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Xanax is a prescription drug from the group of anxiolytics (anti-anxiety tranquilizers) and is a benzodiazepine derivative by its chemical structure. The drug is used for the long-term treatment of panic attacks, as well as various disorders manifested by increased pathological anxiety (generalized anxiety disorder, neurosis, depression with an anxiety component, etc.).

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Xanax (Alprazolam)

In addition, Xanax is used in short courses to relieve anxiety, fear, and worry. Since there is currently a wide range of safer and better-tolerated tranquilizers-anxiolytics, Xanax is used in short courses to quickly relieve fears, anxiety, and worry, and other drugs are chosen for long-term therapy.

Therapeutic effects

Xanax has the following pharmacological effects:

• Muscle relaxant (relaxes muscles);
• Anxiolytic (relieves anxiety);
• Anticonvulsant (stops seizures);
• Acts as a sleeping pill.

The main effect of Xanax is anxiolytic, but the tablets also have a sedative-hypnotic effect. That is, the drug reduces the degree of emotional and nervous tension, eliminates or reduces the severity of anxiety, fear, and obsessive thoughts, and also acts as a powerful sedative and hypnotic. Xanax reduces the excitability of the brain and inhibits reflexes.

The moderate hypnotic effect of Xanax is manifested in the form of a shortening of the period of falling asleep, an increase in the total duration of sleep, and a decrease in the number of night awakenings. In addition, the drug reduces the impact of various stimuli (emotional, motor, and vegetative) on the process of falling asleep.

The anticonvulsant effect consists in the elimination of muscle spasms and severe tension, which contributes well to the general relaxation of a person and helps to relieve a state of excessive anxiety.

Xanax is quickly absorbed from the intestines, and the maximum concentration of the drug in the blood is achieved 1 - 2 hours after administration. In the liver, the drug breaks down into metabolites and is excreted from the body in the urine. Xanax does not accumulate in the body, so the risk of overdose with long-term use is low.

Indications for use

Xanax tablets are indicated for use in the following conditions and diseases:

• Neuroses or anxiety states with a pronounced feeling of anxiety, emotional tension, restlessness, irritability, with worsening sleep and somatic disorders (such as sweating, impotence, palpitations, bradycardia, anorexia, bulimia, sleep disorders, pain in various parts of the body, etc.)
• Anxiety-depressive states, characterized by a feeling of anxiety, emotional tension, irritability, worsening sleep, somatic disorders, decreased mood, loss of interest in the world around us, agitation (excitability), decreased appetite, changes in body weight, disorders of thought function, suicidal thoughts, and a decrease in overall energy
• Neuroses and anxiety-depressive states caused by any somatic diseases, such as cardiovascular insufficiency, fear heart attack, malignant tumors, withdrawal symptoms from alcoholism or drug addiction, etc.
• Panic attacks
• Agoraphobia (fear of open spaces)
• Tremor
• Insomnia.

How to take Xanax?

The tablets are taken orally 2-3 times a day, regardless of food intake. The tablet must be swallowed whole, without biting, chewing or crushing in any other way, and washed down with a small amount of water (half a glass is enough).

The dosage of Xanax is selected individually, taking into account the age, condition, and sensitivity of the person to the drug. In general, it is necessary to remember that the elderly (over 65 years old) and people taking psychotropic drugs for the first time need lower dosages of Xanax compared to other categories of patients.

If, while taking Xanax, a person develops excessive drowsiness or ataxia (impaired coordination of movements), then the dosage of the drug should be reduced. Each time the dosage of the drug is changed, it is necessary to monitor the patient's condition and well-being again.

The daily dosage of Xanax is divided into 2-3 doses. Moreover, the highest dosage of the drug should be taken before bedtime, in the evening hours, since this promotes better sleep and minimizes drowsiness during the day. For example, the daily dosage of Xanax is 1 mg. In this case, it can be divided into three doses per day, so that the evening dose is the maximum, as follows: 0.25 mg in the morning, 0.25 mg during the day, and 0.5 mg in the evening.

Start taking Xanax with minimal dosages: 0.25 - 0.5 mg per day, with a subsequent increase and bringing the dose to the required therapeutic one. It is necessary to bring the dosage to therapeutic levels slowly, over several weeks. The daily dosage is increased first by increasing the evening single dose, and only after that the daytime and morning doses.

That is, if it is necessary to increase the total daily dosage, first start taking 0.25 mg more in the evening, then another 0.25 g more during the day, and thus bring the dose to the required one.

The required therapeutic dosage of Xanax for various conditions can vary within fairly wide limits since, for each person, the dose effective for eliminating existing anxiety and fear is different.

That is, after starting to take Xanax, a person should gradually increase the dosage by 0.25 - 0.5 mg per day every 3 days until the desired clinical effect is achieved, namely, the elimination of fear, anxiety, restlessness, and other symptoms of neurosis or anxiety disorder.

Therapeutic dosages of Xanax for various diseases and conditions are as follows:

• Anxiety - start taking 0.25 - 0.5 mg three times a day. The therapeutic dosage (to which the initial dosage is increased) is 0.25 - 1.5 mg three times a day;
• Depression - start taking 0.5 mg 3 times a day. The therapeutic dosage (to which the initial dosage is increased) is 0.5 - 2 mg 3 times a day;
• Panic disorders (attacks, phobias) - start taking 0.5 - 1 mg once a day before bed, or 0.5 mg 3 times a day. The therapeutic dosage is 1 - 3 mg three times a day.
• For elderly people with any conditions or diseases, Xanax is prescribed in an initial dosage of 0.25 mg 3 times a day and is increased to a maximum of 0.5 mg 3 times a day.

The maximum permissible daily dosage of Xanax is 10 mg.

The course of treatment with Xanax can be long or short. Short courses of treatment last several days and are used to suppress acute, sudden fear (for example, after some terrible event, a nightmare, etc.). During short courses of therapy, Xanax is taken in initial dosages, that is, 0.25 - 0.5 mg 3 times a day.

Long courses of therapy last from three to eight months and are necessary for the treatment of chronic anxiety and fear. It is during long courses of therapy that the dosage of Xanax is brought to the specified therapeutic one. Xanax Withdrawal

Xanax is discontinued gradually since sudden withdrawal causes withdrawal syndrome, which manifests itself in a sharp return of the symptoms that the drug was taken to eliminate. Moreover, with withdrawal syndrome, the symptoms, as a rule, become more pronounced than before the start of Xanax therapy.

Xanax is discontinued over 2-6 weeks (depending on the therapeutic dose), reducing the daily dosage by 0.25-0.5 mg every three days. First, the morning dose is reduced, then the daytime dose, and only after that the evening dose.

For example, a person took Xanax 1.5 mg 3 times a day. The dosage is reduced as follows: in the morning, they start taking 1 mg, and in the afternoon and evening, 1.5 mg.

After three days, the daily dose is also reduced, and they start taking 1 mg in the morning and afternoon, and 1.5 mg in the evening. After another three days, the evening dosage is also reduced by 0.5 mg, taking Xanax 1 mg three times a day. In this way, the dosage is reduced until complete withdrawal.

If a reduction in dosage by 0.5 mg causes anxiety and fear, then you should return to the original dosage, in which you continue taking the drug for 1 - 2 weeks. After this period, the dosage of Xanax is again reduced, but not by 0.5 mg, but by 0.25 mg.

Interaction with other drugs

When Xanax is used in combination with psychotropic (Aminazine, Haloperidol, etc.) and anticonvulsants (Valproic acid, Vigabatrin, Lamotrigine, etc.), other tranquilizers (Phenazepam, Diazepam, Elenium, Midazolam, Phenibut, Dextropropoxyphene, etc.), sleeping pills, narcotic painkillers, histamine blockers (Diazolin, Suprastin, Fenistil, Claritin, etc.), macrolide antibiotics (Azithromycin, Clarithromycin, Erythromycin, etc.) and alcoholic beverages, the depressant effect on the central nervous system is enhanced.

When taking oral contraceptives, the rate of Xanax elimination from the body decreases, as a result of which it remains in the blood longer in an active concentration, which allows the drug to be taken 2 times a day instead of 3 times.

Taking Xanax with Digoxin increases the risk of overdose of cardiac glycosides.

Xanax leads to an increase in the concentration and severity of the effect of Imipramine and antihypertensive drugs. Itraconazole, ketoconazole, and paroxetine increase the severity of the effects of Xanax.

Fluvoxamine increases the concentration of Xanax in the blood, thereby increasing the risk of side effects. Xanax itself increases the toxicity of Zidovudine.

Xanax, in combination with Fluoxetine, can provoke psychomotor disorders, and with Clozapine, respiratory depression.

Xanax reduces the effect of Levodopa, which requires increasing its dosage in the treatment of Parkinsonism.

Xanax and alcohol

While taking Xanax, you should completely stop drinking alcoholic beverages for a number of reasons. Firstly, alcohol and Xanax enhance each other's effects on the human body, which can result in a sharp drop in blood pressure, impaired blood clotting, worsening cerebral circulation, as well as chills, vomiting, bleeding and hemorrhage, or the development of a stroke, heart attack, coma, or death.

Side effects

Xanax can provoke the following side effects in various organs and systems:

From the central nervous system (usually occur at the beginning of treatment and completely disappear after some time):

• Drowsiness;
• Feeling tired;
• Deterioration in concentration;
• Memory impairment;
• Slowness of mental and motor reactions;
• Euphoria;
• Depression;
• Depressed mood;
• Confusion;
• Dizziness;
• Headache;
• Disorientation;
• Ataxia (impaired movement);
• Unsteady gait;
• Tremor;
• Lack of coordination;
• Uncontrolled movements;
• Muscle weakness;
• Dysarthria;
• Paradoxical reactions (outbursts of aggression, agitation, fear, suicidal tendencies, confusion, muscle spasms, hallucinations, anxiety, insomnia).

From the gastrointestinal tract:

• Dry mouth;
• Salivation;
• Heartburn;
• Nausea;
• Vomiting;
• Deterioration of appetite up to anorexia;
• Dyspepsia (flatulence, bloating, feeling of heaviness in the stomach, etc.);
• Constipation;
• Diarrhea;
• Liver dysfunction;
• Increased activity of ALT, AST, and alkaline phosphatase;
• Blood system disorders:
• Anemia;
• Leukopenia (decrease in the total number of leukocytes in the blood below normal);
• Neutropenia (decrease in the total number of neutrophils in the blood below normal);
• Thrombocytopenia (decrease in the total number of platelets in the blood below normal);
• Agranulocytosis – absence of neutrophils, basophils, and eosinophils in the blood, which is accompanied by chills, increased body temperature, sore throat, fatigue, and weakness.

Urinary system disorders:

• Urinary incontinence;
• Urinary retention;
• Renal dysfunction;
• Change in libido (increase or decrease);
• Dysmenorrhea (menstrual irregularities).
• Cardiovascular system disorders:
• Decrease in blood pressure;
• Tachycardia.

Allergic reactions:

• Skin rashes;
• Itching.
• Others:
• Weight gain or loss;
• Addiction (benzodiazepine dependence);
• Visual impairment (double vision);
• Withdrawal syndrome with a sharp reduction in dosage.

Contraindications for use

Xanax is contraindicated for use in the presence of the following diseases or conditions in a person:

• Coma;
• Shock;
• Myasthenia (muscle weakness);
• Closed-angle glaucoma;
• Poisoning with alcohol, opiate drugs, sleeping pills, or neuroleptics;
• Chronic obstructive airway disease (e.g., COPD, bronchitis, etc.) with manifestations of respiratory failure;
• Acute respiratory failure;
• Severe depression;
• Pregnancy and breastfeeding;
• Age under 18 years;
• Individual hypersensitivity or allergic reactions to any drugs of the benzodiazepine group.

The above conditions are absolute contraindications since, in their presence, the drug cannot be used under any circumstances.

In addition to absolute contraindications, there are also relative contraindications to taking Xanax, in the presence of which the drug can be used, but only with caution. Xanax must be used with mandatory caution in the following conditions:

• Liver failure;
• Chronic renal failure;
• Ataxia;
• Previous drug dependence;
• Tendency to abuse various drugs that affect the central nervous system;
• Hyperkinesis;
• Organic diseases of the brain;
• Psychoses;
• Hypoproteinemia (low level of total protein in the blood);
• Sleep apnea;
• Old age.