Alprazolam (Xanax) belongs to a group of drugs called benzodiazepines. People use Xanax to treat anxiety and panic disorders. It is the single most prescribed psychiatric medication in the United States.

This article will explain why people use Xanax, its potential side effects, and its relevant warnings.

Xanax is an antianxiety medication in the benzodiazepine family. This is the same family that includes diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan), flurazepam (Dalmane), and others.

Xanax works by decreasing abnormal excitement in the brain. The Food and Drug Administration (FDA) approved it in October 1981.

Benzodiazepines act on the brain and central nervous system (CNS) to produce a calming effect.

Xanax slows down the movement of brain chemicals that may have become unbalanced, resulting in a reduction in nervous tension and anxiety. Xanax works by boosting the effects of a natural chemical called gamma-aminobutyric acid, which is made in the brain.

To ensure the safe and effective use of benzodiazepines, doctors will provide the following guidance to anyone with a Xanax prescription:

  • People should inform their doctor about any alcohol consumption and any medications they are currently taking, including over-the-counter (OTC) medications. People generally should not consume alcohol while taking benzodiazepines.
  • Doctors do not recommend Xanax for use in pregnancy. A person should inform their doctor if they are pregnant, are planning to have a child, or become pregnant while they are taking this medication.
  • People should inform their doctor if they are breastfeeding.
  • Until a person experiences how Xanax affects them, they should not drive a car or operate heavy or dangerous machinery.
  • People should not increase the dosage of Xanax without speaking with a doctor, even if they think that the medication “does not work anymore.” Benzodiazepines, even if a person uses them as recommended, may produce emotional and physical dependence.
  • People should not stop taking Xanax abruptly or decrease the dosage without consulting their doctor, as withdrawal symptoms can occur.

A person should inform their doctor if they have:

  • asthma or other breathing problems
  • glaucoma
  • kidney
  • liver diseases
  • a history of excessive alcohol use
  • a history of depression
  • suicidal thoughts
  • an addiction to drugs or alcohol

People should not take Xanax if they:

  • have narrow-angle glaucoma
  • are also taking itraconazole (Sporanox) or ketoconazole (Nizoral)
  • are allergic to Xanax or other benzodiazepines, such as:
    • chlordiazepoxide (Librium)
    • clorazepate (Tranxene)
    • diazepam (Valium)
    • lorazepam (Ativan)
    • oxazepam (Serax)

Other precautions

In certain individuals, the body may handle Xanax differently. This includes people who:

  • drink a lot of alcohol
  • have alcoholic liver disease
  • have impaired hepatic function
  • have impaired renal function
  • are older
  • have obesity

Allergies

People should not use Xanax if they are allergic to alprazolam or other benzodiazepines, such as:

  • chlordiazepoxide (Librium)
  • clorazepate (Tranxene)
  • diazepam (Valium)
  • lorazepam (Ativan)
  • oxazepam (Serax)

Alcohol

People should not drink alcohol while taking Xanax. Xanax can increase the effects of alcohol.

Pregnancy

People should not use Xanax if they are pregnant. Benzodiazepines can potentially cause harm to the fetus. During the first trimester, for example, Xanax increases the risk of congenital abnormalities.

People should usually avoid taking Xanax during the first trimester of pregnancy.

Healthcare professionals should also inform people that if they become pregnant or intend to become pregnant while taking Xanax, they should tell their doctor.

A child born of a person who is taking benzodiazepines may be at risk of withdrawal symptoms from the drug. Respiratory problems have also occurred in children born to people who have been taking benzodiazepines while pregnant.

Nursing

Xanax may be excreted in human milk. As a general rule, people who use Xanax should not breastfeed.

Children

Researchers have not yet studied Xanax use in children.

Gender

Gender does not affect the body’s response to Xanax.

Older adults

Older adults, or people aged 65 years and above, may be more sensitive to the effects of benzodiazepines. For example, the sedative effects of Xanax may last longer in older adults.

Accidental falls are also common in older adults who take benzodiazepines. Therefore, people should use caution to prevent falling or accidental injury while taking Xanax.

Race

Xanax may affect Asian populations more than white populations.

Smoking

Xanax concentrations may be reduced in up to 50% of people who smoke, compared with people who do not smoke.

Suicide

As with other psychotropic medications, there are some precautions to take when people with severe depression or suicidal thoughts take this drug.

Mania

Episodes of hypomania and mania have occurred in association with the use of Xanax in people with depression.

People often misuse Xanax for the fast acting, relaxed “high” it can provide.

According to the Treatment Episode Data Set, the number of people seeking treatment for benzodiazepine misuse almost tripled in 1998–2008. Long-term misuse and addiction to Xanax are associated with depression, psychotic experiences, and aggressive or impulsive behavior.

According to the Substance Abuse and Mental Health Services Administration, in 2011, there were over 1.2 million emergency room (ER) visits related to the nonmedical use of prescription drugs. Xanax was involved in around 10% of those visits.

The number of ER visits involving the nonmedical use of Xanax doubled from 57,419 to 124,902 during 2005–2010 and remained stable at 123,744 in 2011.

The most common drug combinations that healthcare professionals encountered in people presenting to ER were Xanax with alcohol and Xanax with prescription opiates such as hydrocodone (Zohydro ER) and oxycodone (OxyContin).

Many people use Xanax to manage anxiety disorder or to provide some short-term relief from the symptoms of anxiety. Anxiety or tension associated with the stress of everyday life usually does not require treatment.

Generalized anxiety disorder is characterized by unrealistic or excessive anxiety and worry about two or more life circumstances for a period of 6 months or longer. During this period, the person has been bothered more days than not by these concerns.

At least six of the following symptoms are often present in these people:

  • motor tension, such as:
    • trembling
    • twitching
    • feeling shaky
    • muscle tension
    • aches or soreness
    • restlessness
    • feeling easily tired
  • autonomic hyperactivity, such as:
    • shortness of breath or smothering sensations
    • heart palpitations or an accelerated heart rate
    • sweating or cold, clammy hands
    • a dry mouth
    • dizziness or lightheadedness
    • nausea
    • diarrhea or other abdominal symptoms
    • hot flashes or chills
    • frequent urination
    • difficulty swallowing or a “lump in the throat”
  • vigilance and scanning, such as:
    • feeling keyed up or on edge
    • exaggerated startle response
    • difficulty concentrating or “the mind going blank” because of anxiety
    • difficulty falling or staying asleep
    • irritability

Xanax is also indicated for the treatment of panic disorder, with or without agoraphobia, and it may reduce the number of panic attacks a person has.

Panic disorder is characterized by regular panic attacks. Panic attacks are relatively short periods of intense fear or discomfort where four or more of the following symptoms develop all of a sudden and reach a peak within 10 minutes:

  • heart palpitations, a pounding heart, or an accelerated heart rate
  • sweating
  • trembling or shaking
  • sensations of shortness of breath or smothering
  • a feeling of choking
  • chest pain or discomfort
  • nausea or abdominal distress
  • feeling dizzy, unsteady, lightheaded, or faint
  • derealization (feelings of unreality) or depersonalization (being detached from oneself)
  • a fear of losing control
  • a fear of dying
  • numbness or tingling sensations
  • chills or hot flashes

Side effects often occur at the beginning of therapy and will usually disappear when a person stops taking the medication.

Some possible side effects of Xanax include:

  • drowsiness
  • lightheadedness
  • low energy
  • depression
  • headache
  • confusion
  • insomnia
  • nervousness
  • fainting
  • dizziness
  • restlessness
  • impaired coordination
  • irritability
  • memory impairment
  • anxiety
  • abnormal involuntary movement
  • decreased libido
  • confusion
  • muscle twitching and cramps
  • increased libido
  • a dry mouth or increased saliva
  • constipation or diarrhea
  • nausea and vomiting
  • inflammation of the skin due to allergy
  • rash
  • tachycardia or heart palpitations
  • chest pain
  • hyperventilation
  • nasal congestion
  • hypotension
  • blurred vision
  • menstrual disorders
  • tinnitus
  • upper respiratory infection
  • sweating
  • weakness
  • abnormal dreams
  • fear
  • rigidity
  • tremor
  • increased or decreased appetite
  • weight gain or loss
  • edema
  • slurred speech
  • incontinence

The above is not a complete list of side effects, and others may occur. Call a doctor for medical advice about side effects. People can also report any Xanax side effects they experience to the FDA at 800-332-1088.

A person needs emergency medical help if they have any of these symptoms of an allergic reaction to Xanax:

  • hives
  • difficulty breathing
  • swelling of the face, lips, tongue, or throat

A person should call their doctor at once if they have a serious side effect such as:

  • depressed mood, thoughts of suicide or hurting oneself, unusual risk taking behaviors, decreased inhibitions, or no fear of danger
  • confusion, hyperactivity, agitation, hostility, or hallucinations
  • feeling very faint
  • urinating less than usual or not at all
  • chest pain, a pounding heartbeat, or a fluttering feeling in the chest
  • uncontrolled muscle movements, tremor, or seizures
  • jaundice, or a yellowing of the skin or eyes

Xanax comes as a tablet, an extended-release tablet, an orally disintegrating tablet (a tablet that dissolves quickly in the mouth), and a concentrated solution (liquid) to take by mouth.

A person should take Xanax by mouth as a doctor directs. The dosage will be based on the following factors:

  • why the person is taking it
  • their age
  • how their body responds to the treatment

A doctor may gradually increase the dosage of Xanax until the drug works effectively for the person. People should closely follow their doctor’s instructions to reduce the risk of side effects.

If a person has used this medication regularly for a long time or in high dosages, withdrawal symptoms can occur if they suddenly stop taking it.

To prevent this, a doctor may reduce the dosage of Xanax gradually.

Xanax is available in doses of:

  • 0.25 milligrams (mg): This will be white, oval, scored, and imprinted with “XANAX 0.25.”
  • 0.5 mg: This will be peach, oval, scored, and imprinted with “XANAX 0.5.”
  • 1 mg: This will be blue, oval, scored, and imprinted with “XANAX 1.0.”
  • 2 mg: This will be white, oblong, multiscored, and imprinted with “XANAX” on one side and “2” on the reverse side.

A person should not crush, chew, or break a Xanax extended-release tablet. They should swallow the tablet whole. It is specially made to release the drug slowly into the body. Breaking the tablet would cause too much of the drug to be released at once.

People should not share their medications with other people. It may not be suitable for them and may harm them.

What happens if I miss a dose?

If a person misses a dose of Xanax, they should take the missed dose as soon as they remember. However, they should skip the missed dose if it is almost time for their next scheduled dose.

They should not take extra to make up for the missed dose.

What happens if I overdose?

Symptoms of a Xanax overdose include:

Death has occurred in association with overdoses of Xanax by itself, as it has with other benzodiazepines.

If an overdose of Xanax occurs, a person needs emergency medical attention. Somebody should call 911 or Poison Control at 800-222-1222.

Storage

People should store Xanax at controlled room temperature, which is around 68–77°F (20–25°C).

The following drugs may increase the effects of Xanax:

  • ketoconazole (Nizoral)
  • itraconazole (Sporanox)
  • nefazodone
  • fluvoxamine (Luvox)
  • erythromycin (Erythrocin)
  • cimetidine (Tagamet)
  • HIV protease inhibitors, such as ritonavir (Norvir)

Benzodiazepines, including Xanax, can produce extra depressant effects on the CNS when a person takes it alongside:

  • other psychotropic medications
  • anticonvulsants
  • antihistamines
  • alcohol
  • other drugs that produce CNS depression

Some other drugs that may interact with Xanax include:

  • digoxin (Lanoxin), in people aged 65 years and above
  • imipramine (Tofranil) and desipramine (Norpramin)
  • fluoxetine (Prozac)
  • propoxyphene (Darvon)
  • birth control pills

Studies of benzodiazepines other than Xanax suggest a possible interaction with the following drugs:

  • diltiazem (Cardizem)
  • isoniazid (Hydra)
  • some antibiotics
  • grapefruit juice
  • sertraline (Zoloft)
  • paroxetine (Paxil)
  • ergotamine (Cafergot, Ergomar, Migergot)
  • cyclosporine (Gengraf, Neoral, Sandimmune)
  • some heart or blood pressure medications
  • dexamethasone (Cortastat, Dexasone, Solurex, DexPak)
  • imatinib (Gleevec)
  • St. John’s wort
  • antifungal medications, such as miconazole (Oravig) or voriconazole (Vfend)
  • antidepressants, such as fluoxetine (Prozac) or nefazodone
  • some barbiturates
  • some seizure medications

This list is not complete, and other drugs may interact with Xanax. A person should tell their doctor about all the medications they use. This includes prescription, OTC, vitamin, and herbal products.

People should not start a new medication without telling their doctor.

It is important to taper off Xanax gradually. Otherwise, there is a risk of benzodiazepine withdrawal syndrome.

Withdrawal from Xanax

To discontinue treatment of Xanax, a doctor should reduce and taper the dosage slowly. They should decrease the daily dosage of Xanax by no more than 0.5 mg every 3 days.

Some reported withdrawal symptoms include:

  • insomnia
  • lightheadedness
  • anxiety
  • fatigue and tiredness
  • abnormal involuntary movement
  • headache
  • nausea and vomiting
  • sweating
  • diarrhea
  • weight loss
  • decreased appetite
  • tachycardia
  • decreased salivation
  • irritability
  • cognitive disorder
  • blurred vision
  • muscular twitching
  • impaired coordination
  • muscle tone disorders
  • weakness
  • memory impairment
  • depression
  • confusion

Xanax is a safe and effective medication when a person uses it correctly.