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Xanax Overdose: 7 Facts You Should Know

It is also worth noting that dosage may differ for first-time users. “Whether Xanax can lead to an overdose depends on the person’s tolerance to the drug,” Kristen Fuller, MD and Medical Editor at American Addiction Centers, tells WebMD Connect to Care. “If a person is using Xanax for the first time, anything over the recommended daily dosage (0.5 mg to 1 mg) can cause an overdose.”

Xanax Overdose: Can You Overdose on Xanax?

By The Recovery Village | Editor Jonathan Strum
Medically Reviewed By Benjamin Caleb Williams, RN A licensed behavioral health or medical professional on The Recovery Village Editorial Team has analyzed and confirmed every statistic, study and medical claim on this page. | Last Updated: May 25, 2022

Using Xanax improperly or mixing the drug with other substances can lead to a potentially deadly overdose. The amount of Xanax it takes to overdose varies.

Article at a Glance:

Xanax is the brand name for alprazolam, a benzodiazepine drug.
Because the doses for Xanax can vary widely, the amount of Xanax needed for an overdose can vary as well.
Mixing Xanax with other central nervous system depressants, such as opioids or alcohol, can increase the risk of overdose.

Xanax, a widely known brand of the drug alprazolam, is one of the most notoriously abused pharmaceuticals in America. As a result of its widespread abuse, Xanax overdose has become a very real problem, with alprazolam ranking consistently in the top 10 drugs contributing to death in the U.S.

This powerful benzodiazepine is prescribed to treat anxiety and panic disorders by lowering abnormal excitement in the brain and producing a more relaxed, calm feeling. Dosages can vary significantly, ranging from 0.25 mg starting doses to 10 mg Xanax “bars” for severe cases. Given this variability, one can most certainly overdose on Xanax if consumed recklessly.

Can You Overdose on Xanax?

It is possible to overdose on Xanax, especially if you take it with another central nervous system (CNS) depressant, such as an opioid. Because Xanax overdoses can be fatal, it is important to be aware of Xanax overdose symptoms and risk factors.

What Happens if You Overdose on Xanax?

Xanax overdose can also occur if you take too much of the drug. Xanax overdose can be deadly, especially when the drug is mixed with other central nervous system (CNS) depressants like opioids or alcohol.

Almost two-thirds of that $3.3 trillion cost – 64% – is paid for by American tax dollars, and that amount is growing. A study by the American Journal of Public Health predicts that taxpayers will shoulder 67.3% of the burden of healthcare costs by the year 2024, Physicians for a National Health Program

Xanax (alprazolam) is a benzodiazepine. Benzodiazepines alter chemicals in the brain to prevent certain imbalances that cause people to feel nervous or anxious. In the brain, benzodiazepines enhance the effect of a relaxation-inducing chemical called gamma-aminobutyric acid (GABA). Overdosing on Xanax and other CNS depressants increases the effects of GABA to the point of slowing breathing; in some cases, you can stop breathing entirely.

If you find that your Xanax prescription is not relieving symptoms as intended, seek medical advice instead of trying to adjust the dose on your own. Whether you take too high of a Xanax dose or mix the drug with other substances, the risk of overdose death is real.

How Much Xanax Does It Take To Overdose?

The amount of Xanax needed to overdose can vary, especially when the drug is mixed with other substances. Most Xanax overdoses happen when Xanax is taken alongside CNS drugs like alcohol or opioids. Xanax bought on the street can also be counterfeit or cut with the opioid fentanyl, which can increase the risk of overdose.

When combined with the sedative properties of benzos, alcohol and opioids can create a lethal suppression of a person’s breathing or circulatory system. The FDA has a Black Box Warning about mixing benzodiazepines with opioids for this reason.

What Are the Symptoms of a Xanax Overdose?

Whether taking Xanax by itself or with other depressants, it is vital to be able to quickly recognize overdose symptoms in yourself or others. Most of these symptoms are due to Xanax’s CNS depressant effects. Xanax overdose symptoms include:

Drowsiness, slurred speech and mental status changes, which may occur due to the drug’s sedative nature
Slowed breathing, which can occur if the drug has been taken with another CNS depressant
Balance and coordination problems, which may be obvious when performing even simple tasks like walking straight and upright

No overdose symptom should be ignored. If you or someone you know is experiencing any of these symptoms, seek emergency medical assistance immediately.

How Much Xanax Is Too Much?

Different doses of Xanax create different overdose risks for each person. For example, someone who is less tolerant of Xanax may overdose on a lower dose of the drug than someone who has been taking a moderate dose over a longer period of time. Again, combining Xanax with other CNS depressants can increase your overdose risk regardless of the Xanax dose you are taking.

Other FAQs About Xanax Use

How Safe Is Xanax?

Xanax, a prescription drug used for anxiety and panic disorders, is one of the most common medications in the United States. As of 2018, Xanax was the 37th most commonly prescribed medication in the United States, with more than 20 million prescriptions written for it.

Xanax is mostly safe when taken as prescribed, but it can be dangerous when someone combines it with other substances or uses too much. Knowing more information about proper Xanax use — including the dosage and recommended frequency — can help people to understand how much Xanax is too much.

Despite the benefits of using the drug, Xanax can also be extremely addictive. For this reason, benzodiazepines like Xanax are Schedule IV controlled substances. Regularly taking the drug can create a tolerance because the body becomes accustomed to the level of GABA produced. This tolerance means a person would require a larger dose of Xanax to achieve the intended calming effects.

Are There Different Types of Xanax?

Xanax and generic alprazolam come in different dosage forms and doses. These include:

Oral concentrate: At a concentration of 1 mg of alprazolam for every 1 mL of liquid
Orally disintegrating tablets: At doses of 0.25 mg, 0.5 mg, 1 mg, 2 mg
Short-acting tablets: At doses of 0.25 mg, 0.5 mg, 1 mg, 2 mg
Long-acting tablets: At doses of 0.5 mg, 1 mg, 2 mg, 3 mg

What Are Xanax Bars?

“Xanax bars” is a slang term for Xanax that comes in rectangular tablets. Xanax could come in many different forms; however, 2 mg Xanax tablets manufactured by Pfizer come in a white rectangle form with “XANAX” written on one side and “2” written on the other. These “bars” contain three score marks that allow the pill to be separated into four pieces, enabling it to be used for multiple doses in 0.5 mg increments.

What Is a Normal Dose Amount for Xanax?

Each person’s Xanax dose can vary widely depending on their needs and reasons for taking the drug. As such, it is difficult to generalize a normal dose range. For example, a common starting dose of short-acting Xanax is 0.25 mg when used for anxiety. However, the max dose of short-acting Xanax for anxiety is significantly more than that at 10 mg per day.

Is 1 mg of Xanax a Lot?

A normal starting dose of Xanax is 0.25 mg to 0.5 mg, but it may be up to 1 mg depending on what it is being used for. In unusual cases, people may be increased to doses as high as 10 mg per day, although this is not taken all at once. A dose of 1 mg of Xanax is a higher initial dose, but it may be a normal dose for people who take Xanax regularly.

How Often Can I Take Xanax?

The long-acting dosage form of the drug should be taken once daily, while the shorter-acting dosage forms may be taken more frequently. For example, when used for anxiety, some doctors may prescribe Xanax to be taken up to four times a day.

It is important to note that you should only take Xanax as often as your doctor prescribes it. Taking a higher dose than prescribed or using it more often than prescribed can increase your risk of overdose, physical dependence, tolerance and addiction. If your current dose of Xanax is not helping you, talk to your doctor to explore other alternatives — never adjust the dose on your own.

Xanax Overdose Treatment

Like most substances taken at toxic levels, benzodiazepine overdose treatment mostly depends on a case-by-case basis. Because slowed breathing, low blood pressure and slowed pulse are some of the major risks of Xanax overdose, medical professionals will often address these concerns first. In some cases, doctors may administer flumazenil, a benzodiazepine reversal drug. However, the use of flumazenil is quite uncommon due to the risk of seizures that this medication causes.

Find the Help You or Your Loved One Needs

You can avoid Xanax overdose and recover from your addiction with the help of the right rehabilitation program. The Recovery Village has helped countless men and women take back their lives from substance use disorders. With facilities located across the country, we can help you too. Contact us today to learn more about Xanax addiction treatment programs that can work well for your situation.

Editor – Jonathan Strum

Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor’s in Communication in 2017 and has been writing professionally ever since. Read more

Medically Reviewed By – Benjamin Caleb Williams, RN

Benjamin Caleb Williams is a board-certified Emergency Nurse with several years of clinical experience, including supervisory roles within the ICU and ER settings. Read more

Xanax Overdose: 7 Facts You Should Know

The benzodiazepine Xanax can be successfully used to treat anxiety, insomnia, and panic disorders, but abuse of the drug is common. It’s also possible to overdose on Xanax, which can result in long-term health impacts. Read on to discover 7 vital facts about how Xanax misuse affects the body and what the symptoms of an overdose are.

1. Yes, you can overdose on Xanax.

Xanax (alprazolam) is a potent medication, most commonly prescribed to treat anxiety and panic disorder. It is a benzodiazepine, a class of medications that, according to the Alcohol and Drug Foundation, slows down messaging between the nervous system and the body.

What does Xanax do to your body and brain?

Xanax specifically works by enhancing the neurotransmitter gamma-aminobutryic acid (GABA). According to the National Library of Medicine, Xanax “[decreases] abnormal excitement in the brain.” While the medication can be calming, it can also have a variety of side effects—including some that are severe. These include (but are not limited to):

Light-headedness
Tiredness
Headache
Nausea
Appetite changes
Seizures, shortness of breath, and loss of coordination—i n severe cases

What happens if you take more than one Xanax?

Xanax dosage varies from individual to individual. According to Mayo Clinic, adult dosage for anxiety generally starts at .25 to .5 mg three times daily, with a maximum dose generally below 4 mg daily. For panic disorders, the dosage generally starts at .5 mg three times daily, with a maximum of 10 mg daily.

However, Xanax also comes as extended-release tablets that require less frequent dosing. To treat panic disorder in adults, you may be prescribed .5 to 1 mg once daily to start, with a maximum of less than 10 mg daily. It is important to note that dosage may vary for older adults, and will certainly vary for children.

Above all, it is important to never take more Xanax than prescribed by a doctor (and to let a doctor know if you perceive problems with your dosage, or are craving more Xanax than you are being prescribed). While Xanax can be safe if you take it as directed, disregarding your prescription can lead to overdose—which can be fatal.

How dangerous is Xanax?

“You can overdose on Xanax, just like all other benzos. It affects the central nervous system by causing first the relief of anxiety, which is the therapeutic benefit. But in higher doses, you start to have sedation,” Daniel Brown, DO, State Medical Director for Pinnacle Treatment Centers, tells WebMD Connect to Care.

According to the Centers for Disease Control and Prevention (CDC), “[b]enzodiazepines were involved in nearly 7,000 overdose deaths… from January 2019–June 2020,” which amounted to “17% of all drug overdose deaths.” This included a staggering 520% increase in illicit benzodiazepine deaths from Q2 of 2019 to Q2 of 2020.

2. An overdose can look like nodding off.

It’s important to catch an overdose early. At first, Xanax abuse may look like recreational alcohol use.

“People can have confusion, impaired coordination, unsteady gait—things associated with someone intoxicated on alcohol. But with higher doses, you’re going toward overdose, and breathing could cease. It’s on a spectrum,” Brown says.

So, can Xanax make you sleepy? Drowsiness and tiredness are both side effects of Xanax use, according to the National Library of Medicine, and can occur even in situations where overdose is not occurring.

However, this can sometimes make it difficult to tell whether an individual might be at risk of overdose. “Xanax overdose can easily be confused with overdose related to some other drugs, but signs include shallow breathing, clammy skin, and dilated pupils.” Kristen Fuller, MD and Medical Editor at American Addiction Centers tells WebMD Connect to Care. “The pulse can be rapid or weak, even completely absent. In a suspected Xanax overdose, to prevent coma and death, the person needs immediate access to medical attention.”

3. Benzodiazepine poisoning should receive medical attention.

Benzodiazepines can be toxic if ingested in dangerous quantities.

What is benzodiazepine poisoning?

Benzodiazepine poisoning may result from an overdose of these medications. According to the medical database StatPearls, the symptoms of benzodiazepine poisoning include:

Central nervous system depression
Slurred speech
Impaired balance or coordination
Altered mental status

Can benzodiazepines cause death?

Yes, benzodiazepine overdose can lead to death. As noted above, an estimated 7,000 Americans died in situations involving benzodiazepine overdose in the year and a half preceding June 2020.

How do you counteract benzodiazepines?

According to StatPearls, the most common treatment for benzodiazepine toxicity is supportive care, and intubation to help with breathing if needed. In certain cases, flumazenil can be used to reverse sedation caused by benzodiazepines—but this is a less common treatment typically reserved for patients without a history of benzodiazepine abuse.

4. A fentanyl-Xanax overdose can be especially fatal.

According to the Centers for Disease Control and Prevention (CDC), more than 93,000 Americans died due to drug overdose in 2020. The National Institute on Drug Abuse has also noted that, in that same year, 16% of overdose fatalities involving opioids simultaneously involved benzodiazepines such as Xanax.

“Perhaps it is the combination of Xanax and Fentanyl that is most dangerous,” Fuller says. “Fentanyl is often added to illicit street drugs such as heroin and cocaine so many people use and overdose on it without even knowing they took it. Any drug laced with fentanyl is exceedingly dangerous because of the high risk of a deadly overdose.”

According to the National Institute on Drug Abuse, both opioids and benzodiazepines are central nervous system depressants, and taking both at the same time will increase the risk of life-threatening overdose.

In most cases, doctors are advised against prescribing these two types of medications together. It is therefore important to be sure your medical provider is aware of all medications and substances you are currently taking, to lessen the possibility of overdose.

5. The long-term effects of an overdose can impact major organs.

“The longer-term effects of an overdose can be brain damage, kidney, liver, and heart damage if someone has a significant overdose event,” Brown says.

Long-term consequences can occur when someone’s overdose goes unnoticed.

“[People who overdose] spend a long period of time with hypoxia, which means low oxygen levels in the blood. A person who is revived after a longer period of an overdose can have multi-system organ failure and brain damage from low oxygen, [and] heart, liver, and kidney damage if they’re in a state where blood oxygen is not supporting organs,” Brown says.

6. Other drugs and alcohol can impact your risk of overdose or side effects.

Ingesting alcohol with Xanax increases your risk of experiencing serious complications. “When someone takes too much [Xanax], they just become drowsy, fall asleep. but it’s fatal when they take so much they stop breathing. Most of those instances occur when people may have abused alcohol with benzos. This can increase overdose risks,” Brown says.

Alcohol is a particularly dangerous substance to consume with benzodiazepines, as both can slow down the nervous system and cause drowsiness and cognitive impairment. B ut alcohol is not the only substance to avoid with Xanax and other benzodiazepines; there is a long list of substances that potentially do not mix well with Xanax, and may require special prescribing attention from your doctor.

This includes some antihistamines, sedatives, and tranquilizers, certain pain medications, antifungal medications itraconazole and ketoconazole, and potentially other medications, according to Medline Plus. It may also be necessary to avoid grapefruits and grapefruit juice.

It is essential to consult with all of your medical providers when taking Xanax so that they are all informed of any other medications you are taking, and any conditions you have, which may dangerously interact with Xanax.

7. Abuse can lead to addiction.

Also known as substance abuse disorder, addiction can occur in association with both prescribed and recreational Xanax use.

“Oftentimes, misuse leads to full-blown addiction. Addictions occur with use, illicit or licit use. A person has feedback that they feel good taking the medication or drug, so they start to use it more frequently,” Brown says.

According to American Addiction Centers, signs that someone you know may be abusing Xanax are:

Slurred speech
Risky behavior
Drowsy disposition
Poor motor skills

Don’t Wait. Get Help Now.

If you or a loved one are struggling with addiction, WebMD Connect to Care Advisors are standing by to help.

Can You Overdose on Xanax? 6 Questions, Answered

Xanax can help you deal with panic or anxiety, but an overdose is possible—especially when the medication is combined with other substances.

Xanax is a benzodiazepine prescribed to treat anxiety. Meant to be used on a short-term basis, this medication can quickly produce potent effects and unpleasant withdrawal symptoms that make it more prone to being misused. And Xanax overdose can be fatal —especially if the drug is combined with other substances or medications. Read on for the answers to six important questions about this commonly-misused prescription medication.

1. What is Xanax?

“Alprazolam, more commonly known as Xanax, is used to treat anxiety. It is most often prescribed to treat anxiety disorders such as panic disorder,” Bryan Bruno, MD and Medical Director at MidCity TMS, tells WebMD Connect to Care.

Xanax works by affecting the way the brain communicates with the body. “Xanax is in a class of drugs known as benzodiazepines, which slow down the nervous system by raising the level of the inhibitory neurotransmitter GABA in the brain,” Bruno explains.

GABA, short for gamma-aminobutyric acid, is a stress-reducing and sleep-enhancing neurotransmitter, according to a 2020 article published by Frontiers in Neuroscience.

Xanax is rapidly absorbed into the body. However, the medication also has a shorter duration of effect than other benzodiazepines. Its high potency can also cause severe rebound anxiety. These factors make the medication more likely to be misused, according to a 2018 article published by the Journal of Addiction Medicine.

The article also reports that Xanax side effects are common, and can include:

Fatigue
Slurred speech
Disrupted concentration
Irritability

It’s also important to note that Xanax is meant to be used on a short-term basis, but its propensity to quickly produce unpleasant withdrawal symptoms can make it uniquely tempting to misuse.

2. Can you overdose on Xanax?

Yes, it is possible to overdose on Xanax—and in the most severe cases, this can lead to death. According to Mayo Clinic, other signs of a Xanax overdose include the following:

Changes in, of loss of, consciousness
Confusion
Lost coordination
Unusual sleepiness or drowsiness

A Xanax overdose can be life-threatening. According to a 2018 study published by the Journal of Clinical Psychiatry, approximately 17% of benzodiazepine users misused the drug—and so the potential for overdose is not remote. If you suspect that you or someone you are with is having a Xanax overdose, seek emergency medical help immediately.

3. Can Combining Xanax with Other Medications Increase the Risk of Overdose?

Combining other medications with Xanax increases the risk of a fatal overdose. “Most deaths occur when Xanax is combined with the consumption of an opioid, since both types of drugs sedate users and suppress breathing, the main cause of these fatalities,” Bruno says.

4. What should you avoid while taking alprazolam?

All drugs listed above should likely be avoided when taking alprazolam (Xanax). However, these are not the only medications that can interact with Xanax and contribute to an overdose. Antihistamines, sedatives, seizure medications, and other central nervous system depressants can all compound the effects of Xanax. Because the list of medications is potentially long, it is important to consult with your doctor when taking Xanax about other medicines to avoid.

If you have multiple doctors, it is important to coordinate so they are all aware of all medications you are taking. If your doctor is concerned about a bad interaction between Xanax and another medicine, they may recommend substituting another medication.

Finally, alcohol should be avoided when taking Xanax. It can compound the depressant effects of the medication and increase the risk of an overdose.

Mayo Clinic also warns against eating grapefruit or drinking grapefruit juice when taking Xanax. However, a small 2000 study in the journal Psychopharmacology disputed this and suggested grapefruit may not negatively interact with alprazolam. To be safe, it is best to ask your doctor about all foods, drinks, and medications to avoid when taking Xanax.

5. How Many Xanax Pills Can You Take Together?

Xanax dosage varies depending on the individual in question and his/her doctor. “Usual dose is 0.25 to 0.5 mg two to three times a day as needed for panic attacks or generalized anxiety disorder,” Ali says. “Most medical literature recommends a maximum daily dose of 10 mg / day.”

According to the Mayo Clinic, dosage varies based on need (with a higher dosage taken for panic disorder than anxiety) and on age (dosages are less standardized with children).

It is also worth noting that dosage may differ for first-time users. “Whether Xanax can lead to an overdose depends on the person’s tolerance to the drug,” Kristen Fuller, MD and Medical Editor at American Addiction Centers, tells WebMD Connect to Care. “If a person is using Xanax for the first time, anything over the recommended daily dosage (0.5 mg to 1 mg) can cause an overdose.”

Above all, remember that Xanax should always be taken in accordance with a specific prescription given by a doctor. If Xanax users feel a desire to take more than their prescribed dosage, they should speak to their doctor—this can be a sign of potential substance abuse. If dosage is increased without a prescription, a user is more prone to an overdose.

“The only safe dosage is that prescribed by a doctor to a patient,” Fuller says

6. How Much Extended Release Xanax Can Cause an Overdose?

According to a 2004 paper in the journal Expert Opinion on Pharmacotherapy, Alprazolam-XR is a form of Xanax that allows for less-frequent dosing. “Usually dosing for Xanax XR (extended release) is once daily as opposed to twice or three times for Xanax,” Ali says. Mayo Clinic notes that dosage typically starts at .5 to 1 mg once daily for adults, and should not exceed 10 mg daily.

As with the standard release form of Xanax, any dosage beyond what is prescribed by a doctor is dangerous and can lead to overdose. To take extended-release Xanax safely, you should:

Never take more than the amount prescribed by your doctor
Notify your doctor if you feel an urge to take more than your prescribed dosage
Discuss drug and other interactions with your doctor, and avoid medications (like those listed above) and alcohol than can negatively interact with Xanax and increase the risk of overdose

General Xanax Overdose Symptoms

“Xanax can be overdosed on its own, by taking over the amount prescribed, or [by] consuming alcohol while on the drug,” Bruno says.

In addition, combining other medications with Xanax increases the risk of a fatal overdose. “Most deaths occur when Xanax is combined with the consumption of an opioid, since both types of drugs sedate users and suppress breathing, the main cause of these fatalities,” Bruno says.

“Symptoms of a Xanax overdose include changes in consciousness, confusion, drowsiness, lack of coordination, loss of consciousness, and sleepiness,” Bruno says.

In addition to losing coordination and consciousness, there are more dangerous symptoms that can occur. “More severe symptoms of Xanax overdoses include seizures, hallucinations, difficulty breathing/respiratory depression, abnormal heart rhythm, and coma,” Holly Schiff, PsyD and Licensed Clinical Psychologist at Jewish Family Services of Greenwich, tells WebMD Connect to Care.

Some people may be more prone to a Xanax overdose. According to the Mayo Clinic, side effects from Xanax may be more pronounced in the elderly. Individuals with liver disease may also be more prone to overdose, because the medication may stay in the body longer.

If you or a loved one is exhibiting signs of a potential Xanax overdose, it is important to seek emergency medical help immediately. If possible, work to determine how much Xanax was taken, how long it has been in the person’s system, and important medical facts about the person in question (height/weight, underlying conditions, and other medications or substances taken). While waiting for formal medical attention, pay close attention to the individual’s breathing, ensuring it remains steady and is unconstricted and unobstructed.

Overdose prevention is vitally important in cases of known substance misuse. If you or a loved one is exhibiting signs of Xanax addiction—taking more than the prescribed dosage, demonstrating increased tolerance to the drug, or experiencing strong side effects—addiction treatment can help. Detox, therapy, and inpatient treatment if necessary can all help treat Xanax addiction and dramatically limit the risk of overdose.

Don’t Wait. Get Help Now.

If you or a loved one are struggling with addiction, WebMD Connect to Care Advisors are standing by to help.

Xanax Overdose: 7 Facts You Should Know

Xanax Overdose: Can You Overdose on Xanax?