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Key Points
- Xanax (alprazolam) is a benzodiazepine, and taking too much can cause an overdose that may require immediate medical treatment.
- The risk of Xanax overdose increases significantly when it is combined with alcohol, opioids, or other central nervous system depressants.
- Early signs of a Xanax overdose can include severe drowsiness, slurred speech, dizziness, poor coordination, disorientation, and difficulty staying awake.
- Severe Xanax overdose can lead to slowed breathing, unconsciousness, coma, respiratory depression, and death, particularly when other substances are involved.
- There is no universal lethal dose of Xanax because overdose risk varies based on factors such as tolerance, age, liver function, body size, other medications, and the presence of alcohol or opioids.
You can overdose on Xanax. The severity of the overdose can vary from deep drowsiness to potentially fatal respiratory depression (breathing that slows down to where there isn’t enough oxygen in the body and carbon dioxide builds up).
Alprazolam is a benzodiazepine, sometimes called a “benzo,” that is commonly prescribed to treat short-term anxiety disorders and panic attacks.[1]
Benzodiazepines are sometimes prescribed in conjunction with antidepressants to treat chronic mental illness. As with all benzodiazepines, if you take too much Xanax, you can exceed your body’s capacity to metabolize it, and you could experience a benzodiazepine overdose, which constitutes one type of drug overdose that necessitates immediate medical treatment.[2]
Common Risk Factors for a Xanax Overdose
Factors that contribute to the risk of overdose include:
- Amount of Xanax taken
- Buildup of tolerance through repeated Xanax use
- Age
- Liver function
- Pre-existing medical conditions
- Combination with other drugs
When Xanax is combined with opioids, alcohol, or other CNS depressants (the brain and spinal cord), the potential for harm increases significantly.[3] These substances increase the sedation effects of Xanax on the body.
What Occurs in a Xanax Overdose?
Xanax works by enhancing the effect of GABA, a neurotransmitter that decreases brain activity.[4] During a Xanax overdose, the enhanced GABA activity continues to decrease the activity of the central nervous system below a safe limit. Being able to recognize the symptoms of a Xanax overdose early can make a big difference in the patient’s recovery.
Initial Symptoms of a Xanax Overdose
During the early stages of a Xanax overdose, individuals typically experience:[5]
- Significant drowsiness
- Slurred speech
- Disorientation
- Decreased coordination
- Dizziness
- Trouble remaining awake
Because many of the initial symptoms of a Xanax overdose mimic typical side effects of Xanax, identifying an overdose as such is critical.
Advanced Symptoms of a Xanax Overdose
If left untreated, additional symptoms can develop and include:[6]
- Slow breathing or difficulty breathing
- Unconsciousness
- Loss of consciousness
- Coma
- Respiratory depression
- Death
- Changes in pulse and blood pressure
Fatalities From a Xanax Overdose
While fatalities associated with Xanax by itself are relatively rare compared to fatalities associated with opioids, fatalities associated with Xanax can occur.[7] Fatalities associated with Xanax usually involve other substances, such as:[8]
- Opioids (fentanyl)
- Alcohol
- Sleep aids or sedatives
- Counterfeit pills containing fentanyl
Fentanyl has become increasingly prevalent in counterfeit pills sold as authentic pharmaceuticals, which has led to an unprecedented number of overdose deaths over the past few years.[9] Counterfeit pills represent a significant threat to the general population.
Increased Risk of Harm by Mixing Substances
All benzodiazepines (including Xanax), opioids, alcohol, sleep aids or sedatives, and muscle relaxers are classified as CNS depressants, meaning they act as a depressant on the central nervous system.[10]
Taking each individually results in greater suppression of respiration and cardiovascular function than taking either separately. The additive action represents one of the primary reasons for fatalities resulting from benzodiazepine overdoses.[11]
Is There a Lethal Dose of Xanax?
Benzodiazepine overdoses do not follow a universal threshold. Likewise, there is no universally lethal dose of Xanax. The amount of Xanax needed to result in a life-threatening event varies depending on:
- Prior exposure or tolerance to Xanax
- Age
- Liver function
- Weight or BMI
- Number of medications currently being taken
- Presence of alcohol or opioids
Attempting to find one lethal dose for every person can be misleading. Two people can ingest the same amount of Xanax and have vastly different outcomes. Healthcare providers and medical professionals are better equipped to assess an individual’s risk. Individuals concerned regarding their dosage of Xanax should consult a healthcare provider as opposed to relying on generic information.
Will a Xanax Overdose Cause Brain Damage?
Xanax itself cannot cause direct physical damage to the brain. Brain injury from a Xanax overdose is primarily associated with prolonged oxygen deprivation caused by respiratory depression, rather than the neurochemical mechanism exerted by Xanax on brain cells.[12]
When an overdose is allowed to progress, and respiration is compromised for an extended period, it creates a heightened risk for permanent damage to brain tissue. Rapid treatment by emergency personnel is vital to reducing complications (including brain injury).
Which Groups Are at the Greatest Risk for Xanax Toxicity?
Those who engage in the following patterns increase the risks for overdose or toxicity:[13]
- Higher doses of Xanax: Taking larger quantities of Xanax increases risk for overdose unless closely monitored by medical professionals.
- Alcohol: When Xanax and alcohol are consumed simultaneously, both as CNS depressants, they raise risk for respiratory depression.
- Opioids: Combining Xanax and opioids poses one of the greatest dangers, leading to overdose mortality.
- Elderly adults: Often, elderly adults require longer periods for metabolism, increasing the potency of any amount of Xanax taken and increasing risk for complications from overdose.
- Counterfeit pills: Counterfeit tablets labeled as Xanax increasingly contain fentanyl (an opioid); a tiny amount of fentanyl can induce an overdose. Counterfeit pills pose a growing concern for the FDA and local health departments.
What Should I Do if Someone Has Overdosed on Xanax?
Immediately contact 911 if they cannot remain awake or exhibit slow or difficult breathing, have blue-tinted lips or skin, are unresponsive, or are experiencing seizures. While awaiting assistance from emergency responders, clear the airway and position the person on their side if they lose consciousness.
Do not attempt to induce vomiting and remain with them until help arrives. Provide responders with information about the quantity and types of substances ingested. Prompt response by emergency personnel can substantially reduce mortality and morbidity from suspected overdoses and should always be treated as an emergent condition.
Treatment for Xanax Overdose
Possible treatments for a Xanax overdose include:[14]
- Supporting airway and oxygenation
- Monitoring cardiac and pulse activity
- Administration of IV fluids
- Administer activated charcoal selectively
- Administration of flumazenil (in select patients due to risk of inducing seizures)
Treatment will depend on multiple factors including what substances were involved and how responsive the patient remains.
With timely intervention from emergency responders, many people recover completely from Xanax overdoses. Delays in receiving treatment increase the risk for developing complications. Post-overdose follow-up treatment may include evaluation of dependency or addiction issues or guidance for safely tapering off Xanax under close supervision, as abrupt cessation can also be harmful.
Recognizing the Signs of Xanax Overdose
Sometimes an unintentional overdose or intentional overdose indicates an underlying issue such as dependency or misuse or a substance use disorder involving prescription medications. Studies conducted by the National Institute on Drug Abuse report that benzodiazepine abuse frequently relates to broader patterns of misuse that require professional interventions.[15]
If you feel that your usage of Xanax has become uncontrollable, consider seeking treatment options provided by certified addiction specialists such as the team at Freedom Center. Treatment options vary widely from outpatient support groups to inpatient or residential programs.
If you or a loved one is ready to get help but finances are holding you back, give us a call. We can work with your health insurance provider.
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Frequently Asked Questions about Xanax Overdose
The duration of a Xanax overdose will depend on the dose taken, presence of other substances, and timeliness of treatment initiated. The duration of a Xanax overdose can extend anywhere from several hours to greater than 24 hours when other CNS depressants are present or medical treatment is delayed.
Sources
[1][2][3][7][16] U.S. Food and Drug Administration. (2020). FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class
[4][10] Bounds, C. G., & Patel, P. (2024). Benzodiazepines. StatPearls Publishing. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK470159/
[5][6][11][12][14] Kang, M., Galuska, M. A., & Ghassemzadeh, S. (2023). Benzodiazepine toxicity. StatPearls Publishing. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK482238/
[8][15] National Institute on Drug Abuse. (2022). Benzodiazepines and opioids. https://nida.nih.gov/research-topics/opioids/benzodiazepines-opioids
[9] O’Donnell, J., Tanz, L. J., Miller, K. D., Dinwiddie, A. T., Wolff, J., Mital, S., Obiekwe, R., & Mattson, C. L. (2023). Drug overdose deaths with evidence of counterfeit pill use — United States, July 2019–December 2021. MMWR Morbidity and Mortality Weekly Report, 72(35), 949–956. https://www.cdc.gov/mmwr/volumes/72/wr/mm7235a3.htm
[13] Isbister, G. K., O’Regan, L., Sibbritt, D., & Whyte, I. M. (2004). Alprazolam is relatively more toxic than other benzodiazepines in overdose. British Journal of Clinical Pharmacology, 58(1), 88–95. https://pmc.ncbi.nlm.nih.gov/articles/PMC1884537/
