# Xanax XR not working all day



## SKeTchY (Jun 7, 2008)

Wednesday I was prescribed xan xr 2mg once daily, and for the first ten hours of the day it seems to be working great, (11 months ago I was on Effexor, and 2mg xan 4 times daily) before i stopped all meds (i used ultram to wean off over two weeks) the prob is that if I take it at 6 am when I wake up, by 4 pm my anxiety starts coming back? The official website is pretty clear that its a once daily thing, but I've seen some posts that other people take it more then once daily? So Yesterday I took a second one at 6 pm, and that seemed to work great. Anyone prescribed xr more then once daily that can give me some info? I'm afraid my doc will get mad at me for not following the script to the letter (new doc) 
Thanks in advance,


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## Akane (Jan 2, 2008)

Xanax xr does start to lessen after 10hrs. It drops off very slowly for the next 12hrs. Maybe you just need to take a slightly higher dose. There is a 3mg xanax xr pill. Otherwise you could take a small dose of regular xanax to keep the dose up a little longer. You should call your doctor and discuss it.


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## orbit55 (Apr 23, 2008)

I take .5mg of Xanax XR in the morning. I'm allowed to take another one at night but I usually just have a .25mg of regular Xanax, just to keep my dosage low. I have noticed it wears off between 10-12 hours.


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## SKeTchY (Jun 7, 2008)

I tried to call my doc, but his office is closed on Friday :-( I'm afraid the dosage isn't high enough, but I like that with the XR you don't get the peaks and crashes you get with regular 2mg bars.


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## SKeTchY (Jun 7, 2008)

you know I also went and read all the drug company clinical trials and the mean dosage for panic/anxiety for xr was actually 4-10 mg


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## danielk (Jun 4, 2008)

SKeTchY said:


> you know I also went and read all the drug company clinical trials and the mean dosage for panic/anxiety for xr was actually 4-10 mg


I've had this problem with other anxiolytics and told me doctor. Her response? Why didn't you break it in half and take the other half when the anxiety starts to come back? The dosage is the same, just spread out.

Something to think about, anyway.


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## americandancer (Mar 19, 2006)

Can xanax xr be broken in half? I didn't think you were supposed to split extended release medications. Also, can if you are only taking xanax for an anxiety disorder, can it make any underlying depression worsen?


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## danielk (Jun 4, 2008)

americandancer said:


> Can xanax xr be broken in half? I didn't think you were supposed to split extended release medications. Also, can if you are only taking xanax for an anxiety disorder, can it make any underlying depression worsen?


I've never taken XR, but I believe you may be right about not being able to halve it.


Attached PDF said:


> *DOSAGE AND ADMINISTRATION XANAX XR *
> Tablets may be administered once daily, preferably in the morning. The tablets should be taken intact; they should not be chewed, crushed, or broken.


In clinical studies, Xanax XR has been shown to more likely cause/worsen depression than placebo; not by much, though.


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## Foh_Teej (May 5, 2004)

if you have to break an "extended release" pill up, that kindda defeats the purpose. Im not sure what the actual purpose is in the first place since I have never seen any clinical significance in taking 1 XR med as opposed to 3 seperate doses other than convenience-- and definitely no significance to justify the inflated price of the "new and improved" patented XR version unless you really really do value convenience compared to relative efficacy.


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## Akane (Jan 2, 2008)

Do not cut an xr pill. It will not dissolve right and will either hit you all at once (most likely result) or not really work at all. Either way you lose the xr effect and you cannot predict exactly what the result is going to be. If you need to cut pils for an accurate dose ask for the standard pills.

The difference in an extended release versus regular pills is how the medication is broken down and dissolved. With a standard pill it dissolves all at once, hits you all at once, causes a big high, and then drops off quickly. That increases the chance for side effects and causes mood swings or withdrawal symptoms between doses. Extended release pills are designed to dissolve at a steady slower rate so you get a small amount at a time but it's constant. There is no quick up and down. 

Say you take 1mg of standard xanax. Within 10mins you will have nearly all of it in your blood stream and in about 4hrs it will be broken down to useless compounds that are excreted from the body. If you take 1mg of xr the amount in your blood will remain much lower but it will take 10hrs before the dose starts to drop. Less chance of side effects because you don't hit as high of peak and a more steady effect so you don't get those highs and lows that are a problem with xanax use. That also makes it less addictive which is a big reason some doctors won't prescribe xanax. It's more than just not having to take as many doses but a better control over the levels of the medication in the body.


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## Noca (Jun 24, 2005)

Xanax XR is pointless, just take Diazepam to receive the same effect at a MUCH cheaper price. Diazepam lasts probably longer and it doesnt matter if you break the pill in half either.


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## Foh_Teej (May 5, 2004)

Akane said:


> Do not cut an xr pill. It will not dissolve right and will either hit you all at once (most likely result) or not really work at all. Either way you lose the xr effect and you cannot predict exactly what the result is going to be. If you need to cut pils for an accurate dose ask for the standard pills.
> 
> The difference in an extended release versus regular pills is how the medication is broken down and dissolved. With a standard pill it dissolves all at once, hits you all at once, causes a big high, and then drops off quickly. That increases the chance for side effects and causes mood swings or withdrawal symptoms between doses. Extended release pills are designed to dissolve at a steady slower rate so you get a small amount at a time but it's constant. There is no quick up and down.
> 
> Say you take 1mg of standard xanax. Within 10mins you will have nearly all of it in your blood stream and in about 4hrs it will be broken down to useless compounds that are excreted from the body. If you take 1mg of xr the amount in your blood will remain much lower but it will take 10hrs before the dose starts to drop. Less chance of side effects because you don't hit as high of peak and a more steady effect so you don't get those highs and lows that are a problem with xanax use. That also makes it less addictive which is a big reason some doctors won't prescribe xanax. It's more than just not having to take as many doses but a better control over the levels of the medication in the body.


in theory this sounds great but in the real world, it doesnt work that well. Anything with a longer half life than your digestion makes it near pointless. People actually shlt some these pills out before they even dissolve. All benzos (with exception to Halcion) and SSRIs have a long enough half life to be near useless in any XR med.


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## americandancer (Mar 19, 2006)

My doctor actually gave me the choice of regular or extended release xanax. I told him I would like to try the extended release because I tend to get really tired and irritable as the regular xanax wears off. I think if I told him it wasn't working, he would give me the regular. I guess I am lucky that he is willing to prescribe it. That is the main reason I stick with him. He doesn't want me to take any anti-depressants for the time being, to see if just the xanax will work. I am a little concerned that some of my mild depression will come back, and was hoping the xanax would not contribute to it. It seems from danielk's post that it might be possible.

As for the cost, I got the generic. It still wasn't near as cheap as the regular, but it wasn't as near as expensive as the wellbutrin xl I had been taking. So, I guess if I can go this route, I will actually save a little.


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## danielk (Jun 4, 2008)

Foh_Teej said:


> Anything with a longer half life than your digestion makes it near pointless. People actually shlt some these pills out before they even dissolve. All benzos (with exception to Halcion) and SSRIs have a long enough half life to be near useless in any XR med.


Even if one _were_ to eliminate a medication, most of it would still pass through the wall of the intestine. Medication does not digest like food. Xanax XR enters the bloodstream almost as rapidly as Xanax is absorbed. [attachment=0:2hjlqyc0]p2b.gif[/attachment:2hjlqyc0]
Since _some_ of it is processed through the _liver_ because of its longer half-life, it takes approximately a week to build up therapeutic doses. Very little, if any, is eliminated through defecation. If you find yourself eliminating medications in pill form then there is something awry with your digestive system.


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## americandancer (Mar 19, 2006)

Xanax xr doesn't have to build up to a therapeutic dose, though, right? My doctor wants me to take it everyday, but it can be taken on an as needed basis also, correct?


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## danielk (Jun 4, 2008)

americandancer said:


> Xanax xr doesn't have to build up to a therapeutic dose, though, right? My doctor wants me to take it everyday, but it can be taken on an as needed basis also, correct?


If taken PRN it will act; for complete symptom relief:

_While all patients are different, some patients may begin to see improvement in their symptoms as early as the first week. However, the full effect may take several weeks. To get the full benefit of your medicine, be sure to take it as prescribed by your doctor._ - [1]

Everyone is different, YMMV, all that stuff.


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## americandancer (Mar 19, 2006)

Thanks for the reply! I guess it is different than the regular xanax in that regards. I have only taken it twice now, and I can't say exactly how long I have felt it last in my system. I can feel it "kick" in about 2-3 hours after I take it, and then I get tired. I am hoping that by taking it everyday, that will go away. That is why I am concerned about it causing some depression. Depression makes me not want to do anything, and just lie around, and so does being tired from the xanax (I take the generic). I can't have that going on!


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## Foh_Teej (May 5, 2004)

danielk said:


> Even if one _were_ to eliminate a medication, most of it would still pass through the wall of the intestine.


Right



danielk said:


> Medication does not digest like food.


We would agree



danielk said:


> Xanax XR enters the bloodstream almost as rapidly as Xanax is absorbed. [attachment=0:1i9izewm]p2b.gif[/attachment:1i9izewm]


We would agree



danielk said:


> Since _some_ of it is processed through the _liver_ because of its longer half-life, it takes approximately a week to build up therapeutic doses.


Therapeutic dose for benzos is reached in as little as an hour. This is 1 part of why Xanax XR would be near useless. Xanax and Xanax XR have roughly the same metabolism and elimination. The only advantage (if thats what youd call it) to an XR is a more smoothe dose than that of IR.



danielk said:


> Very little, if any, is eliminated through defecation. If you find yourself eliminating medications in pill form then there is something awry with your digestive system.


I am fully aware of how benzodiazepines are eleminated. Some XR meds (not necessarily xanax XR) have infact been known to not dissolve completely before they pass in feces but this point is irrelavant.

The main point remains: if the half life of a med is longer than about 6-8 hours, it is SELF sustaining.


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## danielk (Jun 4, 2008)

Foh_Teej said:


> The main point remains: if the half life of a med is longer than about 6-8 hours, it is SELF sustaining.


That is interesting; I didn't know that. Where can I find more information?


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## Foh_Teej (May 5, 2004)

probably have to find someone more adept in pharmacology than myself but it goes something like this: if you take an IR pill with a half life of say 10 hours, it will peak at full bioavailabilty then drop according to its half life till eleminated from the body. As an XR slowly dissolves, it maintains a smoother plasma level from the slow delivery. The concern is the total concentration of active ingredient in the body after that 10 hour period compared between the XR and IR. There is a difference in between the two but its usually negligible. 
Xanax however, is right there on the cusp between maintaining therapeutic levels not so Xanax XR may appear to have an advantage. If they were the same price, id definitely choose XR but it doesnt justify the patented price IMHO.

This chart from Pfizer sums up better of what im trying to say although it may look a bit exaggerated.

http://www.xanaxxr.com/chart_pop_up.asp

Here an excerpt from rxlist:

Following oral administration of XANAX (immediate-release) Tablets, alprazolam is readily absorbed. Peak concentrations in the plasma occur in one to two hours following administration. Plasma levels are proportional to the dose given; over the dose range of 0.5 to 3.0 mg, peak levels of 8.0 to 37 ng/mL were observed. Using a specific assay methodology, the mean plasma elimination half-life of alprazolam has been found to be about 11.2 hours (range: 6.3-26.9 hours) in healthy adults.

The mean absolute bioavailability of alprazolam from XANAX XR Tablets is approximately 90%, and the relative bioavailability compared to XANAX Tablets is 100%. The bioavailability and pharmacokinetics of alprazolam following administration of XANAX XR Tablets are similar to that for XANAX Tablets, with the exception of a slower rate of absorption. The slower absorption rate results in a relatively constant concentration that is maintained between 5 and 11 hours after the dosing. The pharmacokinetics of alprazolam and two of its major active metabolites (4-hydroxyalprazolam and ?-hydroxyalprazolam) are linear, and concentrations are proportional up to the recommended maximum daily dose of 10 mg given once daily. *Multiple dose studies indicate that the metabolism and elimination of alprazolam are similar for the immediate-release and the extended-release products.*

Heres the the only reference (no citation however) that I could immediately find regarding self sustaining via long half life

http://en.wikipedia.org/wiki/Sustained_release


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## danielk (Jun 4, 2008)

Thanks, Foh_Teej!


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## SKeTchY (Jun 7, 2008)

Doc approved me for taking a second 2mg at night and more as needed until we work out the right dosage for me. 

Some other stuff I learned reading the clinical trials that was interesting - xr is actually about 30% weaker then reg because of the way its absorbed, also being my age, healthy height, weight, matabolism, regular exercise.., the mean extended release time is about 20% less then what is in the pamphlet info, also cigarette smoking can weaken absorption/effectiveness 20-30%... 
For Me personally I totally feel more comfortable with the XR, one big reason! IQ, reg xanax, would lower my IQ about 30 points two hours after taking it, two hours after taking 4 mg XR I scored only about 6 points under my norm, I could still lpass the Mensa test! This is major important to me, also I find I'm less scatter brained and forgetful then when I was on the reg release. 
I am suffering some serious nausea tho :-(
Thanks for all the info


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## Noca (Jun 24, 2005)

SKeTchY said:


> Doc approved me for taking a second 2mg at night and more as needed until we work out the right dosage for me.
> 
> Some other stuff I learned reading the clinical trials that was interesting - xr is actually about 30% weaker then reg because of the way its absorbed, also being my age, healthy height, weight, matabolism, regular exercise.., the mean extended release time is about 20% less then what is in the pamphlet info, also cigarette smoking can weaken absorption/effectiveness 20-30%...
> For Me personally I totally feel more comfortable with the XR, one big reason! IQ, reg xanax, would lower my IQ about 30 points two hours after taking it, two hours after taking 4 mg XR I scored only about 6 points under my norm, I could still lpass the Mensa test! This is major important to me, also I find I'm less scatter brained and forgetful then when I was on the reg release.
> ...


try some anti-emetics like prochlorazine or metoclopramide for your nausea.


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## americandancer (Mar 19, 2006)

Hmmm...haven't had any nausea yet. It sounds like you like the xr version. I like the way it releases much better than the regular. Please tell me the fatigue/sleepiness will go away. It is killing me and I am only taking 1mg! Sketchy, is the xanax xr all you are taking or are you taking an antidepressant also?


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## styler5 (Oct 7, 2006)

Go back to regular. I used to take XR and now I'm regretting it.


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## SKeTchY (Jun 7, 2008)

I'm jus takin xanax - I am an artist and find anti-depressant/serotonin drugs make me unable to do anything artistically.


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