Alprazolam (Xanax): dosage, uses, side effects

If you’ve been struggling with symptoms of an anxiety disorder, your healthcare provider may recommend alprazolam, commonly called Xanax. Anxiety symptoms or having regular panic attacks can make it challenging to go about your daily life, and Xanax may help. 

There are many treatment options available to help manage the symptoms of anxiety. So, let’s break down how the medication alprazolam works, its potential side effects, and whether it may be a good fit for you.

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Alprazolam is the generic name for a type of medication used for treating mental health conditions. It’s more commonly known under its brand name form Xanax. Other brand names include Xanax XR and Niravam. 

Alprazolam falls within a class of psychotropic medications called benzodiazepines. You may also hear alprazolam referred to as an anxiolytic drug. Anxiolytic means it’s a medication primarily used to reduce anxiety. 

Benzodiazepines, like alprazolam, bind to receptors for a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain and central nervous system (CNS). The result is an increase in GABA’s effects, which include reducing anxiety, increasing sedation and muscle relaxation, and others.

Typically, benzodiazepines are used for the short-term management of anxiety symptoms because they’re fast-acting. They can relieve symptoms within 30–60 minutes after taking the medication (George, 2020). 

Healthcare providers most often prescribe alprazolam to help reduce anxiety symptoms. The U.S. Food and Drug Administration (FDA) approves alprazolam for treating anxiety and panic disorders, such as (George, 2020; Chand, 2021):

• Generalized anxiety disorder (GAD): GAD is the persistent and excessive worry about multiple areas of everyday life that the person views as difficult to control. A few of the symptoms include restlessness, fatigue, trouble concentrating, feeling on edge, and muscle tension. 

• Panic disorder: Panic disorders involve recurrent panic attacks and persistent worry about experiencing future panic attacks. Some of the symptoms of a panic attack include chest pain, shortness of breath, lightheadedness, tingling, feeling of dread, and anxious thinking. 

• Agoraphobia: This is the irrational fear of being unable to escape or unable to get help if they develop panic attack symptoms in at least two of the following: using public transportation, being in an open space, being in an enclosed space (shops, theaters, elevators), being in a crowd, or leaving home alone. 

Alprazolam can also be used “off-label” to treat other conditions, meaning the FDA didn’t explicitly approve it for those uses. Healthcare providers can prescribe drugs for an unapproved use if they decide it’s the proper treatment for their patients.

Off-label uses for alprazolam include (George, 2020):

• Depression: Feelings of sadness, loss of interest, and trouble functioning in your daily life. Anxiety symptoms commonly occur alongside depression (Chand, 2021). 

• Premenstrual syndrome: A combination of symptoms some women experience the week or two before their period starts, including mood swings, food cravings, fatigue, and tender breasts (Gudipally, 2020). 

• Insomnia: Sleep disorder characterized by trouble falling asleep, staying asleep, or poor sleep quality (Kaur, 2020)

All medications could lead to some possible side effects. Your healthcare provider will help you weigh the potential benefits and risks of taking alprazolam. Some of the possible side effects of alprazolam include (George, 2020):

• Drowsiness or tiredness

• Dizziness

• Sleep problems (insomnia)

• Memory problems

• Poor balance or coordination

• Slurred speech

• Trouble concentrating

• Irritability

• Diarrhea or constipation

• Increased sweating

• Headache

• Nausea and vomiting

• Upset stomach

• Blurred vision

• Appetite or weight changes

• Swelling of hands or feet

• Muscle weakness

• Dry mouth

• Stuffy nose

• Loss of interest in sex

You may experience other side effects. Pay attention to how you are feeling, and let your healthcare provider know if you are experiencing side effects that significantly disrupt your quality of life.

Alprazolam is available as regular release and disintegrating tablets. These forms are fast-acting to help relieve short-term symptoms, like during a panic attack. 

It’s also available in extended-release tablets, which are formulated to release the medication slowly over time to help manage long-term symptoms. 

Disintegrating tablets will dissolve in your mouth within a few seconds, and then you swallow the residue. You can take a drink of water to help swallow the dissolved tablet if you choose to. The other tablet forms can be taken with or without food and swallowed whole. 

You can take alprazolam daily or only when needed to help manage sudden symptoms. Always follow the dosing instructions provided by your healthcare provider for how often to take alprazolam. 

The typical dose for adults (George, 2020):

• To treat anxiety disorders is 0.25 to 0.5 mg three times a day

• To treat panic disorders is 0.5 to 1 mg once a day

Your healthcare provider will help you find the best form and dose for you.

Talk with your healthcare provider about any medications you are allergic to before taking alprazolam. There are both active and inactive ingredients in medicines that can cause allergic reactions. 

This medication may cause you to feel dizzy or drowsy. The effects of Xanax may begin 30 minutes after taking and may last for around six hours. Do not drive or operate machinery until you can do so safely. Similarly, it’s important to avoid alcoholic beverages while taking Xanax because this can increase these dizzy or drowsy effects. Substance abuse and other recreational drugs, such as marijuana, may increase the risk for serious side effects (George, 2020). 

People who take this medication for extended periods may become dependent on, addicted to, or abuse the drug. In addition, there is a risk for withdrawal symptoms if taken off Xanax suddenly (George, 2020). 

Don’t stop taking any medications without talking to your healthcare provider. If you wish to stop taking alprazolam, your healthcare provider will help you choose other treatment options for your symptoms. They will wean you off Xanax slowly to prevent symptoms of withdrawal. 

Talk to your healthcare provider if you’re pregnant or become pregnant while taking alprazolam. This drug can be harmful to the fetus and potentially cause congenital disabilities. The medication may also lead to withdrawal and excessive sleepiness in newborns. Alprazolam can also transfer through breast milk and should be limited while breastfeeding (Ati-Daoud, 2018). 

Toxicity can occur from taking too much alprazolam, though that’s more when mixing alprazolam with other medications or substances.

Talk with your healthcare provider if you’re experiencing any unusual side effects or have any concerns.

Alprazolam shouldn’t be taken with other benzodiazepine medications because it will increase the risk for common side effects. Mixing alprazolam with other CNS depressants may lead to pauses in breathing, low blood pressure, and can be deadly (George, 2020). 

Other prescription drugs that can change the effectiveness of alprazolam include (George, 2020):

• Other anxiolytic or sedative medications (diazepam, valium, clonazepam, klonopin) 

• Azole antifungals (ketoconazole, itraconazole)

• Cimetidine

• Some antidepressants (fluoxetine, fluvoxamine, sertraline, and nefazodone)

• Some antibiotics (clarithromycin, erythromycin)

• Rifamycins (rifampin)

• St. John’s Wort

• Seizure medications (carbamazepine, phenytoin, lorazepam, ativan)

• Antihistamines

• Muscle relaxants

• Opioids

• Oral contraceptives

When taken as prescribed, Alprazolam is a safe and effective medication. Be sure to follow your healthcare provider’s recommendations on how to use it and ask them any specific questions you have about alprazolam.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

July 16, 2021

Written by

Ashley Braun, RD, MPH

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.