Xanax (alprazolam) is a mild tranquilizer that helps calm the nerves and brings about a feeling of relaxation. It is one of the most widely prescribed drugs in a class of medications called benzodiazepines. 

Xanax tolerance may develop after taking the medication regularly. If this happens, you may notice that your current dose no longer works as effectively as it did previously.

Note that Xanax has a black box warning, which is the most serious warning from the Food and Drug Administration (FDA). 

  • Avoid taking Xanax with opioids. Mixing Xanax and opioids can increase the risk of severe sleepiness, respiratory depression, coma, and death.
  • Using Xanax can lead to physical dependence and life threatening withdrawal if you stop taking Xanax suddenly.
  • Taking Xanax can lead to misuse and addiction. Misuse increases the risk of overdose and death.
  • Only take Xanax as your doctor prescribes. Talk with your doctor if you have any safety concerns related to this drug.

Xanax tolerance

Xanax is known to have the ability to cause tolerance.

If your body develops tolerance, or gets used to Xanax, you won’t get the same effects as before. Symptoms that Xanax used to help you address may crop up again, or you might feel like your symptoms aren’t being managed effectively. 

If this happens, your doctor may recommend increasing your dosage or changing how you take the medication. They may also prescribe a different medication instead of Xanax.

Tolerance to any medication, including Xanax, happens at different rates for different people. For some people, it may happen quickly, while for others, it may happen more slowly. Among other factors, behavioral and genetic elements can impact tolerance. 

Cross tolerance

Cross tolerance is tolerance to other drugs in the same class, even though you have not taken those drugs. In other words, if you develop a tolerance to Xanax, you may also have a tolerance to other benzodiazepines like chlordiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan), or triazolam (Halcion).

If you experience cross tolerance with benzodiazepines, your doctor may prescribe an alternate medication from another class, such as selective serotonin reuptake inhibitors (SSRIs). Examples of SSRIs are sertraline (Zoloft), paroxetine (Pexeva, Paxil), and fluoxetine (Prozac).

Drug tolerance vs. drug dependence

It’s important to know that tolerance isn’t the same as dependence. The difference is how your body reacts to the drug’s absence or presence.

Tolerance

When you take medication, it causes certain cell receptors to activate. When you develop a tolerance, these receptors no longer respond to the drug like they did previously. In some situations, your body may even clear the drug from your system faster than it used to.

Dependence

When your body becomes used to the presence of the medication, it experiences withdrawal when the medication is no longer present (or abruptly reduced). Your body only functions normally with the medication present.

This can be an issue since the physical need for the drug can lead to addiction or substance use disorder. 

It’s important not to stop taking Xanax abruptly, since doing so increases your risk of withdrawal symptoms. If you want to stop taking Xanax or decrease the amount you take, talk to your doctor about how to taper off safely. 

Is Xanax addictive? 

According to a 2018 review published in the Journal of Addiction Medicine, most addiction specialists consider Xanax to be highly addictive. The review indicates that withdrawal symptoms after stopping Xanax appear to be more severe than with other benzodiazepines.

It also noted that Xanax should be avoided during pregnancy and breastfeeding because it may cause withdrawal for the newborn.

When prescribed by a doctor, Xanax can still be beneficial for those with anxiety and panic disorders. The Xanax label notes that the risk of dependence is highest in people who take more than 4 milligrams (mg) of Xanax per day, or people who take Xanax for more than 12 weeks. 

What are the side effects of Xanax? 

If your doctor prescribes Xanax, talk with them about potential side effects. These can include:

  • Drowsiness
  • Lightheadedness
  • Headache
  • Confusion
  • Dry mouth
  • Depression
  • Constipation

Other side effects may also occur. Talk with your doctor about other potential side effects.

Additionally, seek emergency medical help if you have any symptoms of an allergic reaction to Xanax. These include:

  • Hives
  • Difficulty breathing
  • Swollen face, lips, tongue, or throat

You should also seek emergency medical attention if you experience serious side effects like:

  • Depressed mood or thoughts of suicide or self-harm
  • Unusual risk-taking behaviors, decreased inhibitions, or no fear of danger
  • Confusion or hallucinations
  • Hyperactivity, agitation, or hostility
  • Feeling very faint
  • Urinating less than usual or not at all
  • Chest pain, a pounding heartbeat, or a fluttering feeling in the chest
  • Uncontrolled muscle movements, tremor, or seizures
  • Jaundice, or yellowing of the skin or eyes

What’s the typical dosage of Xanax?

Xanax comes as a tablet, an extended-release tablet, an orally disintegrating tablet (a tablet that dissolves quickly in the mouth), and a concentrated solution (liquid) to take by mouth.

Take Xanax by mouth as your doctor directs. The dosage will be based on the following factors:

  • Why you’re taking it
  • Your age
  • How your body responds to Xanax

Your doctor may gradually increase the dosage of Xanax until the drug works effectively for you. Closely follow your doctor’s instructions to reduce the risk of side effects.

If you’ve used this medication regularly for a long time or in high dosages, you may experience withdrawal symptoms if you suddenly stop taking it.

To prevent this, your doctor may reduce the dosage of Xanax gradually.

Xanax is available in doses of:

  • 0.25 mg. This will be white, oval, scored, and imprinted with “XANAX 0.25.”
  • 0.5 mg. This will be peach, oval, scored, and imprinted with “XANAX 0.5.”
  • 1 mg. This will be blue, oval, scored, and imprinted with “XANAX 1.0.”
  • 2 mg. This will be white, oblong, and multi scored.

Takeaway 

If your body gets used to taking Xanax, you may build up a tolerance. Tolerance means that you no longer get the same effect or benefits as when you started using it.

If you develop a tolerance to Xanax, your doctor may increase dosage or prescribe a different medication. However, keep in mind Xanax should be used at the lowest effective dose for the shortest amount of time possible.

Don’t abruptly stop taking Xanax without working with your doctor. Doing so can lead to withdrawal symptoms.