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Xanax Tolerance: What to Do and Is a Break Necessary?

xanax toleranceAlprazolam is the generic name for a benzodiazepine commonly prescribed under the brand name Xanax. Xanax is a psychiatric medication used to treat immediate stress symptoms associated with various anxiety conditions, including panic disorder, general anxiety disorder, and anxiety associated with depression.1 There are several formulations of alprazolam on the pharmaceutical market, including both an immediate- and extended-release Xanax. Although other benzodiazepines may be used to manage insomnia, seizures, and alcohol withdrawal, Xanax is not indicated for these uses. 

Current best practices among physicians prescribing alprazolam indicate that the medication should be used on a short term basis, due to its association with rapidly developing tolerance, dependence, and rebound anxiety. Should tolerance to the therapeutic effects develop, it is important to work with the prescribing doctor to either safely increase the dose, switch to another drug, or detox from the drug and find another approach to treatment that will work long-term.2

Xanax Tolerance Develops Quickly

The National Institute on Drug Abuse (NIDA) characterizes tolerance as the physical state in which a person’s body no longer responds to the presence of a drug or when a larger dose of the drug is needed to produce the substance’s original effects. Many types of drugs, when taken repeatedly over time, can produce tolerance.3

With Xanax and other benzodiazepines, the sedative effects of the medication quickly decrease over two weeks of regular use. The medications interact with gamma-aminobutyric acid (GABA) receptors in the brain to increase the inhibitory effects of the GABA neurotransmitter. For people who have anxiety or a seizure disorder, this interaction can be calming and therapeutic. Especially when misused, such as by taking larger-than-recommended doses, Xanax may elicit a rewarding, relaxing high that contributes to its abuse liability and could hasten the development of a substance use disorder.4

Xanax has a relatively fast onset of action, so the drug quickly produces sedation and relaxation. The drug reaches peak plasma concentrations one or two hours after it is consumed. In healthy adults, Xanax has a half-life of 11 hours; less active metabolites have a similar half-life duration. Consuming other psychotropic medications while using Xanax can be dangerous as it could potentiate the benzodiazepine effects.1

 Many people struggle with abuse of this fast-acting benzo. The Substance Abuse and Mental Health Services Associations (SAMHSA) reported that, in 2011, Xanax and other benzodiazepines were involved in nearly 90,000 emergency room visits that year.

Often, people who abuse drugs like Xanax mix the medication with another substance. Alcohol and opioids are the most commonly encountered drugs in this type of polydrug abuse.5

The Risks of Being Tolerant to Xanax

One risk associated with tolerance development involves patients feeling compelled to increase their dose without consulting a doctor. Although tolerance itself is not the same as physical dependence—which develops as a person grows to need the presence of the substance to feel normal—or addiction, it can play a role in both of these conditions.

For people who have anxiety disorders or struggle with insomnia, studies have shown that some of the sedative, muscle relaxant, and sleep-promoting effects of benzodiazepines are diminished as tolerance develops. One study reported that 10 days of alprazolam treatment led to a tolerance as measured by improvements in reaction speed over that time period. While many people with panic disorders still received the benefit of reduced anxiety from alprazolam after eight weeks of treatment, much of this may be a placebo effect, but it is hard to know for certain.6

Many of those with serious anxiety disorders benefit from having access to Xanax as a treatment, either for a few weeks of consistent use or on an as-needed basis. However, people who abuse Xanax to get high quickly develop tolerance to these effects, which means they are at risk of increasing their dose rapidly. This not only triggers dependence and addiction, but it can also increase the risks of serious long-term harm.6

Common side effects from Xanax include:1

  • Drowsiness.
  • Light-headedness.
  • Impaired physical coordination.
  • Slurred speech as though drunk.
  • Memory problems.

Some of the acute intoxicating effects of benzodiazepines put the individual at serious risk of an accident, like falling or crashing a car. Additionally, once the person develops significant physiological dependence on Xanax or other benzos, they are likely to suffer withdrawal symptoms if they try to quit taking it suddenly. Abrupt attempts at quitting Xanax, without medical detox help, can put the person at greater risk of relapse and subsequent overdose because withdrawal symptoms may be so uncomfortable that an individual resumes use of a larger-than-normal dose to manage them.

Withdrawal symptoms include:7

  • Anxiety.
  • Panic attacks.
  • Insomnia and other forms of disturbed sleep.
  • Dysphoria, or feeling restless and uneasy.
  • Hallucinations.
  • Sweating.
  • Nausea, vomiting, or gastrointestinal upset.
  • Physical tremors or shaking.
  • Convulsions or seizures.

 Withdrawal from benzodiazepines can be troublesome and, in some cases, dangerous. Symptom resolution often takes place over the course of several days to weeks, though protracted symptoms and cravings may present problems for longer periods of time, in some instances.

Taking a Break from Xanax Can Help

People who take Xanax on a regular basis and worry that they may be misusing their prescription should speak with their doctor. A medical professional can either help their patient taper off the drug or use other medical detox approaches (such as substituting a longer-acting benzodiazepine prior to initiating a taper) should the decision be made to end Xanax treatment. The treatment of anxiety and panic disorders may start with a medication like Xanax, but it is rarely a long-term solution to such conditions. People who suffer from chronic anxiety issues may benefit from psychotherapy or other behavioral therapeutic approaches to relaxation and stress management that do not solely rely on drugs. When significant dependence resulting from longer-than-recommended use is a concern, taking a break from Xanax may be appropriate.8

For those struggling with Xanax addiction, it is important to find medical supervision to safely detox. Some of the withdrawal symptoms, like seizures, can be life-threatening, but professional treatment efforts can help manage symptoms and minimize the risk of complications. Addiction specialists understand how to approach detox and rehabilitation for Xanax addiction, benzodiazepine abuse, and polydrug abuse involving these sedatives.9

References

  1. FDA. Xanax. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/018276s044,021434s006lbl.pdf. Accessed June 20, 2019.
  2. Ait-Daoud N, Hamby AS, Sharma S, Blevins D. A Review of Alprazolam Use, Misuse, and Withdrawal. J Addict Med. 2018;12(1):4-10.
  3. 6: Definition of tolerance | National Institute on Drug Abuse (NIDA). https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/6-definition-tolerance. Accessed June 22, 2019.
  4. Griffin CE, Kaye AM, Bueno FR, Kaye AD, Kaye AD. Benzodiazepine pharmacology and central nervous system-mediated effects. Ochsner J. 2013;13(2):214-223. Accessed June 20, 2019.
  5. Schmitz A. Benzodiazepine use, misuse, and abuse: A review. Ment Heal Clin. 2016;6(3):120-126.
  6. Vinkers CH, Olivier B. Mechanisms Underlying Tolerance after Long-Term Benzodiazepine Use: A Future for Subtype-Selective GABA(A) Receptor Modulators? Adv Pharmacol Sci. 2012;2012:416864.
  7. Nichols H. What you need to know about Xanax. Medical News Today. https://www.medicalnewstoday.com/articles/263490.php. Published 2017. Accessed June 20, 2019.
  8. Principles of Effective Treatment | National Institute on Drug Abuse (NIDA). https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment. Accessed June 21, 2019.
  9. Vorma H, Naukkarinen H, Sarna S, Kuoppasalmi K. Long-term outcome after benzodiazepine withdrawal treatment in subjects with complicated dependence. Drug Alcohol Depend. 2003;70(3):309-314.
About The Contributor
Shirley received her MD from the University of Western Ontario. She trained in family medicine and has experience working in laboratory medicine, medical education, medical writing, and editing. Shirley recently completed a MHSc in Translational... Read More