How Does Xanax (Alprazolam) Work?

If you have ever taken Xanax, known someone who has taken it or considered taking it, you may wonder how Xanax works. Xanax is a widely-used drug, so it’s not an uncommon question.

Xanax, or alprazolam, is the most prescribed psychiatric drug in the United States because of its potency and ability to work so quickly. Xanax is the brand name of alprazolam, which is prescribed to treat a range of panic and anxiety disorders.

This drug acts on specific receptors in the brain to slow down excessive brain activity and reduce feelings of stress and panic. Xanax is extremely effective for many people, but can be dangerous if used outside of the prescribed dosage.

How Does Xanax and Other Types of Benzodiazepines Work?

Xanax — along with Valium and Ativan — is part of a class of drugs called benzodiazepines, a group of medicines that produce a state of calm in users.

There are around 13 types of benzodiazepines, commonly referred to as “benzos,” that are approved for use as prescription medications by the FDA. They’re typically prescribed for the treatment of anxiety disorders and insomnia. To be considered one of these drugs, the substance must have certain properties in addition to providing relief from anxiety. For example, these drugs also act as muscle relaxants, anticonvulsants and have hypnotic effects.

What many people either don’t understand or may ignore is that benzos aren’t designed as a long-term treatment option for anxiety and other disorders. These medications are prescribed and intended for short-term use for acute symptoms, such as rapid-onset anxiety or panic attacks. If it’s taken for anything else or in any other way, there is the potential for abuse and dependency.

How Does Xanax Work on the Central Nervous System?

Xanax and other benzodiazepines are central nervous system depressants. The central nervous system is what’s responsible for maintaining the primary functions of our bodies, including the regulation of heart rate, breathing, blood pressure and body temperature. When taken, Xanax slows down these functions somewhat.

Many of its effects are similar to drinking alcohol. The level of impairment, sleepiness and slow reaction time one may feel from Xanax are similar to drinking too much.

Some of the side effects of short-term Xanax use include physical and mental relaxation and reduced feelings of fear, agitation and anxiety. Adverse side effects of taking Xanax can include extreme drowsiness, coordination problems, feeling dizzy or lightheaded or experiencing emotional problems.

How Does Xanax Work for Anxiety?

When you experience excessive stress or anxiety, the brain increases certain nerve signals that lead to feelings of anxiety. During these times, the brain produces an unbalanced amount of chemical signals, increasing brain activity, feelings of fear and anxiety and restricting the ability to calm the mind.

Xanax works by creating a calming effect by impacting the effects of gamma-aminobutyric acid (GABA), a naturally-occurring chemical in the brain. GABA is meant to be our natural tranquilizer and is found in 80% of the brain’s nerve connections. If you become anxious or nervous, your brain releases it to calm down the negative activity. If you have anxiety or panic disorders, Xanax works by binding to these receptors and stimulating its signals.

Related: How Does Xanax Work for Flight Anxiety

How Fast Does Xanax Work?

Once ingested, Xanax takes 1-2 hours to reach peak levels in the bloodstream. Taking Xanax regularly may increase tolerance levels, so it may take more time to feel the effects. How quickly the drug is absorbed and eventually leaves the body is also affected by the person’s age, weight, alcohol use, liver function, metabolism, race and whether or not they smoke.

Xanax XR, an extended-release form of Xanax, reaches peak levels at the same speed as Xanax, roughly 1-2 hours. However, concentrations remain constant in the bloodstream for between five and eleven hours. High-fat foods up to 2 hours before taking the medication can increase the amount absorbed.

How Long Does Xanax Work?

When you take Xanax, the effects tend to take hold quickly, but they don’t last long. Xanax has a relatively short half-life, meaning it doesn’t take long for its effects to reach a peak after it is ingested. That’s one of the reasons Xanax has such a high abuse potential; drugs with a short half-life tend to be more commonly misused.

The effects of Xanax usually last about four hours, and that’s why it’s prescribed on an as-needed basis, rather than as a long-term therapy for anxiety. The short half-life and duration of effects are why Xanax is often prescribed to manage infrequent panic attacks.

What Happens When Xanax Stops Working?

As a person continues to take Xanax over time, the brain will start to produce less GABA on its own as a result. The liver will also start to be more efficient in its processing of Xanax. Together, these two functions diminish the effectiveness of Xanax. When this happens, a doctor may increase the dosage of a prescription. More frequently, a person may start taking larger doses without consulting their doctor. Taking a higher dosage of Xanax when it is not prescribed is highly dangerous and can quickly spiral into Xanax addiction.

There are several types of medications that can be used to manage anxiety on a long-term basis. These include:

• Beta-blockers such as Inderal (propranolol) and Tenormin (atenolol)
• BuSpar (buspirone)
• Selective Serotonin Reuptake Inhibitors (SSRIs) such as Prozac (fluoxetine), Zoloft (sertraline), Lexapro (escitalopram) and Paxil (paroxetine)
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) such as Effexor (venlafaxine), Pristiq (desvenlafaxine) and Cymbalta (duloxetine)
• Tricyclic Antidepressants such as Elavil (amitriptyline) and Anafranil (clomipramine)

Someone who needs medication for long-term anxiety management should discuss with their doctor which treatment option is best for them before starting a new medication.

Xanax Tolerance

The effectiveness of Xanax will change over a short period of time. After a few weeks, people can develop a tolerance for the drug, often needing higher doses or increased use to achieve the same feeling of relief.

The brain can quickly adjust to Xanax effects, creating a physical and physiological dependence on the drug. When someone’s brain has adjusted to the presence of Xanax and then they suddenly stop taking it, adverse side effects, such as seizures can arise as the brain struggles to compensate for losing the presence of a substance it has grown used to.

Along with a physical dependence, a psychological dependence can form from consistent Xanax use. Xanax’s effects can be so relieving and pleasant that even those without anxiety may feel the psychological need to continue taking it. They may feel like they’re unable to function without using Xanax. There’s ultimately the potential for both physical and psychological addiction to Xanax.

Other Details on Xanax & How it Works

There is some belief among researchers that because of how Xanax works, it can not only create the potential for physical and psychological abuse, but also the possibility of long-term effects on memory, cognition and learning. A meta-analysis of 10 different studies, for example, highlighted the potential for long-term Xanax users to be at an increased risk of dementia.

Also critical to learning how Xanax works is to know the risk of overdose that can occur. Between 2005 and 2010, the estimated number of emergency room visits related to misusing alprazolam (Xanax) doubled to more than 120,000 in 2010. These visits are often the result of combining benzos like Xanax with other substances like alcohol or opioid pain relievers. Since substances like alcohol also act as depressants of the central nervous system, they can slow the body’s essential functions so much that the person goes into a coma or dies from an overdose.

If you or someone you know is taking this medication under a doctor’s supervision, understanding how Xanax works is important to anticipate how it will affect the brain and body — and to steer clear of a Xanax addiction.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.