What Happens When You Combine Alprazolam (Xanax) and Alcohol

Xanax And Alcohol. This drug has boxed warnings. These are the most serious warnings from the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous.

• Taking benzodiazepines with opioid drugs increases your risk for severe sleepiness, respiratory depression, coma, and even death. Xanax shouldn’t be taken with an opioid unless there are no other available treatment options.
• Using benzodiazepines, even as prescribed, can lead to physical dependence and withdrawal if you stop taking the drug suddenly. Withdrawal can be life threatening.
• Taking this drug can also lead to misuse and addiction. Misuse of Xanax increases your risk of overdose and death.
• Only take this drug as your doctor prescribes. Talk with your healthcare provider if you have any concerns about safely taking this drug.

Xanax is a brand name for alprazolam, a drug used to treat anxiety and panic disorders. Xanax is part of a class of anti-anxiety drugs called benzodiazepines.

Like alcohol, Xanax is a depressant. That means it slows down nervous system activity.

Serious side effects of Xanax include:

• memory problems
• seizures
• loss of coordination

Serious side effects of drinking too much alcohol include:

• seizures
• vomiting
• loss of consciousness
• impaired coordination
• alcohol poisoning

Xanax and alcohol can have dangerous side effects when taken together, enhancing their individual effects.

Read on to find out about side effects, overdose, and long-term effects of combining Xanax and alcohol.

Xanax and alcohol interaction

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The negative effects of both drugs will be exacerbated if you take Xanax together with alcohol.

Researchers are unsure about the precise cause of this. It most likely has to do with how Xanax and alcohol interact chemically in the body.

According to a 2018 animal research, ethanol, the primary component in alcoholic beverages, may raise the maximal concentration of alprazolam in the bloodstream.

In turn, this may result in both greater side effects and an amplified high or “buzz.” Since the liver also breaks down Xanax and alcohol in the body, it must work harder.

Sedation

Alcohol and Xanax both have sedative effects. This implies that they could make you feel worn out, sleepy, or impaired. You may experience sleepiness after ingesting either.

Your muscles are also impacted by both medications. Muscle control, coordination, and balance may become more difficult as a result. You can stutter while speaking or trip over your own feet.

When used combined, Xanax and alcohol have more sedative effects.

Mood and behavioral effects

Xanax can lead to a depressed mood as well as irritability and confusion. It may also cause some people to experience suicidal thoughts, but it’s not common. Other rare side effects include:

• rage
• aggression
• hostile behavior

Additionally, alcohol has a number of effects on mood. Despite being a depressant, it temporarily lifts some people’s spirits. Others could encounter unfavorable side effects, such as sorrow.

Aside from lowering inhibitions, alcohol also clouds judgment. This makes it simpler to do actions that you otherwise wouldn’t.

In general, when Xanax and alcohol are taken simultaneously, these behavioral consequences and mood changes intensify.

Memory impairments

Xanax and alcohol are both associated with memory loss. This effect is greater when the two substances are combined.

Combining both substances increases your risk for a blackout. In other words, after taking Xanax and alcohol together, you might not remember what happened.

Physical side effects

Besides fatigue and drowsiness, physical side effects of Xanax include:

• headaches
• low blood pressure
• blurred vision

Xanax is also associated with gastrointestinal symptoms like nausea, vomiting, and diarrhea.

Drinking too much alcohol can also lead to headaches and blurred vision as well as gastrointestinal issues. Combining the two substances will increase your risk for experiencing physical side effects.

Long-term effects

Physical and psychological dependency may develop with long-term Xanax and alcohol usage.

This indicates that your body becomes used to both drugs and need both to operate properly without feeling the negative consequences of withdrawal. Anxiety, impatience, and convulsions are among possible withdrawal effects.

Long-term risks from combining Xanax and alcohol include:

• changes in appetite and weight
• cognitive and memory impairments
• decreased sex drive
• depression
• liver damage or failure
• personality changes
• cancer
• heart disease and stroke
• other chronic illnesses

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Xanax and alcohol overdose

Combining Xanax and alcohol can result in a life threatening overdose.

If you or someone you know is thinking about intentionally overdosing or having suicidal thoughts, call the National Suicide Prevention Lifeline at 800-273-8255 for 24/7 support.

Immediately call 911 if you believe someone is at immediate risk for suicide.

Xanax and alcohol overdose symptoms

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Call 911 immediately if someone has taken alcohol and Xanax and is exhibiting the following signs of overdose:

• sleepiness
• confusion
• impaired coordination
• impaired reflexes
• loss of consciousness

Death

Taking high doses of either Xanax or alcohol can be fatal. When combined, these substances are more likely to cause death. Alcohol levels in Xanax- and alcohol-related fatalities tend to be lower than alcohol levels in alcohol-only fatalities.

Lethal dose of Xanax and alcohol

Xanax prescriptions for anxiety and panic disorders may range from 1 to 10 milligrams per day. Doses vary depending on the individual and form of Xanax (immediate or extended release).

Even if you’ve been using Xanax for a while with no problems, adding alcohol can trigger unpredictable side effects.

A lethal dose depends on a lot of factors, such as:

• your body’s ability to break down (metabolize) both Xanax and alcohol
• your tolerance to either substance
• your weight
• your age
• your sex
• other health issues, such as heart, kidney, or liver conditions
• whether you took additional medication or other drugs

In short, a lethal dose for someone might not be lethal for someone else. There’s no recommended or safe dose: Taking Xanax and alcohol together is always dangerous.

Dangers of mixing alcohol with other benzodiazepines

Benzodiazepines, also known as benzos, have strong sedative effects. They can lead to dependence. Some common benzodiazepines include:

• alprazolam (Xanax)
• chlordiazepoxide (Librium)
• clonazepam (Klonopin)
• diazepam (Valium)
• lorazepam (Ativan)

The risks of mixing alcohol with the benzodiazepines listed above are comparable to the risks of mixing alcohol with Xanax.

In general, risks include:

• enhanced sedation
• mood and behavioral changes
• memory impairment
• physical side effects

This combination also increases the risk of a fatal overdose.

Other drugs, including opioids and SSRIs, can also adversely interact with benzodiazepines and alcohol.

When it’s an emergency

Call 911 or visit the emergency room right away if you or someone you know is exhibiting the signs of an overdose. Don’t wait for symptoms to get worse.

While you wait for emergency help, call the National Capital Poison Center at 800-222-1222. The person on the line can offer you additional instructions.

Seeking medical help for an addiction

There are options available if you believe you or someone you know is abusing Xanax and alcohol.

You can better understand your choices by talking to a healthcare professional, such as your regular physician. They may assist you in making choices that lower your likelihood of experiencing negative side effects.

The American Society of Addiction Medicine’s Find a Doctor search engine will help you locate an addiction expert. To find physicians in your region, all you need to do is enter your ZIP code.

The Find a Specialist directory of the American Academy of Addiction Psychiatry is another option.

In addition to offering a list of treatment facilities in your area, the Substance Abuse and Mental Health Services Administration (SAMHSA) can also assist you in finding a facility.

Call the National Drug Helpline at 844-289-0879 if you can.

Additional online resources are available for people with substance use disorders and their families at the National Institute on Drug AbuseTrusted Source.

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Takeaway

Xanax amplifies the effects of alcohol, and vice versa. It also increases the likelihood of an overdose. This combination is not safe at any dose.

If you’re currently using or considering taking Xanax, talk to a healthcare provider about your alcohol use. They can answer additional questions about how Xanax and alcohol interact.

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FDA Warnings

This drug has boxed warnings. These are the most serious warnings from the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous.

• Taking benzodiazepines with opioid drugs increases your risk for severe sleepiness, respiratory depression, coma, and even death. Xanax shouldn’t be taken with an opioid unless there are no other available treatment options.
• Using benzodiazepines, even as prescribed, can lead to physical dependence and withdrawal if you stop taking the drug suddenly. Withdrawal can be life threatening.
• Taking this drug can also lead to misuse and addiction. Misuse of Xanax increases your risk of overdose and death.
• Only take this drug as your doctor prescribes. Talk with your healthcare provider if you have any concerns about safely taking this drug.

Does it feel the same for everyone?

Xanax, or its generic version alprazolam, doesn’t affect everyone in the same way.

How Xanax will affect you depends on several factors, including your:

• mental state at the time you take the drug
• age
• weight
• metabolism
• dosage

If you’re taking this anti-anxiety medication for the first time, it’s important to understand its side effects and potential interactions before use. Read on to learn what it should and shouldn’t feel like, and answers to other commonly asked questions.

What does Xanax feel like if you’re using it recreationally?

Many people who take Xanax recreationally, or without a prescription, describe the feeling as sedating or calming.

Unlike some drugs, such as cocaine, that produce a “high” or euphoric feeling, Xanax users describe feeling more relaxed, quiet, and tired. These feelings may lead to falling asleep or passing out for a few hours.

Some people have also reported memory loss or blacking out and not remembering what happened for several hours. Higher doses will have stronger effects.

What if you’re using it to treat an anxiety or panic disorder?

If you take this medication as it’s intended — it’s commonly prescribed to treat anxiety or panic disorders — you may feel “normal” after your first dose.

The sedating effect can help alleviate symptoms of anxiety and calm your body’s response to the anxiety or stress.

What if you drink alcohol after taking Xanax?

Alcohol increases the effects of Xanax and slows down how quickly your body can clear the drug from your system. If you take the medicine and then drink alcohol, you may experience extreme lethargy and prolonged memory loss.

It’s advised that you avoid combining the two substances. It’s possible that the combination will lead to dangerous, even deadly side effects. These include:

• difficulty breathing
• extreme drowsiness
• confusion
• seizures

What if you combine Xanax with another drug or medication?

You should avoid combining Xanax with several other drugs due to their interactions. Xanax can interact with many medications, including some:

• oral contraceptives
• antifungals
• antidepressants
• antibiotics
• heartburn drugs
• opioids

These drugs can prevent the pathway that’s responsible for eliminating Xanax from your body from removing it as quickly as should happen. Over time, this may lead to a toxic buildup of the drug and eventually an overdose.

Speak with your doctor or a pharmacist about all the medications you’re currently taking to ensure that they won’t have an interaction. They can assess the risks and discuss them with you.

You should also avoid combining Xanax with drugs — even over-the-counter ones — that can make you sleepy, slow your breathing, or cause extreme lethargy. The compounded effects of combining these drugs may be dangerous and put you at risk for health issues or death.

What shouldn’t you feel when taking Xanax?

The effects of Xanax should be mild, but detectable. If the drug appears to be having a significant impact on you, you should seek emergency medical attention.

Symptoms to watch for include:

• extreme drowsiness
• muscle weakness
• confusion
• fainting
• loss of balance
• feeling lightheaded

You should also seek emergency medical attention if you experience signs of an allergic reaction. Signs may include swelling of the face, lips, throat, and tongue and difficulty breathing.

Likewise, if you experience signs of withdrawal, you should contact your doctor immediately. Xanax is a potentially habit-forming drug, so some people may develop a dependency or addiction without realizing it.

Symptoms of Xanax withdrawal can be serious. They include:

• depressed mood
• thoughts of suicide or self-harm
• confusion
• hostility
• hallucinations
• racing thoughts
• uncontrolled muscle movements
• seizures

Suicide prevention

1. If you think someone is at immediate risk of self-harm or hurting another person:
2. • Call 911 or your local emergency number.
3. • Stay with the person until help arrives.
4. • Remove any guns, knives, medications, or other things that may cause harm.
5. • Listen, but don’t judge, argue, threaten, or yell.
6. If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.

Does the dosage change the way it affects you?

Xanax’s doses are available in milligrams (mg). They include:

• 0.25 mg
• 0.5 mg
• 1 mg
• 2 mg

The effects of Xanax become more significant as the dose increases.

Doctors generally recommend that first-time Xanax users start with the lowest possible dose. Until you know how the drug will affect you, it’s better to take less and build up to a higher dose.

High doses can be fatal. This goes for everyone — from first-time users all the way up to people who’ve used Xanax for many months or years as prescribed by their doctor. You shouldn’t take a higher dose than what’s prescribed by your doctor.

High doses are also associated with a puzzling complication known as the “Rambo effect.” This unusual side effect occurs when a Xanax user begins displaying behaviors that are very unlike them. This might include aggression, promiscuity, or theft. It’s not clear why some people react this way or how to predict if it will happen to you.

How long does Xanax take to kick in?

Xanax is taken by mouth and absorbed quickly by the bloodstream. Some people may first begin experiencing the effects of Xanax within 5 to 10 minutes of taking the pill. Almost everyone will feel the effects of the drug within an hour.

One of the reasons why Xanax is so effective for treating panic is that peak impact from the dose comes quickly. Most people will experience it between one and two hours after taking their dose.

How long will its effects last?

The effects of Xanax are brief. Most people will feel the strongest impacts from the drug for two to four hours. Lingering effects or “fuzzy feelings” may stretch out beyond that for several more hours.

How long it takes for the drug to impact you will depend on several factors. They include:

• your weight and metabolism
• your age
• other medications you may be taking

It’s possible to build up a tolerance to Xanax quickly. If that happens, you may begin to notice it takes longer for you to feel the sedative effects of the drug, and the feelings may wear off more quickly.

What does it feel like when Xanax wears off?

Xanax has a half-life of about 11 hours. By that point, your body will eliminate half of the dose from your bloodstream. Everyone metabolizes medications differently, so the half-life is different from person to person.

As Xanax wears off, most people will stop feeling the calm, relaxed, lethargic sensations that the drug is associated with.

If you take this medication to relieve symptoms of anxiety, like a racing heart, those symptoms may begin to return as the drug is eliminated from your system. If you don’t have these symptoms, you’ll begin to return to a “normal feeling.”

Is a Xanax comedown the same thing as withdrawal?

A Xanax comedown isn’t the same thing as withdrawal. A comedown is the letdown of high emotions following peak drug effects. Many people who take Xanax don’t report a “comedown” because Xanax doesn’t cause a “high.”

However, some people may experience feelings of depression or anxiety, even if they’ve never had an issue with these conditions, as the chemicals in their brain adjust to the lack of the drug. This rebound anxiety or depression is usually temporary.

What does withdrawal feel like?

Xanax has high potential to be a habit-forming drug. Symptoms of withdrawal typically begin two to seven daysTrusted Source after your last dose. They can last two to eight weeksTrusted Source.

If you take Xanax, don’t stop it without talking to your doctor first. Some withdrawal symptoms can be dangerous. You need to follow a program with your doctor’s supervision to taper off the high doses and ultimately quit entirely.

Symptoms of withdrawal include:

• sleep problems and insomnia
• restlessness
• nervousness
• aggression
• poor concentration
• suicidal thoughts
• worsened anxiety or panic attacks
• depression
• seizures

Your doctor can administer medication to help ease these symptoms and prevent further complications.

The bottom line

If you’re considering taking Xanax or are curious about its potential to help you feel less anxious, talk with your doctor.

It’s also a good idea to tell your doctor if you’re using the drug recreationally. Xanax can interact with several common medications, resulting in serious side effects. Your doctor can monitor your overall health and help prevent complications.

Your doctor can also work with you to find a more sustainable, long-term medication to help soothe any symptoms you’re experiencing and alleviate your desire to use Xanax.

Last medically reviewed on June 20, 2018

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