the recovery, and the damage it causes may be irreversible, leading to long-term health issues even if the individual survives.

Increased Vulnerability to Infections

Xanax overdose and delayed treatment can make individuals prone to respiratory infections or aspiration pneumonia. When the body’s protective reflexes are suppressed, inhaling foreign or dangerous substances is easier, causing lung infections. In addition, immobility due to the overdose can elevate the risk of pressure sores and other infections even after initial treatment.

Coma and Loss of Consciousness

If a significant overdose occurs, the individual may lose consciousness, slipping into a coma. Coma occurs due to the drug’s depressant effects on brain activity, making the individual unresponsive. At this stage, medical intervention is necessary, as extended unconsciousness can cause long-term damage or even death if untreated.

Risk of Death

According to studies, untreated Xanax overdose can also lead to death. As respiratory and cardiac functions slow down, the body cannot function at all, making urgent critical care necessary to prevent fatal outcomes. [5]

Treating a Xanax overdose requires urgent medical intervention and ongoing support to stabilize the individual and prevent further complications. Treatment generally includes a combination of the following:

Immediate Treatment Strategies

  • Flumazenil Administration: Flumazenil counteracts Xanax’s effects by blocking its effects on the central nervous system. However, experts advise caution with its use as it can cause withdrawal symptoms in individuals who have been using Xanax for an extended period.
  • Respiratory Assistance: If breathing is slow or shallow, oxygen therapy becomes crucial to allow t the brain and body to receive enough oxygen. In severe cases, mechanical ventilation may be fundamental.
  • Activated Charcoal: Activated charcoal may be helpful, particularly if the overdose is detected shortly after ingestion. It absorbs any remaining Xanax in the stomach, limiting the drug’s absorption into the bloodstream.
  • IV Fluids: Intravenous fluids help maintain hydration and support the body’s ability to process and eliminate the drug.

Ongoing Treatment

  • Consistent Vital Checking: Medical staff checks heart rate, blood pressure, and oxygen levels to track the individual’s response to treatment.
  • Supportive Care: Beyond stabilization, supportive care such as physical assistance promotes recovery and prevents secondary issues.
  • Psychiatric Evaluation: In cases of intentional overdose, a psychiatric evaluation may be necessary to address underlying mental health issues and create a plan for ongoing mental health treatment.
  • Gradual Tapering Plan: For individuals with a history of Xanax dependency, a tapering plan may help prevent withdrawal symptoms. This approach ensures a safe decrease in dosage over time.

In addition to visiting a healthcare provider regularly and following professional guidelines, the following strategies can help reduce overdose risk:

  • Use a Medication Tracker App: Medication tracker apps send reminders for taking doses at set times and can track daily intake. These reminders help users to prevent accidental double-dosing and reduce the risk of Xanax overdose.
  • Request Smaller Prescription Refills: Ask your healthcare provider for smaller refills. Limited quantities reduce the chances of taking too much at once and aid in regular monitoring by the prescribing professional.
  • Find an Accountability Partner: Share medication information with a trusted friend or family member who can remind you about doses, specifically if there’s a history of missed doses.
  • Exercise before Medication Use: Doing mindfulness exercises before taking Xanax helps in conscious use and reduces the likelihood of impulsive and unscheduled doses, specifically during high-stress levels.
  • Use Pill Organizers: Weekly pill caddies with marked compartments can aid in tracking each dose, decreasing the risk of accidental overdoses.
  • Know About Potential Interactions: Understand and avoid substances that interact with Xanax, such as alcohol, certain pain medications, and herbal supplements. Awareness of these interactions can prevent accidental interactions that enhance Xanax’s effects and increase the risk of overdose.

Xanax overdose is a severe risk that highlights the need for responsible use of this powerful medication. While Xanax can be beneficial for certain mental health conditions, understanding its potential for overdose and dependency is essential. Recognizing the symptoms, knowing the risk factors, and following prevention strategies are vital steps in lowering the chances of an overdose. In cases of overdose, timely medical intervention can be life-saving, highlighting the significance of awareness. With guidance from healthcare professionals and safe usage techniques, it is possible to use Xanax effectively and responsibly without compromising health.

[1] Griffin CE, Kaye AM, Bueno FR, Kaye AD. Benzodiazepine pharmacology and central nervous system–mediated effects. Ochsner Journal. 2013 Jun 20;13(2):214-23.

[2] Ait-Daoud N, Hamby AS, Sharma S, Blevins D. A review of alprazolam use, misuse, and withdrawal. Journal of addiction medicine. 2018 Jan 1;12(1):4-10.

[3] Cho J, Spence MM, Niu F, Hui RL, Gray P, Steinberg S. Risk of overdose with exposure to prescription opioids, benzodiazepines, and non-benzodiazepine sedative-hypnotics in adults: a retrospective cohort study. Journal of general internal medicine. 2020 Mar;35:696-703.

[4] Vinkers CH, Olivier B. Mechanisms underlying tolerance after long‐term benzodiazepine use: a future for subtype‐selective GABAA receptor modulators?. Advances in Pharmacological and Pharmaceutical Sciences. 2012;2012(1):416864.

[5] Isbister GK, O’Regan L, Sibbritt D, Whyte IM. Alprazolam is relatively more toxic than other benzodiazepines in overdose. British journal of clinical pharmacology. 2004 Jul;58(1):88-95.

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