Common and Severe Side Effects of Xanax (Alprazolam)

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Xanax is a brand name for the drug alprazolam, a type of benzodiazepine that is approved by the Food and Drug Administration to treat panic disorder and anxiety disorders. It is sometimes prescribed off-label to treat depression. Benzodiazepines are sedatives that often produce feelings of relaxation or sleepiness.

Xanax is commonly prescribed alongside an antidepressant in people with generalized anxiety disorder; it may help relieve the feeling of nervousness that antidepressants initially cause in some people. However, experts do not recommend using Xanax for an extended time.

If you are taking Xanax, you should be aware of the potential side effects and know when to contact your doctor or healthcare professional.

Common Xanax Side Effects

Alprazolam is one of the most commonly prescribed benzodiazepines in the United States. However, there are still many side effects associated with it. If you are taking Xanax, you may experience any of these common side effects:

  • Drowsiness or fatigue
  • Dizziness
  • Dysarthria (slurred or slow speech)
  • Headache
  • Memory impairment
  • Depression

Be sure to check with your doctor if you notice any of these effects. Though it's typical to experience some side effects when taking Xanax, it's best to keep a close eye on them and have your healthcare professional monitor them.

Severe Side Effects

Benzodiazepines should not be used for longer than two to four weeks. Studies show there are serious health concerns connected to chronic use of Xanax. These include:

If you experience these, contact your healthcare provider, who can help you taper off Xanax safely. Alprazolam has been found to have the most severe withdrawal effects of all benzodiazepines.

Addiction


Another risk of using Xanax is developing a tolerance to it. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders states that the following are the criteria for a drug tolerance:

  1. You feel diminished effects of a drug over time when taking the same amount.
  2. You require larger amounts of the drug over time to feel the same effects.

Alprazolam has been found to have a high "misuse liability," meaning individuals often develop a physical dependence on the drug. Alprazolam has the potential to become highly addictive.

One study found that after four to eight months of treatment with benzodiazepines, 40% of patients became dependent on them.

Those with substance use disorders may be at a higher risk of developing an addiction to Xanax.

Those who chronically use benzodiazepines non-orally (using methods such as injection into the bloodstream) show significant respiratory distress and experience a tranquilizing effect on the central nervous system (CNS).

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

Warnings and Interactions

Prior to taking Xanax, tell your doctor about any pre-existing health conditions, history with addiction, and current medications you may be taking.

Liver Function

If you have liver disease or your liver isn't fully functioning, your doctor may choose not to prescribe you Xanax. If they do prescribe it, you will need to be closely monitored for liver damage since Xanax is metabolized by the liver. Your doctor may order a blood test to measure your liver function before you start Xanax.

Substance Use Disorder

If you have substance use disorder or a history of substance misuse, consult with your doctor prior to taking Xanax due to its high potential for misuse and/or addiction.

People who are withdrawing from opiates sometimes self-medicate with Xanax. People with addictions to other benzodiazepines such as Valium (diazepam) and Ativan (lorazepam) may also be more likely to misuse Xanax since it produces a similar sedating effect.

Self-medicating with Xanax or mixing it with other substances has life-threatening consequences, including overdose. Be sure to talk to a healthcare professional if you are mixing Xanax with other substances.

People Over Age 65

People over age 65 should exercise caution when taking Xanax. There is a higher chance for negative side effects in older adults, particularly if they combine Xanax with other medications affecting the central nervous system. These effects include:

  • Unsteady gait
  • Memory problems
  • Loss of balance
  • Cognitive impairment
  • Risk of falling
  • Risk of motor vehicle collision

If you are an older adult who is taking Xanax, you should be closely monitored by your doctor or healthcare professional.

Pregnancy or Breastfeeding

Xanax may harm the baby if taken during pregnancy. Potential effects include low birth weight, respiratory and feeding difficulty, convulsions, floppy baby syndrome, neonatal drowsiness, and hypotonia. An infant may also show irritability and withdrawal symptoms.

High doses of Xanax taken during the third trimester are associated with fetal benzodiazepine syndrome. This includes floppy baby syndrome, withdrawal symptoms, and problems regulating temperature.

Breastfeeding isn't recommended while taking Xanax or other benzodiazepines.

Xanax has been shown to transmit to an infant through breastmilk. The potential side effects on an infant include sedation, poor temperature regulation, and lethargy.

Other Medications

Do not take Xanax with other CNS depressants, such as Valium (diazepam) or Klonopin (clonazepam), alcohol, barbiturates, tricyclic and tetracyclic drugs, dopamine receptor antagonists, opioids, and antihistamines. 

Mixing Xanax with these substances may result in excessive sedation, respiratory depression, and in some cases, overdose.

If you experience side effects from mixing Xanax and other substances, get to the emergency room right away. Dial 911 and request an ambulance.

If you are with someone who is experiencing these side effects, call 911. The person's healthcare provider should also be notified that they are in the emergency room.

Tapering Off Xanax

Tapering off a drug means that you gradually reduce the dosage until you stop taking it altogether. Tapering off Xanax is recommended because it may help minimize the severity of withdrawal effects.

Decrease your Xanax dosage by no more than 0.5 milligrams (mg) every three days. Consult with your doctor if you are tapering off Xanax; they will provide you with specific instructions on how to do so safely.

Withdrawal

Though tapering off Xanax may help with the intensity of withdrawal, certain symptoms are still common when you discontinue Xanax. Patients who experienced anxiety prior to starting Xanax may feel more anxious after stopping Xanax. This is known as "rebound anxiety."

Other common effects of withdrawal include:

  • Malaise
  • Dizziness
  • Insomnia
  • Tachycardia (fast heart rate)
  • Severe sleep disturbance

One study found that out of 17 patients with panic disorder, 15 of them experienced a "reoccurrence or increase" in their panic attacks after tapering off alprazolam.

Patients with post-traumatic stress disorder (PTSD) who gradually discontinued alprazolam experienced effects such as irritability, nightmares, worsened anxiety, hyper-alertness, rage, and homicidal ideation.

There have been multiple case studies reporting delirium and psychosis in patients who discontinued alprazolam. These withdrawal effects have not been linked to any other benzodiazepine.

If you have experienced these or any other concerning side effects as a result of withdrawing from Xanax, seek medical attention right away.

Overdose 

Overdose may happen when a person takes larger doses of Xanax than they are prescribed, they take it more frequently than prescribed, they inject the drug, and/or they mix it with other CNS depressants.

Signs of an overdose can vary depending on the person. However, the following are common signs:

  • Trouble breathing
  • Confusion
  • Dizziness
  • Blurred vision
  • Impaired motor skills
  • Blue-tinted lips or fingernails
  • Tremors
  • Coma

Other serious complications from overdose include pneumonia, muscle damage, brain damage, and even death.

If you or someone you know is experiencing any signs of overdose from Xanax, be sure to call 911 immediately.

Anyone experiencing an overdose should receive immediate medical attention. Once at the hospital or with emergency services, they are often given intravenous fluids, respiratory support, and/or medications to help combat the effects of the overdose.

A Word From Verywell

It's important to be aware of the side effects you may experience if you're taking Xanax. Though the side effects listed here are often associated with Xanax, you may experience other effects unique to you. Be sure to follow the guidelines given to you by your doctor and talk to your doctor about any concerns. If you are unsure about taking Xanax, ask your doctor about potential alternatives.

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