Last updated: 04/29/2021
Author: Dr Alan Lucks, MD
Reading Time: 7 minutes
Drug overdoses are a major problem for both illness and death in our country.6 In 2017, over 70,000 Americans died of drug overdoses.7 Xanax is the ninth “best selling” drug in the United States and the fifth most prescribed medicine in America. There are 125,000 emergency room visits every year in our country due to Xanax overdose and use.8
Because Xanax is a central nervous system depressant, it causes an inhibition of brain activity at an appropriate level when prescribed and taken at correct doses. However, with too much Xanax ingested, an excessive decrease in brain activity occurs and causes problems. This is when you run into trouble as your heart, lungs, and other organs shut down. The brain becomes so sedated that it does not send appropriate signals to these vital organs.
Table of Contents
Potential Causes of a Xanax Overdose
An overdose on Xanax can be intentional or accidental. Intentional overdoses can occur when there are mental health issues involved, including depression.
Accidental Xanax overdoses are more common and there are multiple reasons why this can happen.
When you become tolerant to the drug you need more and more Xanax to achieve the desired results. When you keep taking Xanax an overdose can happen.
Mixing Xanax with Other Drugs
Xanax is very dangerous when mixed with other drugs, especially alcohol and opioids. These combinations depress the cardiopulmonary system and can result in a coma, severe sedation, and even death.9 You should never use opioids and Xanax at the same time.10
Certain ethnic groups metabolize Xanax at different rates. For example, Asian individuals accumulate concentrations of Xanax approximately 20% higher than Caucasian individuals.11 Thus, Asian individuals will have higher amounts of Xanax in their bodies even when taking the same doses that Caucasian individuals are consuming.
Taking erythromycin, cimetidine, and anti-fungal medicine increases the concentration of Xanax in your system, which can lead to an overdose. Digitalis concentrations increase in the body if you are on Xanax at the same time. This is especially prevalent if you are over 65 years of age, making digitalis toxicity more common in this age group.
Sudden discontinuation of Xanax can cause a shock to your system and make side effects worse. The process of detoxing from Xanax involves gradual tapering off of the drug, so you don’t send your body into shock.
Age and Weight
Aging increases the risk of Xanax toxicity, and many health care providers prescribe lower doses of the drug to senior citizens.12 Your body weight also affects how much Xanax you have in your system—smaller people are more prone to a Xanax overdose when taking large amounts.
Xanax Overdose Symptoms
The characteristics of Xanax overdose symptoms depend on your age, how much you take, your body size, and the type of other drugs consumed. An overdose is usually characterized as mild, moderate, or severe.
The signs and symptoms listed below intensify as the severity of the overdose increases:13
- Slurred speech
- Slow reflexes
- Decreased coordination
- Uncontrollable physical movements
- A rapid heartbeat
- Loss of balance
- Severe drowsiness
- Breathing problems
- Decreased level of consciousness
- A depressed mood
- Memory difficulties
- Nausea or vomiting
You should take immediate action if you, or an acquaintance, are experiencing a decreased level of consciousness, difficulty breathing, confusion, or any of the severe symptoms mentioned above.
What to Do When a Xanax Overdose Happens
Call 911 immediately if you or someone you know is experiencing a Xanax overdose. Help and transportation to a hospital are vital. Stay with the overdose victim until assistance arrives—this is vital since a confused person may behave erratically and inflict additional harm.
If the patient is unconscious, place them on the side to minimize any ill effects of vomiting. No Narcan-type medications can reverse a Xanax overdose like it can for other drugs.
If you have overdosed, try to stay awake until the ambulance comes since important information will be needed by the medical personnel. The ambulance crew and professionals at the emergency room will need to know:
- How many pills were taken
- What time were they ingested
- If there any other substances in your system (important because mixing alcohol or opioids with Xanax is very dangerous)
It is also important to stay awake so you can tell the medical personnel about any past medical problems.
If you can, remove and take all Xanax pill bottles to the emergency room with you. The date of the prescription refill compared to how many pills remain in the bottle will verify the number of pills you’ve taken.
Treatment for a Xanax Overdose
One of the first things done to treat a Xanax overdose is to eliminate as much medicine as possible from the stomach. The less this drug is available for absorption the better your chances are for recovery.
Activated charcoal given either by mouth or via a feeding tube is very helpful to help get the Xanax out of your system if done soon after you’ve taken the drug.14
Supportive care is the backbone of the treatment for a Xanax overdose. The main goal is to keep you alive. Every attempt focuses on maintaining:
- Normal blood pressure
- A regular heart rate
- Adequate respiratory function
- Normal organ function
You will likely recover if your internal organs are working well and you can excrete the Xanax. The good thing about Xanax is that it’s a rapid onset, short-acting benzodiazepine so it will not stay in your system for a prolonged period.
Note: If you stop taking Xanax suddenly, you will likely experience withdrawal symptoms, with the severity depending on your history with Xanax.
IV Fluids and Ventilator
Medical professionals may give you intravenous fluids to keep you hydrated and ensure your kidneys function normally.
If you experience severe breathing problems, you may require a ventilator, which will breathe for you. This device ensures that your lungs are getting enough air and will let your doctor know if your oxygen levels are low. This is important since blood, and therefore oxygen goes to all parts of your body.
Xanax metabolization occurs in the liver and the excretion of Xanax occurs through the kidneys.15 Routine blood tests monitor how the liver and kidneys are functioning.
The gradual tapering of Xanax is required because an abrupt stoppage of this drug is dangerous. This is sometimes done by switching to a long-acting benzodiazepine such as clonazepam (Klonopin).
Klonopin has a slower onset of action and a more gradual release.16A smoother discontinuation is possible and less stress occurs in the body. Following an overdose, rehab is crucial.
Follow-Up Care After a Non-Lethal Xanax Overdose
After a Xanax overdose, medical and emotional issues will still exist. The underlying problem that was being treated by Xanax is still present. Whether it is anxiety or panic attacks, not only are they still evident, the situation may have worsened. Further treatment requires some major decisions.
Various forms of counseling are available at this point such as:
After a non-lethal Xanax overdose, various emotional issues may need addressing. Depression is common and counseling helps this situation along with non-addictive antidepressant medication. Shame and guilt are possible, and counseling can help to channel these emotions into positive feelings.
The fear of another drug overdose is something that you may think about, and this dread can be debilitating. Counseling is also beneficial for this concern.
If you or a loved one is struggling with Xanax addiction, call 800-926-9037 Who Answers? to speak with a treatment specialist.
What is Xanax?
Alprazolam (Xanax) is an addictive sedative in the benzodiazepine family of medications approved for the treatment of anxiety and panic disorders.1 Xanax works by affecting the receptor sites in your brain and, thus, changes your nervous system chemicals.2 This is a federally controlled medicine, and its manufacturer, Pfizer, warns that sedation, respiratory depression, coma, and death may occur especially when mixed with other drugs.3
Because of the serious nature involved in consuming benzodiazepines, the U.S. Food and Drug Administration (FDA) has required that an updated “Black Box Warning” be in the Xanax prescribing information.4 This additional information addresses the serious risks in taking this medicine. Anyone taking Xanax is at risk for an overdose.
Xanax can be a beneficial medicine for you, but care is essential because of the possibility of misuse whether intentional or accidental. Xanax is only for specific diseases and in the dosage prescribed by your health care provider.
It is risky to buy Xanax illegally as the street sale of this drug is often unsafe and lethal. Toxic materials can be present in “counterfeit” Xanax, and it is dangerous to buy Xanax from questionable sources.5
- Viatris. (n.d.). Important safety information and indications.
- Entringer, S. (2021). Alprazolam.
- Pfizer. (n.d.). XANAX®(ALPRAZOLAM).
- U.S. Food and Drug Administration. (2021). Drug Safety Communications.
- Entringer, S. (2021). Alprazolam.
- Levine, M. (2020). General approach to drug poisoning in adults.
- Wilson, N., Karlisa, M., Seth, P., et al. (2020). Drug and opioid-involved overdose deaths-United States.2017-2018. MMWR Morb Mortal Wkly Rep 2020, 69(290).
- HealthResearchFunding.org. (n.d.). 20 profound Xanax addiction statistics.
- Pfizer. (n.d.). XANAX®(ALPRAZOLAM).
- Caporuscio, J. (2020). What to know about Xanax overdose.
- Durbin, K. (2021). Xanax.
- Bogunovic, O., & Greenfield, S. (2004). Practical Geriatrics: Use of benzodiazepines among elderly patients.
- MedlinePlus. (2021). Alprazolam.
- Soto, P. (2015). Activated charcoal an effective treatment for poisoning.
- George, T., & Tripp, J. (2020). Alprazolam.
- Albeck, J.H. (1987). Withdrawal and detoxification from benzodiazepine dependence; a potential role for clonazepam. J Clin Psychiatry 1987, 48(sup):43-49.