Xanax or Toprol--what's the real difference?

[Ane__0__0]

  I have been taking beta-blockers for my heart condition for 7 years. During this time I was also prescribed Xanax by my cardiologist due to the fact that my adrenalin response and nervousness increases my heart problems (coronary artery spasm, tachycardia).  From what I've read on the Forum, it seems that you consider Xanax a dangerously addictive drug with long term consequences. My question is, in my mind I am just as "addicted" to beta-blockers seeing as how I will have to remain on them as long as I live. Beta-blockers also have considerable side-effects, dangerous withdrawal effects and  long-term consequences of use. So why is it a "bad" thing that I also take Xanax? Or are you saying that it's only bad if abused? what is abuse? Is one Xanax a day typified as "abuse"? Thank-you.

[SA, M.D. - HVMA]

_
Dear Anne,
Anti-anxiety agents like Xanax (alprazolam) are often prescribed for patients with heart conditions which can be exacerbated by stress and anxiety.  The primary difference between the different anti-anxiety agents is their duration of action.  Xanax has a relatively brief duration of action.  The advantage of shorter acting medications like Xanax is that their effects are relatively short-lived (a few hours), so they don't cause much in the way of long-lasting sedation.  The disadvantage of shorter-acting medications is that some people experience withdrawal anxiety when they wear off.  This is especially true when they are taken frequently (several times a day, every day, which is not the case for you).  As the effects of short-acting agents wear off, some people have a tendency to require  higher doses, more and more frequently.  This can lead to physiological dependence, which means that you need more and more as time goes on (that's called tolerance), and that you suffer uncomfortable withdrawal symptoms if they are stopped or tapered too quickly.  Such physiological dependence may lead to outright abuse and addictive behavior, although this is not always the case.
Taking Xanax once a day as prescribed by your physician does not represent abuse.  I would suggest that you talk to your doctor about his or her rationale for using an anti-anxiety agent with a relatively short half-life.  The possibility of your developing physiological dependence (tolerance and withdrawal symptoms) may be less for people taking intermediate half-life anti-anxiety agents such as lorazepam (Ativan), although  doctors may have some very good reasons for selecting  short-acting agents.
Although you rely on beta-blockers on a daily basis, this certainly does not represent addiction.  Although it's not a good idea to discontinue any necessary medication without checking with your doctor, beta-blockers do not fall in the category of potentially addictive medications which lead to true physiological dependence characterized by tolerance and withdrawal.
For more information about substance abuse, dependence, and addiction, check out my Ask DrSteve web site conveniently hyperlinked below.
Steve Adelman, M.D. (a.k.a. DrSteve)

This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
key words: dependence, tolerance, withdrawal, benzodiazepines, alprazolam, Xanax

Ask DrSteve:  The Real Story About Smoking, Drinking & Getting High