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Alprazolam Side Effects

Updated on February 28, 2012

Alprazolam - Background

Alprazolam is a prescription medication belonging to a family known as "benzodiazepines" and was first introduced to the U.S. market in 1981 under the brand name of Xanax. Alprazolam is a controlled substance, meaning that the DEA has determined it has some potential for addiction and/or abuse. In the U.S. it is classified as a Schedule IV controlled substance (this is based on a scale of 1-5, with 5 having the lowest potential for addiction/abuse and 1 having the highest). Alprazolam is amongst the most widely prescribed prescription medications to treat anxiety and panic attacks. For this reason I am providing an article which explains the potential side effects of alprazolam for patients.

This article is not about the legitamacy of alprazolam and is not intended to promote its use. Anxiety, and anxiety-related conditions are complicated, and it is not my intention to suggest that medication is always the best (or only) way to address persistent and uncontrolled fears.

Concerns about alprazolam side effects and even accidental overdose and deaths are on the rise. Currently alprazolam is second only to oxycodone for the number of drug-related deaths. The information provided in this article is intended to help patients use alprazolam safely, if they determine it is necessary. Nothing in this article is intended to substitute for or replace the advice of your personal physician.

Although alprazolam has been the object of misuse and abuse, it has also been used widely, safely and legitimately by patients who have found it to help control their symptoms, allowing them to engage in work and other social settings they otherwise would need to avoid.


All prescription medications have reported side effects. Manufacturers must carefully record and document all side effects reported by patients during clinical trials, as well as during post-marketing studies and those side effects received via consumer contacts.


1. Drowsiness/Fatigue - the #1 reported side effect with alprazolam is drowsiness. Up to 41% of patients reported feeling drowsy when given this medication. This should not be surprising. Alprazolam works by producing a sedative effect upon the central nervous systom (CNS) and therefore this side-effect of alprazolam is actually just a function of the way it works. Many patients find that after several days of use they are no longer bothered by the drowsiness.

2. Light-headedness - The second most frequently reported side effect with alprazolam is a feeling of light-headedness. Again, this is a direct result of the way it is working and is generally to be expected.

3. Impaired Coordination - This side effect was reported from 10% to 40% depending on the study and treatment group.

CAUTION: Because the above side effects are likely to reduce your ability to safely drive or operate machinery, do not attempt such things until you have had the opportunity to see how this medication will affect you.

TIP: If possible, begin alprazolam on a day and at a time when driving will not be necessary. A weekend may be a good choice.

4. Memory and/or mental impairment - Patients reported memory imprairment as a side effect while using alprazolam. As with the previous side effects, this is likely due to the way alprazolam works to sedate the CNS.

TIP: Exercise your memory with games and puzzles. Keep track of any concerns about your memory and share them with your doctor.

5. Constipation - More patients repoted constipation on alprazolam than in the placebo groups.

TIP: If this occurs, a good approach is to increase fluid intake, increase fiber intake and consider a stool softener (like docusate sodium).

6. Dry mouth - This side effect was variable. Dry mouth can be associated with anxiety, and may actually be alleviated by alprazolam in some patients. Others reported that alprazolam caused dry mouth.

TIP: Hard candy or gum may be helpful. Also, in the toothepaste aisle of most pharmacies you will find "saliva substitute" products to help moisten the mouth. Drink extra water also.

7. Difficulty speaking - Also known as "dysarthria." Some patients reported various difficulties in articulating words or speaking while taking alprazolam.

TIP: Try to slow down, rather than speaking quickly. If speaking difficulty continues, let your doctor know.

The above side effects are the ones reported most commonly and in greater frequency than when compared to placebo (a pill with no medicine).

It is interesting to note that several side effects were reported LESS frequently with alprazolam than the placebo group, including insomnia, headache and tremors.


The side effects from alprazolam reported above are the most common. Other side effects have also been reported. Many of these are reported approximately as often as the placebo, so it is difficulty to confirm they are truly caused by the medication itself.

These include:

Depression, Libido decrease, Libido increase, Depression, loss of appetite, increased appetite, nausea, throat pain, muscle pain, hot flashes, difficulty breathing, itching, runny nose, irritability, anxiety, talkativeness, blurry vision, ringing in the ears, sweating, menstrual disorders, fluid retention and infection.


  • Drug Interactions: Avoid taking alprazolam with other drugs which may cause significant drowsiness, including alcohol. Also, alprazolam should not be used with drugs like ketoconazole and itraconazole, because they will interfere with the metabolism of alprazolam and cause dangerously high blood levels of alprazolam. Other Interactions: alprazolam appears to increase blood levels of desipramine and imipramine (older antidepressants). Both fluoxetine (AKA Prozac) and oral contraceptives tended to increase blood levels of alprazolam. Carbamazepine (a medicine used for epilepsy) might decrease blood levels of alprazolam. NEVER take alprazolam with alcohol and do not mix with other CNS depressants (like pain killers) without consulting with an MD. The combined effects of these drugs can be very dangerous.
  • Dependence and Withdrawal: Discontinuation of alprazolam, especially when patients are taking more than 4mg daily, can produce withdrawal. Symptoms of withdrawal would include insomnia, muscle aches, vomiting, sweating, tremors and even convulsions. It is often difficult to distinguish between withdrawal symptoms and recurring panic attacks or anxiety. Patients should never discontinue alprazolam abruptly, but rather taper their dosage slowly according to the direction of their physician. A study in 2011 found that patients on 5mg of alprazolam daily were able to successfully discontinue the medication without serious withdrawal using a carefully monitored and tapering approach.
  • Pregnancy/Nursing: Alprazolam is classified as Pregnancy Category D - meaning it should NOT be used during pregnancy. Infants born to mothers who have been taking alprazolam may go through withdrawal after birth which may include difficulty breathing. Alprazolam IS secreted into breast milk and may cause side effects in nursing infants.
  • The Elderly - Older patients are more effected by the side effects of alprazolam, and tend to have higher blood levels due to decreased rates of metabolism.


As a pharmacist I receive a lot of questions about alprazolam side effects. This article intends to answer some of the questions that may arise when considering taking alprazolam. Many other issues must also be considered when deciding to treat anxiety or panic attacks, but hopefully this information has provided some material that will help in that process.

If you have any other questions about alprazolam or the side effects of alprazolam, feel free to leave your question or comment below.

© Jason Poquette R.Ph.


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    • pharmacist profile image

      Jason Poquette 3 years ago from Whitinsville, MA

      ne33 - This is a good tool to check for drug interactions:

    • profile image

      ne33 3 years ago

      can ativan 2mg and naltrexone 50mg be safe to use together?

    • pharmacist profile image

      Jason Poquette 6 years ago from Whitinsville, MA


      Thank you for the kind words. Glad the article was useful to you. Yes, clonazepam is 1 approach used to help get patients off of alprazolam when necessary. Best wishes!

    • Jlbowden profile image

      James Bowden 6 years ago from Long Island, New York

      Very well-written and thought out article about xanax and its side-effects. Working within the pharmaceutical field as a medical consultant, I have found this article alone, to be very useful as well as interesting. I didn't realize that Alprazolam next to Oxycodone is responsible for multiple related drug deaths. I have a few friends who currently take this medication and told them that if they find the side-effects and/or withdrawal symptoms too overwhelming, try asking their doctor about clonzepam which I believe produces a similar effect but is easier to get off of in the future because of its half life being less then xanax. Not sure if this is correct or not, but have read this somewhere. Really enjoyed this useful and interesting info. once again about this drug and look forward to reading others.


    • Jen's Solitude profile image

      Jen's Solitude 6 years ago from Delaware

      Good approach to explaining this drug in a factual way. Thank you for the information.

    • KimberlyLake profile image

      Kimberly Lake 6 years ago from California

      Very detailed. Good hub.

    • profile image

      Gary 6 years ago

      Good job i will use this thanks in fact I'm going to print off for the right patients.

    • teaches12345 profile image

      Dianna Mendez 6 years ago

      Thanks for sharing. My question was answered on the cause of death.

    • pharmacist profile image

      Jason Poquette 6 years ago from Whitinsville, MA


      The deaths are virtually all due to (1) overdose or (2) combining alprazolam with other CNS depressants (e.g. narcotics or alcohol). Good question. Sad situation.

    • cloverleaffarm profile image

      Healing Herbalist 6 years ago from The Hamlet of Effingham

      Are the deaths due from overdose or taking it wrong?