Can You Overdose on Xanax? Signs, Risks, and What to Do

Xanax is the brand name for alprazolam, a short-acting benzodiazepine that is FDA-approved for the treatment of anxiety and panic disorders.[1] It is also one of the most frequently abused benzodiazepine medications in the United States.[2]

Can You Overdose on Xanax?

Yes, it is absolutely possible to overdose on alprazolam. Alprazolam works by enhancing the effects of the neurotransmitter GABA (gamma-aminobutyric acid), which decreases activity in the central nervous system and creates sensations of calmness and relaxation.[3] The calming, fast-acting nature of the drug is what makes it extremely addictive and can lead to physiological dependence even in people taking only prescribed amounts.[4]

The potential for overdose increases significantly when alprazolam is misused (either by taking higher doses or by taking it more frequently than prescribed) or mixed with other drugs.[5]

While benzodiazepines taken alone (not combined with other substances) are less likely to result in overdose fatalities than drugs like opioids, an alprazolam overdose is a life-threatening emergency.[6] The toxicity associated with alprazolam increases with the amount ingested, and the effects on the body are compounded exponentially if other central nervous system depressants are taken with it.

According to the National Institute of Drug Abuse, the majority of benzodiazepine overdose fatalities occur in combination with opioids.[7] With the widespread use of fentanyl among illicit drug users, the risk associated with overdosing on alprazolam has risen exponentially.[8]

Xanax Toxicity: How Much Xanax Is Too Much?

Alprazolam toxicity occurs when the amount in the body exceeds its ability to successfully metabolize or break down the drug safely. There is no universal “lethal” dose of alprazolam, since the threshold is affected by variability in body weight, tolerance, age, liver functioning, and the concurrent use of other drugs.[9]

One fact that is true is that the higher the alprazolam dose, the exponentially higher the risk of overdose will be. When someone has used alprazolam for a while, they develop a tolerance to it, which then pushes them to increase dosage or frequency in order to elicit the same effect as before, which also increases the risk of overdose. For someone without a tolerance, taking high doses can lead to life-threatening respiratory depression far more quickly.

Taking even small doses of alprazolam can be dangerous if it is taken with other CNS depressants, such as alcohol, opioids, or antidepressants, due to their cumulative effects on slowing the central nervous system, which can lead to life-threatening respiratory depression (slowed or shallow breathing).[10]

What Happens if You OD on Xanax?

It is vital to be able to quickly identify possible signs of an alprazolam overdose, as the effects can worsen rapidly. Every minute the person does not receive medical attention increases the likelihood of permanent damage or death.

Early symptoms include:

• Extreme drowsiness or sedation beyond normal effects
• Slurred speech
• Confusion and disorientation
• Impaired coordination and balance
• Blurred vision

More severe symptoms include:

• Significant slowing of breathing
• Dangerously low blood pressure
• Slowed heart rate
• Unresponsiveness
• Loss of consciousness
• Coma

When taken with opioids such as fentanyl, respiratory depression is usually the primary cause of death, as breathing slows enough to completely stop, sometimes without any warning signs.[11] This is one of many reasons that mixing alprazolam with other drugs can have such catastrophic effects.

Brain damage is another significant risk associated with alprazolam overdoses because the brain cannot receive oxygen if breathing stops or becomes too shallow. Even a few minutes of oxygen deprivation can result in permanent cognitive impairment, memory loss, or other neurological consequences.

What to Do in Case of a Xanax Overdose

If you suspect that someone may have overdosed on alprazolam, it is a medical emergency, and you must take action immediately.

1. Call 911. Don’t wait to see if they get better or not. Be sure to tell the dispatcher what the circumstances are related to the situation. If there are any drugs taken with alprazolam, tell the dispatcher what the drug is. In most states, a Good Samaritan law protects people who call for help from being prosecuted.
2. Keep the person safe. If unconscious but breathing, roll the person onto their side so that if they vomit, they will not choke. Do not leave the person alone.
3. Administer naloxone if opioids may be involved. Because alprazolam is increasingly found mixed with fentanyl if acquired illicitly or if you suspect the person combined alprazolam with opioids, administer naloxone (Narcan). Naloxone will not reverse a benzodiazepine overdose on its own, but it can reverse the opioid component of a combined overdose and buy critical time for medical help to arrive.
4. Begin CPR if the person is not breathing. Continue until emergency services arrive at the scene.
5. Do not give the person food, water, or stimulants in an attempt to wake them up.

How Is a Xanax Overdose Treated?

Treatment for an alprazolam overdose is mostly supportive. Medical teams work to stabilize heart rate, blood pressure, and breathing until the drug is eliminated from the body.

In some cases, healthcare professionals will use flumazenil, a benzodiazepine antagonist, to reverse the sedative effects of alprazolam. This must be used carefully, however, because flumazenil may lead to withdrawal symptoms for those who are already dependent on benzodiazepines.[12] Additionally, the half-life of flumazenil is shorter than that of alprazolam, meaning that sedation can return.

If the person is having respiratory difficulties, the healthcare provider will give the patient oxygen therapy or put them on a ventilator. They may also provide IV fluids, cardiac monitoring, and monitor the patient closely to detect complications during this period. Following stabilization, healthcare providers will typically recommend a full assessment for substance use disorders and a referral to addiction treatment.

Risk Factors for Xanax Overdose

There are several risk factors that increase the probability of a life-threatening alprazolam overdose:

• Mixing alprazolam with other depressants, such as opioids or alcohol
• Taking illicit alprazolam, which may have fentanyl mixed into it
• Using higher doses than what is prescribed or using alprazolam without a prescription.
• Having a history of a substance abuse disorder or a history of abusing benzodiazepines.
• Taking alprazolam along with an antidepressant or other medication that affects the central nervous system.
• Using alprazolam alone without anyone to help you

• Underlying mental health conditions that contribute to heavy use

Xanax Addiction and the Path to Treatment

Alprazolam addiction is a serious substance use disorder that comes with long-term risk of overdose. It poses a great deal of risk for the user due to the cycle of tolerance, dependence, and escalating use that is often impossible to stop without professional intervention. Stopping alprazolam abruptly is dangerous as well. Patients experiencing withdrawal from benzodiazepines may develop seizures or extreme psychological distress when quitting cold turkey.

At Soba NJ, we offer comprehensive benzo addiction treatment built around each individual’s needs. Our treatment programs include medically supervised detox to safely manage withdrawal symptoms, inpatient and outpatient levels of care, evidence-based therapies, and mental health support for co-occurring anxiety disorders or panic disorders that may have contributed to Xanax use in the first place.

If you or a loved one is struggling with Xanax use, do not wait for an overdose to be the turning point. Reach out to Soba NJ today.

Frequently Asked Questions About Xanax Overdose