Alprazolam (Xanax) is a drug useful for certain mental health problems. It works quickly and stays in the body long after the effects disappear.

Doctors often prescribe Xanax for generalized anxiety or panic disorder. It is one of the most widely used drugs to treat this disease. It belongs to a class of drugs called benzodiazepines .

It works by increasing the effects of gamma-aminobutyric acid, a neurotransmitter in the brain that makes it easier to feel calm.

When does Xanax start to work?

People usually feel its effects within an hour. The body quickly absorbs the medicine.

Blood peaks occur 1 to 2 hours after taking a dose. However, the person feels the effects before the levels reach their peak. A study of 14 healthy people found that people felt the effects within an hour (average 49 minutes).

How long does Xanax stay in the body?

Like many medicines, Xanax stays in the body for a long time even if a person stops feeling its effects.

Experts use a measurement called a half-life to determine how long a drug stays in the body. Half-life is the time it takes for the body to eliminate half of the drug.

Its half-life is 8 to 16 hours in a healthy person, with an average half-life of 11 hours. It is shorter than that of other benzodiazepines.

The term « half-life » can however be misunderstood. This is because it takes four to five half-lives for the body to completely eliminate a drug. This means that Xanax can take an average of 44 to 55 hours, or about 2 days, to be eliminated from the body.

In another study, researchers reported that they could detect the drug in a person’s saliva more than 2 days after the last dose.

Which factors modify the efficacy of Xanax ?

The half-life of Xanax can vary from person to person. Several factors can affect the half-life of the drug:

• age
• be of asian descent
• to smoke
• to be obese
• have alcohol-related problems
• have kidney or liver problems

All of these factors can increase the time it takes for the body to completely eliminate Xanax.

What drugs can interfere with Xanax?

Some medicines reduce the activity of CYP3A, an enzyme in the liver that helps remove medicine from the body. These drugs are called CYP3A inhibitors.

Taking a CY3PA inhibitor with Xanax means that the body will take longer to get rid of the medicine. This can cause Xanax to build up in the blood and increase the risk of serious side effects.

Only take a CYP3A inhibitor with Xanax if recommended by a healthcare practitioner.

Here are some CYP3A inhibitors:

• oral contraceptives;
• antifungal agents (eg ketoconazole and itraconazole) which can treat certain fungal infections;
• cimetidine, which reduces stomach acid and treats stomach ulcers, gastric reflux and other digestive problems;
• selective serotonin reuptake inhibitors of antidepressants such as fluvoxamine and fluoxetine.

Xanax may interact with certain other drugs and substances, including:

• diltiazem;
• isoniazid;
• macrolide antibiotics, such as erythromycin and clarithromycin;
• grapefruit juice.

Interaction with opioids

Opioids are prescription pain relievers that block pain signals transmitted to the brain. Xanax can interact with opioids and these interactions can be serious.

Opioids include:

• fentanyl
• morphine
• codeine
• oxycodone
• hydrocodone

Taking Xanax and opioids can cause a fatal overdose, in addition to serious interactions. This is because this combination slows down a person’s breathing, and their combination can cause breathing to stop.

If a person is taking an opioid pain reliever, they should talk to their healthcare professional before taking Xanax. Likewise, anyone taking Xanax should talk to a doctor before taking an opioid.

How long is the Xanax withdrawal period?

People can become dependent on this medicine even if they take it as prescribed. The risk of dependence is increased if a person takes a higher dose for a longer period of time.

When a person stops taking Xanax, its absence can cause a series of physical and mental symptoms. These are withdrawal symptoms.

Withdrawal symptoms from short-acting benzodiazepines, including Xanax, may begin 1 to 2 days after the last dose. They can last at least 2 to 4 weeks.

However, in 10-25% of long-term benzodiazepine users, withdrawal symptoms may last 12 months or more. This is called a prolonged withdrawal syndrome.

Withdrawal syndrome can be dangerous. Symptoms include:

• headache
• sweat
• sensitivity to light or sound
• muscle contractions
• muscle cramps
• insomnia and other sleep problems
• blurred vision
• diarrhea
• difficulty thinking or concentrating
• panic attacks
• anxiety
• epilepsy

A doctor can help a person gradually reduce their dose of Xanax, which may minimize the risk of serious withdrawal symptoms, including seizures.

Two clinical trials have shown that 71% to 93% of people can stop taking Xanax completely within 8 weeks, following a dose reduction schedule prescribed by a doctor.

Expiration date

A bottle of Xanax must have an expiration date and the date the pharmacist filled the prescription.

The expiration dates indicate how long the drug is safe and effective. This date is based on when the production plant manufactured the drug.

An expired medication may no longer provide all of its benefits. In addition, there is an additional risk of side effects.

Correct storage of the drug helps to ensure that the drug is effective until its expiration date. It should be stored in a dry place at room temperature.

Do not store Xanax in a bathroom, as moisture can cause the medicine to break down faster. The bottle should also be kept out of direct sunlight and out of the reach of children and pets.

If the Xanax has expired, it may not be effective or safe.

Because it carries a high risk of addiction, it is important to properly dispose of outdated or unwanted pills.

In summary

Xanax can be an effective treatment for anxiety disorders and panic attacks if a person follows their doctor’s advice.

Factors – other drugs and illnesses – can affect how well Xanax works and how long it lasts in the body.