How Does Xanax (Alprazolam) Work?

Xanax and other benzodiazepines are designed for short-term use for anxiety and panic attacks. When used correctly, Xanax depresses the central nervous system for a calming effect.

Xanax, the brand name for alprazolam, is a benzodiazepine commonly prescribed to treat a range of panic and anxiety disorders. It is the most commonly prescribed benzodiazepine in the United States.

This drug acts on specific receptors in the brain to slow down excessive brain activity and reduce feelings of stress and panic. Xanax is effective for many people but can be dangerous if used outside of the prescribed dosage. The drug is a short-term solution for anxiety that is intended for use alongside other medications and therapy.

How Does Xanax Work?

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

There are around 13 types of benzos that are approved for use as prescription medications by the FDA. Some are prescribed to treat anxiety disorders, but they can also be used for other conditions like seizures, panic disorder and alcohol withdrawal.

Benzos aren’t designed as a long-term treatment option. Instead, these medications are prescribed and intended for short-term use for acute symptoms, such as rapid-onset anxiety or panic attacks. This is because tolerance develops with long-term use, meaning that a person needs higher and higher doses to achieve the same effects.

How Does Xanax Work on the Central Nervous System?

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

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

Some of the effects of short-term Xanax use include physical and mental relaxation and reduced feelings of fear, agitation and anxiety. However, 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 creates a calming effect by impacting the effects of gamma-aminobutyric acid (GABA), a naturally occurring chemical in the brain. 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 enhancing the effects of GABA in your brain.

Because Xanax is only intended for short-term treatment of anxiety, it is important to pursue other treatment options for long-term control of anxiety. The gold standard for treating anxiety is therapy, including cognitive-behavioral therapy, cognitive therapy and applied relaxation. If medications are needed to treat anxiety, the first-line choices are antidepressants, which can impact anxiety as well as depression.

How Fast Does Xanax Work?

Once ingested, Xanax takes one to two 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 after long-term use. 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 much more slowly than Xanax, taking about ten hours to achieve maximal concentration in the blood.

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 reason 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 a few hours, which is why it is typically prescribed to be taken up to three to four times a day. This is also why the drug is prescribed on an as-needed basis for infrequent panic attacks rather than as long-term therapy for anxiety.

What Happens When Xanax Stops Working?

As a person continues to take Xanax over time, the brain will develop tolerance, becoming less responsive to the effects of the drug. When this happens, a doctor may increase the dosage. Sometimes, 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.

Risks of Taking Xanax

Xanax can have both a short- and long-term negative impact on a person taking the drug. Beyond the risk of Xanax addiction, other consequences include the drug’s side effects, tolerance to the drug, and a possible long-term impact on memory, cognition and learning.

Xanax Side Effects

Xanax has a variety of common side effects that can have an adverse impact on someone taking the drug. These include drowsiness, which impacts up to 77% of people, weight gain, which impacts up to 27% of people, and a decreased sex drive, impacting up to 14% of people.

Xanax Tolerance

The effectiveness of Xanax will change over a short period of time. After ten days, 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 dependence on the drug. When someone’s brain has adjusted to the presence of Xanax and then suddenly stops taking it, adverse side effects, such as seizures, can arise as the brain struggles to compensate for losing a substance it has grown used to.

Along with physical dependence, 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.

Negative Effects of Long-Term Xanax Use

Some researchers believe that because of how Xanax works, it can create long-term effects on memory, cognition and learning. One study showed a potential for long-term Xanax users to be at an increased risk for dementia.

Risk of Overdose With Xanax

There’s a risk of overdosing on Xanax. This is especially true in those who combine benzos like Xanax with other substances like opioid pain relievers or alcohol. The FDA has a Black Box Warning about using benzos and opioids together for this reason.

Since substances like alcohol also act as depressants of the central nervous system, benzos and alcohol can slow the body’s essential functions so much that the person goes into a coma or dies from an overdose.

Who Shouldn’t Take Xanax?

Some people should avoid Xanax. This includes:

• Older adults, who are at a higher risk of dangerous slowed breathing from benzos
• Pregnant women, because Xanax can cross the placenta and may be harmful to a fetus
• People with serious liver problems, because the liver is involved in removing Xanax from the body

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.

Editor – Melissa Carmona

Melissa Carmona puts years of writing and editing experience to work helping people understand substance abuse, addiction and mental health disorders. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more