Can CBD Replace Xanax? [Explored]
Xanax is one of the most well-known drugs in a family known as benzodiazepines. These medications are frequently used for conditions such as anxiety and panic disorder but have a high potential for addiction and abuse.
Despite this, Xanax continues to be routinely prescribed, while safer alternatives such as CBD remain on the Controlled Substances list. However, CBD has garnered much attention in recent years as a potential treatment for anxiety disorders. It may even benefit people who are addicted to other drugs.
So, could CBD replace Xanax as one of the most popular anti-anxiety remedies? Let’s take a look.
Xanax: What Is It?
Xanax is the proprietary name for the drug alprazolam , a member of the benzodiazepine family. It was first approved by the Food and Drug Administration (FDA) way back in 1981 and has been a popular medication ever since.
Alprazolam is indicated in the treatment of anxiety and panic disorder, but it is often misused by people looking for a quick high. One of the major issues surrounding Xanax is its addictive nature. The FDA recommends that it only be prescribed for “short term relief of symptoms,” but in reality, many people end up taking Xanax for much longer than they should.
How Does Xanax Work?
The exact mechanism of Xanax and how it affects the brain is still not fully understood. However, it is believed to influence several cell receptors in the central nervous system, including BNZ-1, BNZ-2, and GABA-A receptors.
BNZ-1 receptors have a sedative, anti-anxiety effect, while BNZ-2 receptors influence muscle relaxation and have anticonvulsant activity, as well as affecting memory and coordination. GABA-A receptors are associated with the neurotransmitter GABA, which inhibits excitation in the central nervous system to bring about feelings of calm.
The recommended Xanax dosage varies from person to person but usually begins at 0.25mg daily and goes up to a maximum of 4mg daily. The recommended dosage for panic disorders is generally higher than that for anxiety.
Dosages of Xanax over 0.75mg daily are associated with an increased risk of side effects and addiction .
Xanax Side Effects
Xanax has become one of the most frequently prescribed benzodiazepines as it is thought to cause fewer adverse effects than other medications in this drug class. However, side effects are still common and may include:
- Abnormal, uncoordinated movement
- Memory problems
- Slurred speech
- Dry mouth
If an overdose of Xanax is taken, other serious side effects may occur. These may include confusion, seizures, coma, and even death. The risk of overdosing on Xanax is significantly increased when it is combined with other drugs that suppress the central nervous system, for example, opioids or alcohol.
Xanax can also interact with several other drugs, including the antifungal medications ketoconazole and itraconazole. Taking these drugs alongside Xanax could significantly increase the risk of overdose.
Xanax has been linked with a number of celebrity deaths including Michael Jackson, Heath Ledger, and Whitney Houston. Despite this, benzodiazepines like Xanax continue to be routinely prescribed. In fact, between 1996 and 2013, benzodiazepine prescriptions increased by a shocking 67%, rising from 8.1 to 13.5 million per year !
The Link Between Xanax and Addiction
As well as affecting the neurotransmitter GABA, Xanax is thought to interact with dopamine, a neurotransmitter associated with pleasure and reward. This makes alprazolam a highly addictive substance and one which should be used with extreme caution.
It is easy to develop tolerance to Xanax, meaning that you need to keep increasing your dose to achieve the same effects. If you are taking Xanax and want to stop, you will need to wean off your medication gradually, or you may experience withdrawals. The most common of these is ‘rebound symptoms,’ a worsening of the problems for which you took Xanax in the first place.
Due to the feelings of relaxation and calm that it induces, some people even use Xanax recreationally. This worrying trend is another reason why Xanax is so addictive and dangerous. People who use Xanax recreationally may keep increasing their dose to gain the same high, thus increasing the risk of adverse effects.
With all of its associated risks, it is little wonder that many people are now seeking more natural methods of relieving their anxiety. One remedy which is showing promise is cannabidiol , more commonly known as CBD.
CBD: What Is It?
CBD is a major cannabinoid, one of the active compounds found in the cannabis plant. Unlike THC, CBD is non-intoxicating and will not get you high. However, it is believed to have calming properties and may help to relieve conditions such as stress and anxiety.
Because CBD is non-intoxicating, it is currently legal in the majority of places, providing that it is extracted from hemp containing less than 0.3% THC. It is most often used in the form of an oil which is taken by allowing it to dissolve under the tongue. However, CBD is now available in a wide range of forms, including:
- Vape juice
Preparations such as vape juice may be especially helpful for people suffering from anxiety or panic disorder as CBD works much faster when vaporized compared with taking it orally.
How Does CBD Work for Anxiety?
CBD works by influencing the endocannabinoid system (ECS). This system comprises cell receptors known as CB1 and CB2 receptors; chemicals called endocannabinoids, and enzymes. Its function is to maintain a state of homeostasis (internal balance) in an ever-changing external environment.
One of the best-studied endocannabinoids is a compound known as anandamide . Anandamide has been nicknamed the ‘bliss molecule’ thanks to its calming effects on the nervous system. It is believed that anandamide levels in the body increase under stressful circumstances and help us to keep our cool.
One of the ways that CBD might help with anxiety is by slowing the rate at which the body reabsorbs anandamide. CBD is also thought to affect serotonin receptors, and as you may know, serotonin is a neurotransmitter linked to the feelings of happiness and well-being.
Although research into CBD for anxiety is ongoing, the results from preliminary studies are incredibly positive overall. For example, one well-known study found that CBD helped patients with social anxiety disorder stay calm during a simulated public speaking exercise.
CBD Dosage for Anxiety
The dosage of CBD that you will need to take depends on several different factors. These include your genetics, body weight, and how severe your condition is, as well as what brand and strength of CBD you choose.
As a general rule, we suggest you start with the absolute minimum dose of CBD and increase it gradually as necessary. This method will help you to find the lowest dose that has therapeutic value and reduce the risk of negative side effects as well as avoiding wastage.
CBD Side Effects
CBD is considered safe and does not usually cause serious side effects. However, it is possible to have some unpleasant reactions after taking CBD . Some of the most common CBD side effects include:
- Dry mouth
- Increased appetite
- Red eyes
- Feelings of euphoria
Can CBD Help Xanax Addiction?
As well as helping to curb the symptoms of anxiety, CBD has also been investigated for its anti-addiction properties. Although the research so far is somewhat inconclusive, it has been suggested that CBD could help to reduce stress and cravings for people who are trying to come off addictive substances such as drugs and alcohol. If confirmed, this would mean that CBD could be a useful tool for battling Xanax addictions in the future.
Can You Take CBD and Xanax Together?
Both CBD and Xanax are metabolized in the liver by what is known as the CYP450 pathway. This means that taking the two together could increase the bioavailability of Xanax and increase the risk of overdose.
If you are taking Xanax and are interested in replacing it with CBD, be sure to discuss this in depth with your physician who will help you to make the transition safely.
Can CBD Replace Xanax? Final Thoughts
Xanax is a popular medication, but it is certainly not without risks. Although it is thought to cause fewer side effects than other benzodiazepines, the risk of addiction and overdose is still high. The drug is especially dangerous when used recreationally or mixed with alcohol or opioids.
With so many potential hazards, it is no wonder that many people suffering from anxiety or panic disorder would prefer to try a more natural treatment such as CBD. However, it essential to make the switch under close medical supervision to reduce the risk of withdrawal symptoms.
We hope you found this article entertaining and educational. However, we are not doctors, and you should not take any of this information as medical advice. Always speak to your physician before making changes to your medication to ensure that you stay safe and symptom-free.
Does CBD Interact With Alprazolam (Xanax)?
Information on risks & possible interactions between CBD & alprazolam.
The use of CBD is gaining rapid momentum because of its safety and effectiveness in treating a host of medical conditions, including anxiety and insomnia.
This has many wondering whether CBD is safe to use with the common anti-anxiety medication, alprazolam (Xanax), and whether CBD is a safer alternative or not.
Here, we’ll explore the potential drug interactions between CBD and alprazolam.
Table of Contents
Does CBD Interact With Alprazolam (Xanax)?
When used in conjunction with psychotropic medicines like alprazolam (Xanax), CBD may cause moderate to severe risk of negative interactions or side effects.
The main issue with this combination is that CBD interferes or slows the metabolism of alprazolam, thus increasing the chances for side effects to occur.
1. Slowed Elimination (Metabolic Inhibition)
Drug metabolism is the process of breaking down the drugs inside the body via various enzymes, mainly for the ease of excretion. A family of liver enzymes called cytochrome P450 is responsible for the metabolism of most of the drugs in the human body. Alprazolam is extensively metabolized and eliminated via cytochrome P4503A4 (CYP3A4).
Studies have concluded that CBD most potently inhibits the CYP3A4 system of enzymes . Most interactions with alprazolam are with drugs that inhibit or induce CYP3A4.
Compounds that are potent inhibitors of CYP3A tend to increase plasma alprazolam concentrations. Drugs that inhibit this metabolic pathway may have a profound effect on the clearance of alprazolam.
Without proper metabolism, a drug may remain in the system longer than is necessary and cause unintended adverse effects.
CBD is also metabolized by the same sets of enzymes as alprazolam. Hence, CBD may compete for or interfere with these enzymes, leading to an altered concentration of alprazolam in the body. Such an interaction is called metabolic competition. It is the most common type of interaction between CBD and other medications.
2. Increased Effect (Agonistic Interaction)
When CBD is consumed together with alprazolam (Xanax), these drugs enhance each other’s actions. This combination can result in a marked increase in the final effects of these medicines that can be more harmful than beneficial.
An agonistic interaction occurs when two or more substances exhibit the same effect on the body. These substances might act on the same or different receptors, but they produce certain effects in the same direction when consumed together.
CBD and alprazolam may exhibit compounded effects towards the sedative, muscle-relaxant, and hypotensive effects. Both substances exert a similar influence in these areas and may cause side effects from causing too strong of a push in this direction.
Side effects of this interaction would include dizziness, lightheadedness, fatigue, and fainting.
Patients need to exercise caution and should only take these medicines together under the close monitoring of a physician.
List of Alprazolam Trade Names
Alprazolam is sold under many different names. All share the same risk and potential interactions.
Other names for alprazolam include:
Alprazolam is classified as a benzodiazepine. CBD and benzodiazepines all share similar risks for interaction and side effects.
Here’s a list of similar medications that share a similar level of risk when combined with CBD:
- Chlordiazepoxide (Librium)
- Clonazepam (Klonopin)
- Clorazepate (Tranxene)
- Diazepam (Valium)
- Estazolam (Prosom)
- Flurazepam (Dalmane)
- Lorazepam (Ativan)
- Midazolam (Versed)
- Oxazepam (Serax)
- Temazepam (Restoril)
- Triazolam (Halcion)
- Quazepam (Doral)
Is It Safe to Take CBD & Alprazolam (Xanax) Together?
Low doses of CBD are generally considered safe to use with alprazolam (Xanax). However, you should always speak with your prescribing physician about combining CBD or any supplements alongside alprazolam. Other factors or medications could contraindicate the use of CBD.
It’s also not a good idea to use large doses of CBD, THC, or other cannabinoids alongside alprazolam or other benzodiazepines.
Side effects are compounded to dangerous levels if alcohol is used in combination with CBD and alprazolam.
Hence, one must exercise extreme caution while consuming these medicines together. It may alter the concentrations of benzodiazepines and influence either safety or efficacy. It is mandatory to consult a trained physician if anyone seeks to combine or replace alprazolam with CBD.
Is CBD a Viable Alternative to Alprazolam (Xanax)?
CBD carries a host of anti-anxiety benefits without interfering with the patient’s well-being and daily functioning as it is both non-intoxicating and non-psychoactive. Hence, patients are keen to use CBD to treat various disorders like seizures, schizophrenia, anxiety, cancer, chronic pain, and inflammation as a natural alternative and adjunct to other pharmaceutical medicines.
It restores the balance of the endocannabinoid system (ECS) by interacting with cannabinoid (CB) receptors throughout the human body. CBD might be effective and safe in treating conditions such as anxiety and panic disorders with fewer side effects than benzodiazepines [2, 3].
Hence, it is tempting to replace traditional anxiolytics with CBD to beat the blues. However, stopping anxiolytics like alprazolam abruptly can result in withdrawal. Alprazolam, like other benzodiazepines, can result in drug dependence even when used within the prescribed doses for a short time.
When alprazolam (Xanax) is stopped suddenly, several systems of the body get affected. Blood pressure, temperature, respiration, and heart rate may increase rapidly. Seizures that can result in coma and even death may also occur.
Some of the physical warning signs of alprazolam withdrawal include:
- Blurred vision
- Myalgia and tremors
- Tension in the jaw and/or toothache
- Numbness and Tingling in the fingers, arms, and legs
- Photosensitivity/ Sensitivity to sound
- Altered sense of smell
- Loss of appetite
- Heart palpitations
- Sweating and/or fever
Some of the psychological symptoms of alprazolam withdrawal are:
- Thoughts of suicide
- Inability to control emotions
- Short-term memory loss
- Mood swings
- Trouble concentrating
Hence, one must be extremely cautious before combining or replacing alprazolam with CBD. Whether by decreasing the dose of alprazolam or spacing the two medications, a trained physician will be able to devise the most appropriate way to include CBD in the treatment regime.
Patients should discuss in detail their reason to make such a change with their doctors. After understanding your health condition and evaluating the safety and effectiveness, a doctor will guide you on the best possible method to incorporate such natural anxiolytics either as an alternative or an adjunct to your current medications.
Alprazolam may need to be tapered gradually over several days or weeks to minimize the side effects and suffering of the patient. A physician with adequate knowledge of the use of CBD and alprazolam in the treatment of anxiety/panic disorder will be able to advise you on the right way of making the shift.
What Is Alprazolam (Xanax)?
Alprazolam (Xanax) is a prescription medicine of the class “triazolobenzodiazepines.”
It’s the most commonly prescribed psychotropic medication for the treatment of anxiety and panic disorders.
Alprazolam is a schedule IV controlled substance in the USA. Alprazolam, like other benzodiazepines, works by enhancing the activity of GABA, a natural chemical compound in the human body.
Alprazolam (Xanax) Specs:
|Trade Name||Xanax, Xanax XR, Niravam|
|Interaction with CBD||Metabolic inhibition|
|Risk of Interaction||Moderate|
What Does Alprazolam (Xanax) Do?
Alprazolam (Xanax) is a highly potent triazolobenzodiazepine indicated in the treatment of anxiety and panic disorders. It is also used as an adjunct to other treatment modalities to treat chemotherapy-induced nausea and vomiting.
Some of the off-the-label uses of alprazolam include reducing the aches, irritability, and tension of premenstrual syndrome. Alprazolam binds two benzodiazepine receptors in the central nervous system, BNZ1 and BNZ2, respectively.
The BNZ1 receptor is responsible for sleep regulation, while BZN2 is mainly concerned with muscle relaxation, memory, anticonvulsant activity, and coordination.
The binding activity of alprazolam causes a calming effect on the body by increasing the action of a chemical called gamma-aminobutyric acid (GABA). GABA is an inhibitory neurotransmitter, which means it slows down neuronal activity in the central nervous system. This results in reduced anxiousness and muscle relaxation and can also cause drowsiness.
What Are the Side Effects of Alprazolam (Xanax)?
Alprazolam (Xanax) has many potential side effects. Most of them are mild, but a few can become pretty severe. Side effects become more common with higher doses or long-term use.
The potential side effects of alprazolam include:
- Blurred vision
- Changes in libido
- Constipation or diarrhea
- Dry mouth
- Increased Salivation
- Insomnia/Dream abnormalities
- Memory impairment
- Muscle tone disorder
- Nasal congestion
- Weight gain or loss
These side effects generally appear at the beginning of the treatment and are short-lived and self-resolving. However, some symptoms might linger for a longer period.
Additionally, some rare but serious effects may occur following the consumption of alprazolam, such as:
- Mental changes (such as hallucinations, thoughts of suicide)
- Yellowing of eyes or skin
- Severe allergies
- Severe lapses in memory
Precautions While Taking Alprazolam (Xanax)
The following issues need to be discussed with the treating physician while consuming alprazolam (Xanax) for your health condition:
Concomitant Use With Opioids
When alprazolam is used with opioid drugs, it might cause potentially fatal respiratory depression and sedation. These medicines shouldn’t be used concomitantly unless supervised by a health care provider. Patients shouldn’t drive or operate heavy machinery until the effects of this combination have been determined.
Patients should avoid consumption of any alcoholic beverages as it might lead to fatal interactions.
If the patient is on or plans to take any prescription or over-the-counter drugs, it must be discussed with their physician due to the risk of potential interactions.
Alprazolam (Xanax) is contraindicated to use during pregnancy. Therefore, physicians should be informed if anyone is pregnant or planning to have a child or become pregnant while taking this medication.
Patients should not breastfeed their children if they are taking alprazolam.
Interference With Cognitive & Motor Performance
Until one knows how this medication affects them, activities that require mental alertness and motor coordination, such as driving, should be avoided.
The dosage of this medicine shouldn’t be altered without consulting the treating physician, even if one feels that the medication isn’t working. Benzodiazepines, even when used as recommended, may produce emotional and physical dependence.
This medication shouldn’t be stopped abruptly without consulting the physician since serious withdrawal symptoms can occur.
Key Takeaways: Is It Safe to Take Alprazolam With CBD?
Alprazolam (Xanax) and CBD are both effective in the treatment of anxiety and panic disorders. However, as CBD inhibits the enzymes needed for the metabolism of alprazolam, these can interact easily, leading to adverse effects. Hence, it is generally recommended not to mix these two medications.
However, if anyone is willing to use CBD alongside or replace alprazolam, they must do it under the supervision of a physician. During the concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression.
Cautious dosage titration may be required, especially at the beginning of the treatment. Patients must notify their physician if they experience excessive or prolonged effects that interfere with their normal activities.
CBD and Xanax – February 2022
Does CBD interact with Xanax and other benzodiazepines (tranquilizers and sedatives)?
- Alprazolam (Xanax) is mainly metabolised by CYP3A4 (a type of enzyme that belongs to the CYP450 family), as confirmed by a Japanese study in the Yamagata University School of Medicine (1 ) . Found mostly in the liver and small intestine, the CYP3A4 enzyme is responsible for breaking down many of the medicines that enter the body.
- In a Japanese study published in Life Sciences, it was indicated that CBD (cannabidiol) most potently inhibited the catalytic activity of the human CYP3A system of enzymes (2 ) .
- When the CYP450 family of enzymes is influenced in this way, it leads to higher levels of certain drugs in the system at one time, which can cause unwanted side effects, and sometimes, an overdose (3 ) .
- Authors of a study published in Cannabis and Cannabinoid Research do not recommend that cannabis can or should be used as an alternative or supplement to medically indicated and prescribed benzodiazepines (4 ) .
- Given that the benzodiazepines are metabolized by the same enzymes that CBD inhibits, taking CBD with Xanax or any other benzodiazepine is not recommended. It is crucial to consult with a doctor experienced in cannabis use before including CBD in a regimen.
Can CBD be taken with Xanax?
People who have anxiety may have an imbalance of chemicals in the brain, and Xanax aids in correcting these.
Veterinarians also use Xanax for dogs suffering from anxiety or panic. Even if the U.S. Food and Drug Administration (FDA) has not approved Xanax as veterinary medicine, veterinarians still prescribe this as an “off-label” or “extra-label” drug.
Alprazolam (Xanax) is a benzodiazepine. Benzodiazepines are categorized under a group of medicines called central nervous system (CNS) depressants, which are medicines that calm down the nervous system by acting on the GABA receptors (5 ) .
Enzymes are proteins made from amino acids, and they help speed up chemical reactions in the body.
A family of enzymes, called Cytochrome P450, are essential for the metabolism of many medicines and compounds within the human body.
CYP3A4, which belongs to the CYP450 family, contributes to the detoxification of the bile acid, the termination of steroid hormones activity, and elimination of chemicals in food and medicines.
Alprazolam (Xanax) is mainly metabolised by the CYP3A4 system of enzymes, as confirmed by a Japanese study in the Yamagata University School of Medicine (6 ) .
Mainly found in the liver and the intestine, CYP3A4 is an enzyme involved in the metabolism of almost half the drugs in use today (7 ) .
The drugs affecting CYP3A4 activity inhibit or induce the metabolism of the benzodiazepines metabolized by this enzyme. The enzymes cause side effects or reduce the therapeutic effects of these drugs (8 ) .
There have been no clinical trials or case studies documenting a Xanax and CBD interaction.
However, CBD has been shown to inhibit the cytochrome P450’s ability to metabolize certain drugs, leading to an overall increase in processing times (9 ) .
In a Japanese study published in Life Sciences , it was indicated that CBD most potently inhibited the catalytic activity of human CYP3A enzymes, especially CYP3A4 and CYP3A5 (10 ) .
When the CYP450 system is influenced in this way, it leads to higher levels of certain drugs in the system at one time, which can cause unwanted side effects, and sometimes, an overdose (11 ) .
This interaction is due to how CBD interacts with the endocannabinoid system, a complex cell-signaling system in the body. If the side effects are not correctly understood, the risks could be dangerous.
When more of the medication enters the bloodstream than average, it could increase the side effects of Xanax.
Common side effects of Xanax include fatigue, changes in patterns and rhythms of speech, memory problems , poor coordination, lack of appetite, irritability or trouble sleeping.
Less common side effects of Xanax include ear congestion, vomiting of blood, hyperventilation, irregular heartbeats, seizures , and uncontrolled twisting movements of the legs, neck, trunk, or arms (12 ) .
Thus, consult with a doctor experienced in cannabis use before including CBD in a regimen that includes Xanax.
Also, using Xanax with other medications like itraconazole (Sporanox) or ketoconazole (Nizoral) is not recommended, as using any of them together may increase the chance of serious side effects.
However, there may be cases when the combination of Xanax with other medications, such as the ones mentioned above, is unavoidable. In situations like this, the doctor may change the dose or how often Xanax is used, or give special instructions about the use of food, alcohol, or tobacco (13 ) .
Can another benzodiazepine be a substitute for Xanax so CBD oil can be taken?
Cytochrome P450(CYP)3A4 is one of the CYP enzymes catalyzing oxidative metabolism, and is involved in the metabolism of many drugs.
Among benzodiazepines, alprazolam, triazolam, brotizolam and midazolam are mainly metabolized by CYP3A4. Meanwhile, quazepam, diazepam (Valium) and flunitrazepam are partly metabolised by this enzyme (14 ) .
Thus, taking CBD oil with any other benzodiazepine may lead to the same interactions, given that the benzodiazepines mentioned above are metabolized by the same enzymes that CBD inhibits.
Can CBD replace Xanax?
There is no specific study that shows CBD as a safe replacement for Xanax or any benzodiazepine medication.
The only study that came close to examining the possible impact of THC (tetrahydrocannabinol) and CBD among subjects who used benzodiazepine is that of a 2019 study published in the journal Cannabis and Cannabinoid Research (15 ) .
Researchers of the said study found that approximately 45 percent of the subjects had stopped taking benzodiazepine within about six months of beginning medical cannabis. Many of them also reported decreased daily distress due to medical conditions after being prescribed cannabis.
However, medical cannabis given to the subjects contained varying levels of THC and CBD (16 ) .
Thus, it cannot be concluded that it was CBD alone that brought about the improved condition among the subjects who discontinued their use of benzodiazepines.
Also, the distribution of cannabinoid (CBD and THC) proportions was not significantly different among patients who continued and those who discontinued benzodiazepines.
The researchers were not able to gain access to information on cannabis strains, growth and producers. Nor were they able to generalize the results to products that were available in Canada.
Still, study author Chad Purcell and his team from Dalhousie University do not recommend that cannabis can or should be used as an alternative or supplement to medically indicated and prescribed benzodiazepines (17 ) .
Also, one essential reminder is not to stop taking Xanax without checking first with a doctor.
The doctor will want the Xanax dose gradually reduced before completely stopping it, which may prevent a worsening of the medical condition and reduce any possibility of withdrawal symptoms, like convulsions (seizures), stomach or muscle cramps, sweating, tremors, vomiting, or unusual behavior.
Note that Xanax may be habit-forming. Thus, if the medicine is not working as well, do not use more than the prescribed dose, and call a doctor for instructions.
Also, do not take other medications, including prescription or nonprescription over-the-counter medicines or supplements, unless they have been discussed with a doctor (18 ) .
What to Know Before Using Alprazolam
When using medication, the risks must be weighed against its benefits. For taking alprazolam, the following points should be considered:
Tell the doctor of any unusual or allergic reaction to this medicine or any other medicines. Also, tell a healthcare professional of any other forms of allergies, such as allergies to foods, preservatives, dyes, or animals. For non-prescription products, carefully read the ingredients on the package label.
Appropriate studies have not been done on the relationship of age to the effects of alprazolam in children. Safety and efficacy have not been known.
Studies conducted to date have not demonstrated geriatric-specific problems that would limit the usefulness of alprazolam in the elderly.
However, older adults are likely to have unwanted effects (e.g., severe drowsiness, dizziness, confusion, clumsiness, or unsteadiness) and kidney, liver, or lung problems, which may require caution and an adjustment in the dose for patients receiving this medicine.
Studies in pregnant women have shown a risk to the fetus, according to Mayo Clinic. However, the benefits of therapy in a life-threatening situation or a severe disease may outweigh the potential risk.
Studies of alprazolam use in breastfeeding women have demonstrated harmful infant effects, according to Mayo Clinic. An alternative to this medicine should be prescribed, or breastfeeding should be stopped while using this medicine.
Alprazolam and Other Drug Interactions
Specific medicines should not be used together at all. However, in some cases, two different medicines may be used together even if an interaction might occur.
In these cases, a doctor may want to change the dose, or other precautions may be necessary.
When one is taking this medicine, a healthcare professional must know of any of the medicines listed below. Taking this medicine with any of the following medicines is discouraged.
A doctor may decide not to treat individuals with this medication or change some of the other medicines they take.
Taking this medicine with any of the following medications is usually not recommended, but may be required in some cases. If both medicines are prescribed together, a doctor may change the dose, and how often the medicines are used.
For a complete list, click here (19 ) .
A Close Look at Benzodiazepines
An article on Harvard Health says that for many years, benzodiazepines continued to be the most popular prescription tranquilizers and sedatives (20 ) .
Benzodiazepines, sometimes called benzos, have a standard basic chemical structure, and they increase the activity of the receptors for the neurotransmitter gamma-aminobutyric acid (GABA).
GABA inhibits the activity of neurons, slowing down the brain and nervous system, so benzos are calming and promote sleep.
Benzodiazepines differ primarily in how quickly they are absorbed, how long their effects last, and how long they take to leave the system.
Benzodiazepines are also prescribed for acute seizures, severe muscle spasms, tremors, and alcohol and drug withdrawal symptoms. However, their main uses are still in the treatment of insomnia and anxiety (21 ) .
Meanwhile, according to an article posted by the Anxiety and Depression Association of America, benzodiazepines, such as alprazolam, clonazepam, diazepam, and lorazepam, promote relaxation and reduce muscular tension, including other physical symptoms of anxiety.
B enzodiazepines are also frequently used for short-term management of anxiety, such as for minor medical procedures (22 ) .
Long-term Use of Benzodiazepines
In a 2015 study published by Australian Prescriber, the authors said that there are well-recognised harms from long-term use of benzodiazepines. These include dependency, cognitive decline and falls (23 ) .
Over the last two decades, the quantity of benzodiazepines on every prescription has increased, and alprazolam became the second most popular drug (24 ) .
Of specific concern are those who have been taking benzodiazepines for over six months. There are a few indications for long-term therapy, and they are controversial (25 ) .
Benzo-related problems include misuse, dependency, driving impairment, and morbidity and mortality related to overdose and withdrawal (26 ) .
In the elderly, benzos have been linked to cognitive decline, dementia and falls (27 ) . Also, there is evidence of increased mortality with long-term use (28 ) .
In February 2014, in response to a surge in illicit use, alprazolam was rescheduled to Schedule 8. Alprazolam has more significant toxicity in overdose and associated mortality compared with other benzodiazepines (29 ) .
The effect of this rescheduling is yet to be determined, as this barrier to prescribing has placed a new focus on benzo dependence.
However, there is a lack of research on the optimal management of benzo dependence, according to the authors of the review published by Australian Prescriber (30 ) .
Some benzodiazepines, like alprazolam, appear to have a higher propensity for misuse and are more dangerous in overdose.
The reasons for this propensity include perception of intoxication, potency relative to the formulation (e.g. a single 2 mg alprazolam tablet is equivalent to four 5 mg diazepam tablets), shorter half-life and risk of withdrawal phenomena (31 ) .
A common approach is substituting these shorter half-life drugs, such as alprazolam, with more extended half-life drugs, such as diazepam (32 ) .
When tapering benzodiazepines, fewer patients taking more extended half-life drugs drop out.
However, there is a lack of robust evidence supporting substitution. Studies in older patients have found gradual withdrawal without substitution can be successful (33 ) .
Abrupt cessation of benzodiazepines after a period of 1–6 months of use can cause life-threatening seizures so the dose should be gradually reduced (34 ) .
Benzodiazepines and Post-Traumatic Stress Disorder (PTSD)
Benzodiazepines were once the primary agents in PTSD treatment (35 ) .
Individuals with post-traumatic stress disorder (PTSD) show a higher rate of panic disorder than other people. People with panic disorder regularly suffer intense episodes of anxiety, known as panic attacks (36 ) .
Alprazolam and clonazepam have been used extensively, but the efficacy of benzodiazepines against the significant PTSD symptoms has not been proven in controlled studies (37 ) .
These agents are effective against anxiety, insomnia and irritability, but they should be used with great caution because of the high frequency of comorbid substance dependence in patients with PTSD. Patients should be fully informed of the risks and benefits of these medications, including the risks of dependency and withdrawal after abrupt discontinuation.
Benzodiazepines are Not Recommended for People with PTSD or Recent Trauma
Although benzodiazepine drugs are widely used in patients with post-traumatic stress disorder (PTSD), available evidence suggests that they are not sufficient and may even be harmful, concluded a 2015 systematic review and meta-analysis in the July Journal of Psychiatric Practice (38 ) .
“Benzodiazepines are ineffective for PTSD treatment and prevention, and risks associated with their use tend to outweigh potential short-term benefits,” wrote Dr Jeffrey Guina and colleagues from Wright State University, Dayton, Ohio.
They also found evidence to suggest that using benzodiazepines in patients with recent trauma can even increase the risk of developing PTSD.
Potential Ways CBD Helps with Depression and Anxiety
CBD has been shown to possess potential medical benefits, from nausea to blood pressure to inflammation (39 ) .
CBD oil , which is derived from the cannabis plant, is available in tincture or vape liquid, or CBD-infused foods and beverages.
CBD oil has also shown promise as possible depression and anxiety medications, which could be why those who live with these disorders are interested in this natural approach.
In one 2019 Brazilian study , subjects received either oral CBD or a placebo 90 minutes before they underwent a simulated public speaking test (40 ) .
The researchers indicated that a 300-mg dose of CBD was the most helpful at significantly reducing anxiety during the test.
In the study, no significant differences in anxiety levels were observed on the subjects given the placebo, a 150-mg dose of CBD, and a 600-mg dose of CBD.
In another study , CBD oil has even been used to safely alleviate insomnia and anxiety in children with PTSD (41 ) .
CBD has also exhibited antidepressant-like effects in some animal studies (42 ) .
These characteristics are associated with CBD’s potential ability to trigger the brain’s receptors for serotonin, a neurotransmitter that regulates mood and social behavior.
For example, other studies have demonstrated that treatment with CBD improved complex, sleep‐related behaviors for people with Parkinson’s disease (43 ) .
Also, animal and test-tube studies have shown that CBD may decrease inflammation and help prevent the neurodegeneration associated with Alzheimer’s disease (44 ) .
In one study, researchers gave CBD to mice genetically predisposed to Alzheimer’s disease, finding that it helped prevent cognitive decline (45 ) .
Though CBD is generally well-tolerated and considered safe , it may cause adverse reactions in some people.
Side effects noted in studies include (46 ) :
- Changes in appetite and weight
CBD also interacts with several medications. Thus, before starting to use CBD oil, discuss it with a doctor to avoid potentially harmful interactions (47 ) .
This reminder is essential when taking supplements or medications that come with a grapefruit warning.
Both CBD and grapefruit interfere with cytochromes P450 (CYPs), the enzymes that are essential to drug metabolism.
One study showed that CBD-rich cannabis extracts have the potential to cause liver toxicity (48 ) .
Although the study above was done on mouse models, there have also been a handful of human studies related to chronic pain , anxiety, and stress.
A 2010 study published in the Journal of Psychopharmacology indicated that CBD oil was associated with a decreased level of subjective anxiety, suggesting that CBD can reduce anxiety in patients experiencing social anxiety disorders (49 ) .
Clinical trials have shown promising results for treating anxiety symptoms with CBD. A 2011 study found that CBD helped lessen anxiety in subjects that were put through a stressful public speaking simulation (50 ) .
A 2015 study published in Neuropathics found parallel evidence supporting CBD’s anxiolytic properties.
The authors stated, “Overall, current evidence indicates CBD has considerable potential as a treatment for multiple anxiety disorders, with the need for further study” (51 ) .
The National Institute on Drug Abuse ( NIDA ) recently concluded one of the most comprehensive CBD studies involving human subjects (52 ) .
NIDA uses multiple sources to monitor the prevalence and trends regarding drug use in the United States (53 ) .
Researchers of the said NIDA study evaluated CBD in comparison with THC, Alprazolam, and placebo in healthy recreational drug users to determine whether or not CBD should still be a Schedule I drug or be recommended for deregulation.
Subjects received different doses of the alprazolam capsule for 18 days. Then, a series of assessment questions were given, and vital signs and ECG readings were evaluated. Researchers completed the study in May 2018. However, results for publication are still pending.
The high rate of dependency and misuse among Xanax users may be the reason why there is an interest in alternative, Xanax-free treatments, including CBD oil.
CBD’s antidepressant-like and anxiolytic-like effects have been shown in several studies, such as the 2014 study that was published in the CNS and Neurological Disorders – Drug Targets (54 ) .
However, CBD is also known to interact with several medications. Thus, before using CBD oil, discuss it with a doctor and ask for medical advice to avoid potentially harmful interactions .
To date, the U. S. Food and Drug Administration (FDA) has not approved an application for cannabis for the treatment of any disorder or medical condition except for one cannabis-derived drug, Epidiolex, and three cannabis-related drug products (55 ) .
Epidiolex contains a purified form of the drug substance CBD for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome in patients two years of age and older.
There have been no clinical trials or case studies, specifically documenting a Xanax and CBD interaction. However, taking CBD oil or CBD products with Xanax or any other benzodiazepine may lead to adverse interactions such as elevated levels due to reduced clearance from the body, given that benzodiazepines are metabolized by the same enzymes that CBD inhibits.