The US Food and Drug Administration (FDA) reports in the prescribing information for Xanax that the maximum daily dose should not exceed 10 milligrams per day or an overdose may occur. In the treatment of an anxiety disorder, Xanax may be prescribed to be taken in doses between 0.25 milligrams and 0.5 mg three times a day, up to 4 milligrams total. For panic disorder, a higher dosage may be required, and the average dose is 5-6 milligrams per day, again not to exceed 10 milligrams.
Higher than recommended amounts of the benzodiazepine drug alprazolam, the active ingredient in Xanax, can lead to a toxic buildup in the body and cause overdose. Deaths from overdoses to benzodiazepines have risen in recent years, with the Chicago Tribune reporting more than 30 percent of fatal prescription drug overdoses in 2013 involving one of these drugs.
Xanax is a sedative-hypnotic drug designed to treat anxiety and panic disorders. Benzodiazepines like this act on the central nervous system slowing down blood pressure, respiration, and heart rate, and lowering body temperature. By increasing levels of the natural sedative gamma-aminobutyric acid (GABA) in the brain, Xanax reduces stress, tension, and anxiety.
These drugs may be commonly diverted and abused for the euphoric “high” and also for the sedative effects they may produce. During a xanax overdose, the pulse becomes weak, breathing shallow, skin cool to the touch, movements sluggish, mental confusion sets in, and nausea and vomiting may occur. Individuals may become very sleepy, lose consciousness, slip into a coma, or stop breathing and die.
Deaths from benzodiazepine drugs spiked to near 8,000 overdose fatalities in 2014, five times more than the number of deaths in 2001, the National Institute on Drug Abuse (NIDA) reports. While Xanax can lead to overdose on its own, it is also regularly mixed with other drugs or alcohol. This combination, particularly when it involves another central nervous system depressant, can be lethal.
The Drug Abuse Warning Network (DAWN) reports over 100,000 emergency department (ED) visits for negative reactions when abusing alprazolam in 2011. That same year nearly a half-million individuals needed ED treatment for an adverse reaction due to the combination of a benzodiazepine drug with alcohol. Adding alcohol or another central nervous system drug, like an opioid for instance, to the mix when taking or abusing Xanax greatly increases the odds for suffering an overdose and also decreases the amount of Xanax needed for an overdose to occur.
Aspects Involved in A Xanax Overdose
There is no set amount of Xanax that is “safe” to take recreationally. Anytime someone takes a prescription drug without a legitimate medical need and without permission from a medical professional, it can be risky. The drug may have unintended side effects or interact in the body in a way that may be unexpected.
Taking drugs recreationally, especially when mixing them with alcohol or other drugs, can also result in an adverse reaction. When someone gets Xanax through illicit channels, it is difficult to know exactly what the drug is or what dosage the medication contains.
There are several factors that may impact how much Xanax it takes for a person to suffer an overdose. Not everyone will overdose on exactly the same amount. The following aspects can all play a role in an overdose:
- Method of use: Snorting, smoking, or injecting Xanax as opposed to swallowing it can send the drug quickly across the barrier between the blood and the brain and lead to overdose more rapidly. If extended-release, Xanax XR, tablets are altered (e.g., chewed or crushed and then snorted, smoked, swallowed, or injected), the entire dosage is sent into the bloodstream at once instead of in the intended slow-release format over a set period of time. This increases the risk of overdose, as the body is not meant to receive the entire dosage at once.
- Amount of time and dosage: Someone who takes more Xanax in a short period of time is more likely to suffer an overdose as the dosage may shock the system when the whole amount catches up to the person. For example, if someone is not feeling the drug’s effects right away and keeps taking more, once it all becomes active in the body, a toxic buildup can occur and overwhelm the system.
- Genetics: A family history of drug dependence may increase the risk factor for someone to also suffer drug dependence or battle an addiction involving mind-altering drugs. The journal Clinical Pharmacology & Therapeutics publishes that addiction is heritable around half of the time. Drug dependence can cause a person to take more Xanax more regularly, which can increase the odds for an overdose. Addiction is a viable risk factor for overdose as the less control someone has over taking drugs, the more likely they are to take too much too often.
- Biology: A medical or mental health condition may increase the likelihood for suffering from an overdose as Xanax may interact in the body differently in someone who has an underlying disorder. Everyone’s metabolism is different and how fast someone breaks down Xanax may affect the amount it takes to overwhelm the system. Body mass index, age, race, and gender are all factors. In fact, age may play a major role in overdose, since metabolism slows as a person ages. This means that they may not be able to handle Xanax in the same amounts as before and therefore may more easily overdose. The British Journal of Clinical Pharmacology (BJCP) cites advanced age as a significant risk factor for an alprazolam overdose.
- Environment: A person’s environment, stress level, and exposure to trauma may affect drug use and dependence. The more stressed a person is, the more likely they may be to abuse drugs and at higher amounts, thus increasing the odds for an overdose.
- Polydrug abuse: Other drugs and alcohol greatly increase the risk for an adverse reaction and overdose on Xanax. Some people may take Xanax to blunt the effects of stimulants or to increase the “high” from other depressant drugs. This is highly dangerous, and both drugs can interact with each other with disastrous results. Other medications may also interact with Xanax and the way it is absorbed into the body, resulting in a potential toxic interaction or overdose.
Another thing to consider is relapse. Addiction is considered a brain disease that is chronic and relapsing, the American Society on Addiction Medicine (ASAM) reports. When someone stops taking a drug like Xanax after a dependence has formed (through repetitive and chronic usage), withdrawal side effects when the drug wears off can be significant and even potentially dangerous. The brain chemistry and circuitry may take a bit to heal and restore balance. During this time, the tolerance someone may have built up to Xanax will drop, and they may no longer be able to handle the same amounts of the drug as before. If someone goes through detox and Xanax is fully processed out of the body and then suffers a relapse, which is a return to drug abuse after a period of sobriety, taking it in amounts previously tolerated may be too much and overdose may result.
Xanax should never be taken outside of the watchful eye of a trained medical or mental health professional. Even then, it should be taken with care and not combined with other drugs or alcohol. Xanax is a psychoactive drug that can be safely tolerated when taken exactly as directed and necessitated by a legitimate prescription. Any nonmedical use of Xanax is dangerous and can lead to a potentially life-threatening overdose.