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Doctors' Answers to "Frequently Asked Questions" - Xanax

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 09/23/2000]
Question: I have been fighting a staph infection in my pacemaker site for 3 months, which ment most of the summer in the hospital and 7 trips to the OR. During my last admission they began giving me Zanax .25 mg 4 X a day, because of my anixity and because I was not sleeping at all. It helped some but when I was discharged I was continued on it .25 2 X day. I have been on it for 4-5 weeks now. I did not relize what they were putting me on and on discharge no one told me about the side affects or that I should not stop it without the Dr's supervision. I did not take it the other day and began to have feeling that I was chilling all over, felt shaky, and just not well. When I took it again these feeling went away with in a short period of time. Could I have become dependent on this so fast. Will it be hard to stop taking this drug?

Answer: You're probably dependent at this point. This is a drug that should not be stopped "cold turkey" discuss tapering/stopping it with your md.

[posted 04/23/2000]
Question: xanax side effects if i stop using it?any meds that might take its place?

Answer: Xanax and that class of drugs should not be stopped abruptly as one can experience seizures. Work with your md to taper it and then stop if that is appropriate. There are many other sedatives/anxiety type drugs which can be used depending on why you are taking it which was not in the question. Let me know, it that will help.

[posted 03/22/2000]
Question: I am currently taking .25 of Azoprazolam 3 times a day.
I have only been on it for approx 2 months.
I have solved all of my problems and causes of my anxiety
since being diagnosed w/Panic Disorder a few months ago.
I want to stop Xanax and know I have to cut down very gradually.
How do I start? Is it Okay to only take two pills a day instead?
Or what would you suggest? Thank You

Answer: Discuss it with your physician, but generally cut it by 1/2 pill a day every 6-7 days.

[posted 03/16/2000]
Question: Doctor,
I was officially diagnosed with Panic disorder in 1996 after suffering with the disease for 10 years, the military failed to diagnose it for that period of time. I have been off and on Prozac which worked very well but my insurance would not pay for it so I was solely taking Xanax .5 to 2.5mg a day. I was concerned about taking so much xanax and tried to stop by not taking any, this produced severe debilitating rebound attacks, working with my doctor she put me on Paxil 20mg a day which over time has helped with my anxiety but two weeks ago I stopped taking the xanax again and although I am not having severe attacks and went through 4 days of hellish withdrawls I still am very scatter brained, my concentration is almost nil and my insomnia is very bad, Am I still going through withdrawls? is this normal when coming off this kind of medication? This is a very uncomfortable feeling. Any advice would be greatly appreciated. Thank you.

Answer: The benzodiazepines as a class are fairly addicting. Withdrawal should be done carefully, but there are still symptoms. What you are describing is probably withdrawal from the xanax.

[posted 02/12/2000]
Question: Hi Doc,

I take ,12 to .25 mg prn of Xanax, usually when I go to school.
I've often thought that I have a low level depression I
sought counseling and the therapist doesn't agree. Is there
any harm in taking St. John's Wort regularly and continuing
to take Xanax prn? Thanks for your time.

Answer: Shouldn't be a problem. Xanax is usually for anxiety, not depression.

[posted 11/25/1999]
Question: Was taking 2 mg. Xanax/day for 10 yrs as well as variety of Tricyclic and SSRIs. Recently stopped Xanax - replaced with 25mg.Librium 3times day. Also taking 200mg Zoloft. First few days without Xanax were very uncomfortable-withdrawal. It's been 3 weeks w/o Xanax but I still feel very shaky, wired, inability to concentrate, hyper, problems sleeping - can't relax. Could this still be some leftover Xanax withdrawal symptom even with the Librium? My psych said maybe could be. Just want your opinion. This is NOT a comfortable feeling. Thanks for responding.

Answer: If I were switching from 2 mg Xanax to Librium, I would use a higher dosage than 25 tid. You probably need a higher dosage of the Librium to avoid these problems. Try going to four times a day and see how you feel, I suspect you'll have the problems improve.

[posted 10/30/1999]
Question: My doctor prescribed Xanax 0.5 to treat anxiety, and I have been taking 2 or 3 a day for approx. 2 months. It works very well for the anxiety, but I need to be alert on my job and it sometimes makes me too drowsy. I have a desk job so safety is not a concern, but I don't like having to fight the drowsiness. Is there anything I can take to achieve the same effect, but without feeling tired all the time?

Answer: The SRI antidepressants like Prozac and the like are often effective in treating chronic anxiety and will allow lowering the amoutn of Xanax needed. Worth trying.

[posted 08/25/1999]
Question: I am finding that I really benefit from the alprazolam and often take six 0.5mg tabs a day, Is there anything wrong with this as long as I can function?
I have already asked the doctor for a refill and plan to ask for stronger tabs. I feel my social anxiety and fear is leaving me and am much happier, is this wrong? Because Zoloft is taken every day
so therefore what is so different about taking something else everyday (both are "habits" when you think about it some people take vitamins every day and it if helps me there is no harm in this, correct? When I run out I get very nervous and don't feel like myself this bothers me ... the only harm I could see is if he should stop prescribing it....Any thoughts, opinions also any risk for liver damage?
Thanks for an awaited reply. Will my doctor think I am taking to much if I keep asking for refills before there supposed to be depleted?
I dont feel I am abusing this drug it just makes me function and feel better.

Answer: In general, this class of drugs is very effective when taken at correct dosing. The dosing depends on the individual, but if there is no sedation would not usually be considered excessive. As you use the drug over time, there is a natual need to increase the dosing since your liver detoxifies it faster and your develop "tolerance". Most physicians with experience in treating anxiety disorders would understand this and increase your dosage as necessary as long as you were functioning socially. Some get hung up on addiction(which you surely have if you take it for a time). But, more importantly is to function. I think you are correct in your statements, but different physicians have different ideas-based more on their social bias than medical evidence.

[posted 10/18/1999]
Question: I have been taking alprazolam (xanax) for over ten years now for severe anxiety/panic attacks. Recently I have been hearing a lot about alternatives that are more natural. Can I take 5-HTP, which increases serotonin levels, with alprazolam? Can you suggest other alternatives to alprazolam to help control anxiety, depression, and insomnia? Thank you!

Answer: There should be no problem combining 5-HTP. However, newer treatments for panic/anxiety center on using SRI antidepressants like Prozac, Paxil etc. These by themselves or in combination with Xanax are very effective and generally with less side effects.

Xanax and Memory Loss [posted 1/4/99]
Question: In May 1996, an abnormal MIR indicated 7 areas of deteriorated gray matter. This was accompanied with lots of memory loss (for example, taking medications over and over, etc). Now I am back on it (after stopping a certain substance use for self medication (marijuana) because of the anxiety. Is there an alternative drug as effective as xanax to treat anxiety without risk of memory loss? Answer: There is no indication that xanax would cause memory loss. But then what is the cause of the deterioration?

Answer: Are you on estrogen replacement? If not worth a consideration. Xanax is addictive;but, if necessary is ok for long term use as long as you don't try to stop suddenly. I doubt Buspar will have much effect, I haven't been impressed much with the drug-although not addictive. Have you tried melatonin? How about Elavil-an antidepressant commonly used in sleep disorders and not addictive.

Xanax Side Effect Concerns [posted 12/02/98]
Question: Ever since my hysterectomy in 1988 I have had severe sleep problems. After trying many different medications we found that the only thing that would work for me was Xanax. I have been unable to sleep without it. I currently am taking 1 MG at bedtime, and .25 MG during the day because I have been having trouble with stumbling over my words when I speak and talk fast at times. I also suffer from severe anxiety and have been treated for depression. I currently am seeing a psychiatrist since my sleep problems have become worse and the fact that I've had to increase my Xanax from the initial dosage of .5 MG to the 1 MG. He currently has me on 30 MG Buspar daily and has tried to wean me off Xanax by using Atarax. I take it in place of the .25 Xanax during the day and it does absolutely nothing. I desperately want to get off Xanax because of all the negative side effects I've read about this drug. But, it has been two months since I have been on Buspar and cannot see any improvement in my anxiety or the depression symptoms. Is the long term use of Xanax serious? It is my choice if I remain on this and just forget about trying to get off it. It seems that the majority of my problems are traced back to lack of sleep - and I cannot sleep without the Xanax. Talk about a Catch 22. Also, since I have been on the Buspar I have gained weight rapidly. Is this normal? I don't like it and cannot seem to get it off. Thank you for any suggestions you may be able to give me.

Answer: Are you on estrogen replacement? If not worth a consideration. Xanax is addictive;but, if necessary is ok for long term use as long as you don't try to stop suddenly. I doubt Buspar will have much effect, I haven't been impressed much with the drug-although not addictive. Have you tried melatonin? How about Elavil-an antidepressant commonly used in sleep disorders and not addictive.

Xanax & Dependence [posted 11/6/98]
Question: I have chronic insomnia related to stress and have been taking Xanax 0.25mg with good results for 8 months. I am concerned about the long term side effects. I am trying Yoga too. I exercise regularly. How concerned should I be at such a low dosage ?

Answer: Well, you can develop physical dependence at small doses if taken for sufficient time. This would vary with body weight etc. But, I suspect you would have a mild dependence at this point.

Xanax [posted 10/2/98]
Question: In may 96, an abnormal MIR indicated 7 areas of deteriorated grey matter. This was accompanied with lots of memory loss eg.taking meds over and over, etc. Now I am back on it (after stopping a certain substance use for self medication [marijuana])b/c of the anxiety. Is there an alternative drug as effective as zanax to treat anxiety w/o risk of memory loss? Please advise.

Answer: There is no indication that xanax would cause memory loss. But, what is the cause of the deterioration?

Xanax and Alcohol [posted 8/7/98]
Question: My sister is 34 years old and very depressed. She has been taking Xanax for over 10 years for panic attacks. She has been on and off different medications for depression for years and recently was put on Paxil. She also takes an antibiotic, Benedryl, Synthroid and Compazine. She also drinks white wine or vodka. Twice this past week I have seen her acting totally wasted, without drinking anything. I asked her what she took and she swears she took nothing, but I don't believe her. She may have forgotten that she took anything, as she has a terrible memory.

Answer: Xanax and alcohol are never a good combination - both enhance the effects of the other.

Question: Currently I'm taking 100 mg of Zoloft daily for depression/anxiety. In a few weeks, my husband and I will be flying to San Francisco on a combination business trip/vacation. I'm terrified of flying, and various people have told me that Xanax is often prescribed for "fearful flyers." My questions are: 1) Is there a problem with combining Zoloft and Xanax? 2) What can you tell me about Xanax, such as how it works, what it does, and possible side-effects? 3) Are there any anti-anxiety medications that would be safer and/or more effective in this situation? I am female, age 42, in good health, but overweight.

Answer: Xanax belongs to the family of drugs called benzodiazepines. These include valium, librium, etc. The side effects are generally sedation or reduced agitation. We use the combination of an SRI(like zoloft) with these drugs all the time, particularly in agitated depression with no major problems other than occasional over-sedation(sleepy only). I'd use the Xanax and enjoy the trip. It usually works well. Don’t consume any alcohol with this however.

Question: How long does Xanax stay in your system once you have stopped taking it?

Answer: Depending on other drugs you are taking from 24-36 hours. It can be detected in a urine test for up to a week or so depending on the test.

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