Deadly breathing problems? Yup, that’s one.
That’s because it takes away anxiety, it’s potent, and it works really well, he says.
But that’s also the problem with it, Muskin notes.
A cousin to Valium, Xanax is a triazolam benzodiazepine that’s used to treat anxiety, insomnia, and seizures. It works by attaching to receptor sites in the brain to depress the central nervous system—calming those racing thoughts and panic attacks that are hallmarks of anxiety. And it’s very popular: American Journal of Public Health.5.6 percent of U.S. adults were on benzodiazepines as of 2013, reports the
But even though Xanax is a very safe drug, says Muskin, it can still have some serious side effects, and it shouldn’t be taken casually.
1 – Addiction
Although Xanax is very safe when used as prescribed, there is a risk you’ll get hooked. “Addiction is the biggest concern, and it certainly happens,” says Muskin.“I don’t think we know accurately how many people are in that population,” he says. Addiction can happen right away, says Muskin—even within the first week.
If you’ve been addicted to alcohol, cocaine, or barbiturates, there’s a greater risk you’ll get hooked on Xanax, too. “It can cause some degree of euphoria, and some people seek that out because they want to get high,” says Muskin. According to the Food and Drug Administration (FDA), addiction is more common in people taking doses greater than 4 mg a day and who are on the drug for more than 12 weeks.
“If taken regularly, even for a matter of weeks, it can be problematic to stop cold-turkey,” says Joseph Bienvenu, MD, Ph.D., an associate professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine.
There’s also a risk of withdrawal from physical dependence, just like with alcohol, including seizures, muscle cramps, diarrhea, blurred vision, and impaired concentration.
If you think you might be addicted to Xanax, it’s safe and smart to confide in your doctor. He or she can help you come up with a plan to ease you off the drug and find safer alternatives to treat anxiety before your dependence becomes a threat to your mental or physical health.
2 – Potentially Deadly Breathing Problems
When paired with alcohol or narcotics like opioids, Xanax can slow down your breathing and even be fatal, according to a 2016 warning from the FDA. From 2002 to 2015, there was a 4.3-fold increase in the total number of deaths from Xanax, according to the National Institutes of Health (NIH).
That’s because drugs like Xanax enhance the sedative effect of narcotics and alcohol. “The combination of [Xanax] with alcohol is potentially lethal,” says Muskin—and it can be easy to overdo it. “Maybe you’re angry and go out and have a few drinks. Then you take a couple of Xanax, get confused, and take a couple more. You may stop breathing, but it’s more likely you’ll aspirate stuff from your stomach into your lungs and die from that.”
Muskin says the million-dollar question patients ask is how much they can drink if they take Xanax. “Realistically many patients who take these drugs drink,” he says. A glass of wine with dinner is one thing—five or six cocktails or a bottle of wine is another. But the real answer: no alcohol at all is considered safe when you’re on Xanax. If you’ve popped a Xanax while drinking and think you might be having trouble breathing, head to the hospital stat or call 911.
3 – Birth Defects
When taken during pregnancy, benzodiazepines like Xanax have been shown to cause birth defects in babies. “There is a risk of cleft palate. It’s a minimal risk, but it’s not zero,” says Muskin. Because no scientist is willing to do experiments on pregnant women, it’s hard to say exactly how great the risk is. However, it’s greatest in the first three months of pregnancy.
Since most women don’t know they’re pregnant for the first six or so weeks, it’s essential to take Xanax under your doctor’s supervision. And if you think you might be pregnant while on Xanax, get in touch with your doctor to figure out the course of action that’s safest for both you and your baby.
4 – Dizziness or Drowsiness
About one in five people on Xanax report feeling light-headed and two in five say they feel sleepy when taking Xanax for anxiety disorders, according to the FDA.
Just how sleepy you’ll feel varies; some people don’t feel tired at all, while others become quite sedated. “All sedative drugs slow our reflexes, or how quickly you’re able to respond,” says Muskin.
For that reason you shouldn’t drive a car for the first week you take Xanax. Check in with your doctor if symptoms persist and interfere with your daily life; he or she may change your dosage or find another treatment option. However, he adds, most people adapt with time and are left with just an anti-anxiety effect.
5 – Increased Thoughts of Suicide
The FDA notes that Xanax and other psychotropic medications that have a depressant effect and have been linked to increased thoughts of suicide.
However, anxiety and depression are linked, and both disorders increase suicide risk. That makes it a bit hard to parse out whether Xanax is actually causing suicidal thoughts, although Muskin says it’s possible.
People who are dependent on Xanax and trying to get off of it do sometimes have suicidal thoughts. And, he says, “Some people are so distressed that treatment with Xanax lowers their distress enough that they can think of harming themselves. Sometimes if you’re too distressed, you can’t actually put together the thoughts to harm yourself.”
If you ever have thoughts of harming yourself, contact your doctor immediately or call the National Suicide Prevention Hotline (800-273-8255) for free and confidential support.
6 – Delirium
Xanax can have cognitive effects and affect your ability to concentrate, with about 10 percent of Xanax users experiencing confusion, according to the FDA. “This is a drug that can effect your ability to pay attention to and recall information,” says Muskin.
Rarely, Xanax can even cause delirium—a state where your brain isn’t functioning well. “It’s like you had a very high fever of 104. You might feel confused, not regulate your emotions correctly, or see things. You might mistake a blowing curtain for someone coming into your home,” says Muskin.
As with every other Xanax side effect, definitely see your doctor if you’re feeling confused or delirious to adjust your dosage or find alternate treatments.
7 – Reckless Behavior
Another good reason to avoid alcohol when you’re on Xanax: Benzodiazepines are known to have an effect that can be kind of like getting drunk, especially the more you take. “There’s a possibility that you might say or do something inappropriate, or do something impulsive that’s dangerous,” says Muskin. “People can get intoxicated on these drugs, and that can affect your critical thinking.”
Bottom line: Xanax is a powerful drug that shouldn’t be taken lightly. That means popping a friend’s Xanax is a bad idea. “Benzos have the potential to help people tremendously, but they can unveil your vulnerability to addiction, confusion, or disinhibition. Like all powerful things should be used with caution,” says Muskin.