Xanax (Alprazolam) is regarded as the single most popular benzodiazepine in the world. It is a highly effective drug when utilized for the medical treatment of acute anxiety, panic attacks, and social phobia. This is due to the fact that Xanax modulates the neurotransmission of GABA (gamma-amino-butyric acid), specifically at the GABA-A receptor sites. To a minor extent, it also is capable of increasing dopamine levels in the striatum.
Despite its high efficacy when utilized on a short-term, “as needed” basis, there are an array of potentially deleterious consequences associated with frequent, long-term ingestion of Xanax. Most regular users of the drug develop rapid tolerance to the drug and require consistent increases in dosing to continuously reap the anxiolytic benefits. The drug is problematic in that it may cause dementia, inhibit formation of new memories, and can significantly impair a person’s ability to operate a motor vehicle or heavy machinery.
In addition, Xanax is considered to have a high potential for abuse and is a highly addictive drug. Due to the fact that people are starting to realize that Xanax (and other benzos) are nothing more than a short-term solution to a long-term problem, they are opting for safer Xanax alternatives. As a result, they are undergoing Xanax withdrawal and hoping to clear the drug from their system as quickly as possible.
How long does Xanax (Alprazolam) stay in your system?
If you’ve quit taking Xanax or are contemplating discontinuation, hopefully you are doing so under the supervision of a skilled medical professional – as the withdrawal process can be dangerous, especially from high doses. Assuming you’ve completely ceased usage of the drug, you’re probably counting down the days until it will be fully excreted from your body. Xanax has an elimination half-life that ranges from 9 hours to 16 hours in healthy adults.
This means that it will take most people within the span of 9 to 16 hours (post-ingestion) to eliminate 50% of the drug from their body. On average (among most users), the half-life of Xanax is around 12 hours. This means that most people will have fully eliminated (100%) the drug from their system within 4 days.
However, the “average” clearance time certainly doesn’t apply to everyone; some will eliminate Xanax from their system at a much quicker rate than others. Assuming you are on the faster end of the elimination spectrum, you could fully clear Xanax from your system within 2.06 days. If you are slower than average in your ability to metabolize and excrete Xanax, it could take 3.67 days to fully clear it from your system.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/8513649
- Source: http://www.ncbi.nlm.nih.gov/pubmed/1687613
Note: It is important to understand that 9 to 16 hours is an estimated half-life range in healthy adults. In healthy elderly subjects the elimination half-life may be longer than 16 hours, and among those with liver disease, the average half-life is 19.7 hours.
Factors that influence how long Xanax (Alprazolam) stays in your system
It is important to realize that there is significant variation in clearance time of Xanax based on a multitude of factors – most of which are based on the individual. One person may quickly process Xanax and clear it from their body in less than 3 days, yet another person may be unable to clear it as efficiently. Factors to consider whenever contemplating clearance times include: the individual (age/genetics/health/etc.), dosage, frequency of usage, and whether they’re using other drugs.
If Xanax were administered to two individuals at the exact same time, with the same dosing and format, then how could one person eliminate it from their system quicker than the other? A considerable amount of a person’s ability to metabolize and clear Xanax from the body is a result of individual factors. These factors include things such as: age, body mass, genetics, food intake, liver function, and metabolic rate.
Age: There are notable differences in clearance times of Xanax between young and elderly individuals. Elderly individuals (age 65+) aren’t able to excrete the drug as quickly, which may be a result of metabolic changes, altered blood flow (especially to the liver), and/or deterioration in other internal functions as a result of aging. Realize that the older you are, the longer it will take to clear Xanax from your system.
Body height / weight / fat: A person’s height, weight, and body fat percentage may influence how quickly Xanax is metabolized and excreted. If a short/lightweight person is given the same dose of Xanax as a tall/heavyweight individual, it is logical to assume that the tall/heavy individual will clear the drug quicker than the short/light person. This is due to the fact that the larger individual is ingesting a smaller amount of the drug in proportion to their body size, making it easier to clear.
Genetics: It is understood that genes influence our ability to metabolize certain drugs. Some people are known as “rapid metabolizers,” while others are classified as “poor metabolizers” due to genetic variants of CYP450 isoenzymes. Xanax is metabolized in the liver, chiefly by the enzyme CYP3A4, which isn’t subject to influence by polymorphisms. However, it is important to consider that secondary isoenzymes may be subject to genetic influence, ultimately expediting or prolonging the breakdown of Xanax.
Liver/kidney function: There is clear evidence that among individuals with impaired liver function, Xanax is retained for a longer duration than among those with normative liver function. Liver disease prolongs elimination and clearance times are substantially extended among those with cirrhosis. While most evidence suggests that kidney impairment doesn’t affect Xanax clearance, some research indicates that renal disease may compromise clearance of the drug in certain patients.
Metabolic rate: It is unclear as to whether a person’s basal metabolic rate could influence the body’s ability to metabolize and excrete Xanax. Some speculate that individuals with a higher BMR may enhance the ability to metabolize and clear drugs like Xanax, whereas a low BMR may result in prolonged clearance. It is possible that BMR could have a slight influence on the body’s ability to clear Xanax.
Urinary pH: Though no research indicates that clearance of Xanax could be influenced by urinary pH, it still could have an impact on excretion. It is known that highly alkaline urine often facilitates reabsorption of drugs (and metabolites), whereas acidic urine promotes efficient excretion. Therefore it could be hypothesized that individuals with acidic urine may clear Xanax quicker than others.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/8513649
- Source: http://www.ncbi.nlm.nih.gov/pubmed/11745908
Taking other drugs (Inhibitors vs. Inducers)
If you take other drugs (regardless of whether they’re prescription, over-the-counter, or illicit) along with Xanax – you could be altering your body’s ability to metabolize and excrete the drug. Drugs that inhibit the enzymatic function of CYP3A4 (in the liver) are known to prolong the breakdown and excretion of Xanax. Examples of such drugs that could slow clearance of Xanax include: Cimetidine, Erythromycin, Itraconazole, Ketoconazole, Ritonavir, and SSRIs (e.g. Fluoxetine).
Should you ingest any of the aforementioned agents along with Xanax, it could result in excessive accumulation of the drug, resulting in adverse effects – as well as delayed liver clearance. Even oral contraceptives have been documented as impairing the body’s ability to process and eliminate Xanax. That said, some individuals may be taking drugs that expedite the metabolism of Xanax in the liver.
Certain drugs are known to enhance CYP3A4 breakdown of Xanax as a result of their “inducing” effects. CYP3A inducers increase average clearance rates from 0.90 mL/min/kg to 2.13 mL/min/kg. Examples of such drugs include: Carbamezepine, Glucocorticoids, Phenytoin, Progesterone, Nafcillin, Phenobarbital, St. John’s Wort, etc. Some research also indicates that Xanax may be cleared at a slightly quicker rate among smokers compared to non-smokers; this finding lacks statistical significance and is therefore questionable.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/11524025
Dosage (High vs. Low)
Individuals that take high doses of Xanax may take longer to metabolize and excrete the drug from their system compared to those taking lower doses. Xanax dosing typically ranges from 0.25 mg to 4 mg for the treatment of anxiety disorders. In some cases, individuals may exceed doses of 4 mg as a result of tolerance, addiction, or dependence.
To prevent dependence, most doctors will ensure that their patients take the minimal effective dose; or just enough for therapeutic relief. The higher the dosage of Xanax you regularly ingest, the greater the amount your body will need to metabolize and excrete. On the other hand, the less Xanax you take, the quicker your body will be able to metabolize and eliminate it.
Frequency of use
How often a person uses Xanax can affect how quickly it is cleared from their system. Frequent/long-term users usually take longer to metabolize and excrete the drug than infrequent/short-term users. This is due to the fact that frequent users often build up rapid tolerance to Xanax’s effects.
Once this tolerance is established, they continue to increase their dosage (which is known to prolong clearance times). As a result of increased dosages and frequent ingestion, the drug isn’t metabolized as quickly and may accumulate to a greater extent throughout the body. Those that use Xanax on an infrequent basis usually aren’t ingesting high doses and aren’t subject to significant accumulation of the drug throughout the body.
Xanax (Alprazolam): Absorption, Metabolism, Excretion (Details)
Following oral administration, Xanax is efficiently absorbed and plasma concentrations peak within 1-2 hours. Plasma levels are directly related to the dosage administered. Research has shown that when administered between 0.5 mg and 3.0 mg, peak plasma levels range from 8.0 ng/mL to 37 ng/mL. The active ingredient “alprazolam” binds to human serum protein (80%).
In the liver, the drug is metabolized primarily by CYP3A4 isoenzymes. It is then broken down into multiple active metabolites including: alpha-OHALP (alpha-hydroxy alprazolam) and 4-OHALP (4-hydroxy alprazolam); alpha-OHALP is considered significantly more active than 4-OHALP. Additionally, it is thought that alpha-OHALP may have a slightly longer half-life in the brain due to its hydrophilicity.
Both alpha-OHALP and 4-OHALP metabolites account for up to 4% of plasma concentrations relative to alprazolam (unchanged) for any dose. Though alpha-OHALP and 4-OHALP are the most prominent metabolites, a total of 29 metabolites have been scientifically identified via urinary excretion. Following enzymatic breakdown of alprazolam in the liver, the metabolites are excreted in the urine as glucuronides.
Since the half-life of Xanax metabolites (alpha-OHALP and 4-OHALP) are similar to that of Xanax itself, these tend to clear from the body between 2 and 4 days. Most individuals ingesting Xanax should have fully excreted the drug (and metabolites) via urine within one week post-ingestion.
- Source: http://pubchem.ncbi.nlm.nih.gov/compound/alprazolam
- Source: http://www.ncbi.nlm.nih.gov/pubmed/2567646
Types of Xanax (Alprazolam) Drug Tests
There are many types of drug tests that can be administered to determine whether someone has ingested Xanax (Alprazolam). Common ways to test for Xanax include: urine samples, blood draws, hair analyses, and saliva tests. Standard drug testing (SAMHSA-5) will not detect the presence of Xanax and only assesses for the presence of drugs like: cannabis, cocaine, amphetamines, opioids, and PCP. That said, more extensive drug tests are capable of detecting Xanax (and its metabolites).
Urine tests: A common way to determine whether someone had ingested Xanax is via a urine sample, followed by a urinalysis. When excreted, approximately 20% of an oral dose remains unchanged in the urine (as alprazolam). Metabolites such as alpha-OHALP can also be detected and confirmed by GC/MS (gas chromatography/mass spectrometry) testing if over 400 ng/mL.
It is thought that infrequent, low-dose users may test positive for Xanax within urine for up to 4 days post-ingestion. Frequent, high-dose users of the drug may test positive for Xanax after a full week post-ingestion via a urinalysis. Results from a urinalysis can be confirmed with technology such as GC/MS.
Blood tests: While collecting a blood sample to determine whether someone ingested Xanax is more invasive than urine testing, it is sometimes necessary. If a patient is hospitalized and medical professionals are attempting to understand whether the individual is dealing with Alprazolam toxicity, they may take a blood draw. Blood tests can accurately detect the presence of Xanax within hours of administration.
A blood sample may test positive for the presence of Xanax for up to a day after ingestion (if taking an extended-release format). Assuming an individual is fully conscious, drawing blood is a relatively invasive way to detect Xanax. Furthermore, a blood test doesn’t provide as long of a detection window as a urine test.
Hair tests: It is possible to detect the presence of Xanax in a hair sample. If someone takes Xanax, the drug will accumulate in outgrowths of hair follicles throughout their body and head. Individuals subject to hair testing will be required to provide a hair sample of 20 to 50 strands for laboratory analysis. A benzodiazepine radioimmunoassay (RIA) will then confirm or deny whether someone had used Xanax for up to 4 weeks (1 month) post-ingestion based on presence of metabolites such as alpha-OHALP and 4-OHALP.
Since it takes approximately one month for 1 cm of hair to grow, hair testing would need to be conducted after the suspected Xanax ingestion to be accurate. If conducted within just a few days of ingestion, hair tests would be unable to detect the drug. Detecting alprazolam is considered more difficult than diazepam on a hair test.
Saliva tests: The cutoff level for detecting alprazolam in oral fluid (saliva) is 1 ng/mL. Studies have shown that the maximum detection time for alprazolam in oral fluid is an estimated 2.5 days. This means that a saliva test could detect Xanax for a longer duration than a blood test, but won’t provide as extensive of a detection period as a urine test.
Though saliva tests are relatively simple to conduct, administration requires that sufficient oral fluid is attained for accurate results. In addition, saliva tests are considered more expensive than urine tests – and therefore aren’t used very often. As salivary drug detection tests continue to improve and decline in cost, they may eventually surpass urinary tests in popularity.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/1576379
- Source: http://www.ncbi.nlm.nih.gov/pubmed/25549207
- Source: http://www.ncbi.nlm.nih.gov/pubmed/2046338
Who is usually tested for Xanax (Alprazolam)?
Unless you are a high-performance athlete, are in rehab, or work in a field requiring constant alertness – you probably won’t be subject to regular Xanax testing. However, below are examples of individuals that may receive random and/or mandatory benzodiazepine testing.
Athletes: While it wouldn’t make much sense for an athlete to take Xanax during a game (due to the fact that it impairs performance), some athletes may use it recreationally. Extensive drug tests may be applied to both collegiate and professional athletes. Should an athlete test positive for benzodiazepines (e.g. Xanax), they may face suspension or be banned from their sport.
Drug rehab clients: Former drug addicts in rehabilitation may be regularly tested to determine whether they’ve been using drugs. Though the standard drug testing panel is limited, rehabilitation clinics may issue more extensive tests to determine whether prescription drugs like Xanax have been ingested by clients. Should they test positive for Xanax, it may complicate their rehab process.
Employees: In certain occupations, maintaining vigilance is crucial. Examples of such occupations include: truck drivers, factory workers, machinists, etc. Since Xanax (and other benzos) impair coordination, slow reflexes, and could increase on-the-job errors – certain employers may issue mandatory testing.
Hospital patients: If a patient is hospitalized and unconscious, they will likely be tested for drug toxicity. Blood draws will reveal whether an individual had ingested Xanax (or other benzos) in combination with other drugs and/or alcohol. Should a hospital patient test positive for Xanax, they may be given a medication to counteract its effects.
Military personnel: Individuals in the military are required to maintain alertness when in training and battle. If a person is taking a drug like Xanax, it will impair their ability to stay awake, follow instructions, and may even result in deadly errors. For this reason, military members may be administered an extensive drug test to determine whether Xanax has been ingested.
Tips to clear Xanax (Alprazolam) from your system
Since Xanax has a half-life subject to significant individual variation, there are things that can be done to expedite its clearance from your system. Understand that should you choose to try or implement any of the items on the list below, they should be okayed by a medical professional.
- Stop taking it: Whenever you decide to fully stop taking Xanax, you’ll need to do so with extreme caution and under the care of a medical doctor. Stopping this drug on your own could be dangerous. That said, once you’ve completely stopped with the help of a doctor, you should avoid going back on it if you want it to be fully cleared from your body. Individuals that are addicted to the anxiolytic effects may have difficulty ceasing Xanax intake – prolonging clearance.
- CYP3A4 inducers: Taking certain CYP3A4 inducers can dramatically increase the rate at which your body metabolizes and excretes Xanax. You could talk to your doctor about taking a CYP3A4 inducers after you’ve fully stopped Xanax for an expedited clearance. Understand that certain CYP3A4 inducers may promote faster clearance of Xanax than others.
- Urinary pH: It is understood that urinary pH has significant influence on the speed by which drugs are excreted from the body. Having a highly alkaline urinary pH is known to promote reabsorption, which would slow the clearance of Xanax. Increasing the acidity of your urinary pH could enhance the speed by which you excrete this drug.
- Exercise: Individuals that exercise daily tend to speed up their basal metabolic rate, enhance circulation, and may improve organ functionality. It is possible that going for a light jog each day could augment your natural ability to metabolize and excrete this drug. Remaining sedentary keeps your metabolism slow, which could prolong clearance.
- Diet / Hydration: Eating a healthy diet and staying hydrated may be beneficial for metabolizing and excreting Xanax. An optimal diet with vegetables and fruits will give your body the antioxidants and nutrients it needs to operate at its best. Staying hydrated will ensure that the excretion process isn’t prolonged.
Have you been drug tested for Xanax (Alprazolam)?
If you’ve undergone a drug test to detect Xanax, share your experience in the comments section below. Discuss the type of drug test, why you had to take the drug test, as well as whether you passed (i.e. tested “negative”) or failed (i.e. tested “positive”). Also mention the time span between your last Xanax dosing and date on which you were administered the drug test.
To help others get a better understanding of your situation, feel free to share why you were taking Xanax, the dosage you were taking, and how often you used it. How long do you think Xanax (and its metabolites) stayed in your system? Do you think you were able to fully clear the drug within a week, or do you think it may have taken longer than a week for your system to excrete it (due to a condition like liver impairment)?