Xanax

Xanax is the brand name of alprazolam, a prescription medicine in the benzodiazepine family that calms the nervous system quickly. Doctors prescribe it for short-term relief of severe anxiety and for panic disorder. It can cause dependence even when taken as prescribed, and it is dangerous mixed with alcohol, codeine, tramadol or other opioids, which is why guidelines keep its use brief.

Also called: alprazolam (the drug’s own name); a benzodiazepine, or “benzo”; a tranquilliser or sedative. “Xanny”, “xans”, “xannies” and “bars” are slang for the tablets, common in music lyrics. Taking them without a prescription is misuse.

Uses

Alprazolam is licensed for the short-term treatment of generalised anxiety disorder and for panic disorder, with or without agoraphobia, in adults. It works quickly, so some doctors use it to bridge the first weeks before an antidepressant takes effect, or in a crisis. NICE and WHO advise against benzodiazepines for ongoing anxiety or panic except very briefly in an emergency, because the benefit fades and the risks grow with time. The treatments guidelines put first are CBT and, where medicine is needed, an SSRI antidepressant, prescribed by a doctor.

What it does in the brain

Benzodiazepines bind to receptors for GABA, the brain’s main calming chemical, and slow brain activity. The result is less anxiety and drowsiness. Alprazolam acts fast, which helps in a panic attack, but anxiety can return between doses as the body adjusts, nudging people to take more.

Side effects

Common ones are drowsiness, dizziness, weakness, poor coordination, slurred speech and memory gaps. Slowed breathing can occur. Driving, operating machinery and drinking alcohol are unsafe while it is in your system. Benzodiazepines can also deepen depression, and use late in pregnancy can leave a newborn sedated or in withdrawal, so tell your doctor if you are or could be pregnant.

Risks

Dependence. The body adapts within days to weeks of regular use, even as prescribed. After that, missing doses brings anxiety, insomnia, shaking and panic, which feels like proof that you still need it.
Withdrawal. Stopping suddenly after regular use can cause seizures, which can be life-threatening, as well as hallucinations and confusion. Some people have withdrawal symptoms that last months. Never stop on your own; your prescriber will reduce it slowly.
Mixing with alcohol or opioids. Alprazolam with alcohol, codeine, tramadol, heroin or any other opioid can cause deep sedation, breathing that slows or stops, coma and death. The US regulator’s strongest warning sits on every benzodiazepine for this reason.
Misuse and addiction. Taking it for the high, taking more than prescribed, or taking someone else’s are all misuse, and misuse commonly involves other substances; most deaths involving benzodiazepines also involve alcohol, opioids or other drugs.

In Nigeria

Alprazolam is a prescription medicine, and a pharmacist should only dispense it on a doctor’s prescription. We do not quote prices for any medicine, and buying it from a patent medicine shop or online means nobody is checking the dose, the interactions or what is in the tablet. In the 2018 national drug use survey, about 0.5% of Nigerians aged 15 to 64, roughly 481,000 people, had used tranquillisers for non-medical reasons in the past year. That is small next to the 4.6 million who had used tramadol, codeine or other pharmaceutical opioids, but the two often travel together, and that combination is the dangerous one. Our entries on codeine and tramadol explain why.

Xanax vs antidepressants

Xanax calms you today but is not a long-term answer. Antidepressants such as SSRIs take a few weeks to work, do not cause this kind of dependence, and treat the anxiety or panic itself rather than the moment. CBT does the same without medicine and teaches you what to do when panic rises. Z-drugs, the sleeping tablets, act on the same receptors and carry similar risks. Our guide to therapy or medication explains how a psychiatrist makes the choice.

When to get help

If someone has taken Xanax with alcohol or an opioid and is hard to wake or breathing slowly, call 112 (or 767 in Lagos) now. If you or someone else is thinking about suicide, call 112 (or 767 in Lagos), or Safe Place Nigeria on 0800 800 2000. The full list is on our helplines page.

If you are taking it without a prescription, or cannot get through the day without it, talk to a doctor; withdrawal needs medical supervision. The NDLEA helpline, 0800 1020 3040, is free and open 24 hours. For the anxiety underneath, you can book a licensed therapist on Mytherapist.ng who works with anxiety and panic attacks,