10 Alprazolam (Xanax) Side Effects You Should Know About
Key takeaways:
Alprazolam (Xanax) is a benzodiazepine medication. It’s approved to treat anxiety and panic disorder. Possible alprazolam side effects include drowsiness, trouble with coordination, and lightheadedness.
Other Xanax side effects include short-term memory issues, weight loss or weight gain, and sexual problems like erectile dysfunction.
Xanax is a controlled substance that can lead to dependence, misuse, and overdose. Taking alprazolam exactly as prescribed minimizes your risk of misuse and overdose.
Table of contents
Alprazolam (Xanax) is a benzodiazepine medication. Commonly known as “benzos,” these medications slow down activity in the brain.
Alprazolam is FDA approved for treating medical conditions like anxiety and panic disorder. A long-acting form of alprazolam, called Xanax XR, is also FDA approved for panic disorder. Like other benzos, alprazolam is a controlled substance that can lead to physical and mental dependence and misuse. There are also restrictions around how it's prescribed and refilled.
If you’ve been prescribed alprazolam, you’ll want to be aware of these possible risks, in addition to several other side effects. Below, we’ll cover 10 alprazolam side effects and how to prevent or manage them.
Alprazolam (Xanax) side effects at a glance
Xanax is typically well tolerated. Still, there are possible adverse effects of Xanax. These adverse effects are similar in men and women.
Possible alprazolam side effects include:
Drowsiness
Fatigue
Trouble with coordination
Decreased sex drive
Memory problems
Difficulty speaking clearly
Increased or decreased appetite
Weight gain or weight loss
Constipation
Serious alprazolam side effects include:
Impaired mental and physical abilities, leading to accidents or injuries from driving and other activities that require alertness
Worsening depression
Episodes of mania or hypomania in people with depression
Withdrawal or sedation in newborns exposed to alprazolam during pregnancy
Breathing problems in people with decreased lung function
Alprazolam also has a few boxed warnings. This is the FDA’s strictest warning for medications. These risks can be life-threatening:
Severe sedation, slowed breathing, coma, or death if alprazolam is combined with opioids
Misuse, which can lead to overdose or death
Severe withdrawal reactions, such as seizures, after stopping alprazolam or reducing the dose too quickly
How does alprazolam work? Learn how alprazolam works and how you’ll know if it’s working for you.
Does alprazolam interact with other medications? Find out which medications can cause drug interactions when taken with alprazolam.
Is alprazolam a first-choice medication for anxiety? Alprazolam isn’t usually recommended long-term for anxiety. Here’s why it may be helpful in the short-term for some people.
Below, we’ll cover 10 notable alprazolam (Xanax) side effects in more detail.
1. Drowsiness
Xanax is known to make you sleepy. In studies, about 3 out of 4 people taking alprazolam for panic disorder reported drowsiness. This is because alprazolam has sedative effects and slows down brain activity.
If you only take alprazolam at bedtime, this side effect may not be a problem. But if you’re taking alprazolam during the day, it may be dangerous to do activities that require you to be alert, such as driving.
If you’ve just begun taking alprazolam, or your dose was recently increased, avoid activities that require focus until you know how it affects you. This includes driving. Although drowsiness may improve as your body gets used to the medication, talk with your prescriber if alprazolam is making you tired. They may lower your dose or recommend a different medication.
Good to know: Many other medications can also cause drowsiness. This includes opioids and some over-the-counter (OTC) medications, such as diphenhydramine (Benadryl). Opioids should be avoided with alprazolam. However, other medications may be necessary to continue. Talk to your prescriber or pharmacist about whether your combination of medications is safe.
2. Trouble with coordination
Trouble with coordination is another common alprazolam side effect. This is likely due to alprazolam’s effects on areas of the brain that control coordination.
Impaired coordination can lead to falls. Falls can be especially risky for people ages 65 and older, as they can lead to fractures or hospitalizations.
If you’re taking alprazolam, let your healthcare team know if you develop coordination problems. This may include difficulty walking and problems with balance.
3. Lightheadedness
Alprazolam can cause lightheadedness, dizziness, or the sensation of feeling “woozy.” Like most alprazolam side effects, this is due to the medication’s effect on the brain. Lightheadedness is more likely if you combine alprazolam with other medications and substances that can cause dizziness, such as alcohol, opioids, or sleep medications.
Feeling lightheaded can make it dangerous to do certain activities. If alprazolam affects your ability to complete daily tasks or move normally, talk to your healthcare team.
Does alprazolam (Xanax) lower blood pressure?
Yes, alprazolam can lower your blood pressure. And lightheadedness is a possible symptom of low blood pressure. Other symptoms include blurry vision, dizziness, or weakness. If you have any of these symptoms, your prescriber may ask you to check your blood pressure at home. They may also recommend lowering your alprazolam dose or switching to another medication.
Although alprazolam can decrease blood pressure, this effect doesn’t last very long. So it’s not prescribed as a blood pressure-lowering medication. Several other medications are FDA approved to decrease blood pressure, and generally have fewer risks than alprazolam.
4. Memory problems
Alprazolam may cause short-term memory loss. This means that after you take a dose, you could become forgetful for several hours afterward and have gaps in your short-term memory during this time.
Short-term memory problems can affect your day-to-day life. If you notice memory issues, let your prescriber know. Often, these problems will improve when you stop taking Xanax. But make sure you talk to your prescriber first. Stopping Xanax abruptly can cause withdrawal symptoms (more on that later).
Does Xanax cause dementia or Alzheimer’s disease?
There is no definitive data showing that Xanax causes dementia or Alzheimer's disease.
Overall, studies on whether benzodiazepines can cause long-term memory loss or cognitive impairment are conflicting. Still, if you need a benzodiazepine, it's best to take it at low doses for the shortest amount of time possible. And as mentioned, if you notice changes in your memory, make sure to let your healthcare team know.
5. Weight loss or weight gain
You may experience changes to your appetite while taking alprazolam. This may be an increase or decrease in appetite, which can lead to weight gain or weight loss.
Eating a nutrient-dense diet and exercising can help you maintain a healthy weight. If you notice appetite or weight changes while taking alprazolam, talk with your healthcare team about what to do next. They may want to explore other possible causes for appetite or weight changes before changing your alprazolam dose or switching to another medication.
6. Difficulty speaking clearly
Alprazolam can cause dysarthria, a speech problem that makes it difficult to talk. Signs of dysarthria can include slurred speech, voice changes, or talking too fast or too slow. Like many alprazolam side effects, this can happen due to alprazolam’s effect on the brain.
If you’re experiencing speech problems with alprazolam, your prescriber may want to lower your dose or switch you to another medication. But don’t make any changes without talking to them first.
7. Sexual problems
Taking benzodiazepines can lead to sexual problems such as changes to libido (sexual desire). They may also cause erectile dysfunction (trouble having an erection) or difficulty with orgasm.
Overall, alprazolam’s effects on sexual function haven’t been heavily studied. It’s also important to note that the mental health conditions alprazolam treats, such as anxiety, can cause sexual problems themselves. So talk to your prescriber if you notice sexual changes after starting alprazolam. They may suggest adjusting your dose or changing to a different medication. They may also want to look further into the cause of these problems, as several medications and health issues can lead to sexual issues. They may also recommend considering tips for improving your sex life.
8. Dependence and misuse
As mentioned, alprazolam is a controlled substance. More specifically, it’s a Schedule 4 controlled substance. Schedule 4 substances have a lower potential for dependence and misuse than those in schedules 1, 2, or 3. But it’s still a possibility.
All benzodiazepines can cause dependence, even if you take them exactly as prescribed. Dependence means your body needs the medication to function normally. Sometimes (but not always), dependence can lead to misuse and sedative use disorder (a type of substance use disorder). In fact, the FDA requires a boxed warning for alprazolam that warns about misuse.
To minimize the risk of benzo misuse or dependence, take alprazolam exactly as prescribed. Ideally, you’ll take alprazolam for the shortest amount of time possible. This helps minimize your risk of dependence and misuse. Additionally, avoiding certain other substances, such as alcohol and opioids, also minimizes your risk of benzodiazepine misuse (and overdose).
If you or a loved one takes alprazolam, it’s a good idea to watch for signs of substance use disorder. This includes taking alprazolam more often or at higher doses than what’s prescribed. Spending a lot of time thinking about alprazolam, craving the medication, and being unable to keep up with life’s responsibilities due to alprazolam use are also signs of substance use disorder.
If you experience any of these symptoms, talk to your prescriber immediately to discuss next steps.
If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.
9. Overdose
Taking too much alprazolam can cause an overdose. And alprazolam may be the most dangerous benzo in overdose situations. Research has shown that alprazolam overdoses require treatment in an intensive care unit (ICU) more often than overdoses from other benzos.
An overdose is more likely if you combine alprazolam with other medications and substances that can cause drowsiness and slowed breathing. These include medications and substances like zolpidem (Ambien), opioids, and alcohol. Additionally, an alprazolam overdose is more likely if the medication is misused or if you have sedative use disorder. So look for the signs of misuse and consider the best ways to talk to your loved one if you’re concerned.
Benzo overdoses are medical emergencies that need immediate attention, usually in a hospital. Symptoms may include extreme tiredness, confusion, or slowed breathing. Some people may experience severe agitation or hallucinations. If you think you’ve witnessed someone having a benzo overdose, call 911 immediately.
10. Withdrawal symptoms
Benzodiazepine withdrawal symptoms can occur when you stop taking alprazolam. Symptoms may include nausea, diarrhea, and sweating more than usual. Anxiety, tremors, and restlessness can also occur. In serious cases, seizures and hallucinations can happen.
Benzodiazepine withdrawal can happen even if you’re taking your medication as prescribed. While the symptoms are uncomfortable, it can often be managed at home with guidance from your healthcare team. However, it can be dangerous and even life-threatening in some cases, requiring treatment in a hospital
Because of the risk of withdrawal, you should never stop taking benzos abruptly. And if you’re reducing your dose, work with your healthcare team to lower it slowly.
Frequently asked questions
Alprazolam isn’t typically recommended to treat insomnia (trouble sleeping). Non-benzodiazepine medications are usually first-choice options. But if a benzodiazepine is needed, other benzos, such as temazepam (Restoril), are typically recommended because their effects last longer.
If you're prescribed alprazolam for another reason, try to take the lowest effective dose for the shortest amount of time possible. Work with your prescriber to determine what amount that is. In some cases, you and your prescriber may determine that taking alprazolam daily or nightly is best for you
People over the age of 65 are more likely to have dangerous effects from alprazolam and other benzos. For example, you may be more likely to have a fall.
Other medications are available to treat the same conditions as Xanax but they have fewer risks for older adults. That’s why benzos such as alprazolam are best avoided in this age group unless your prescriber feels the benefits outweigh the risks.
The bottom line
Alprazolam (Xanax) is a benzodiazepine medication that can treat anxiety and panic disorder. But it’s a controlled substance and comes with many risks and side effects.
Side effects of alprazolam include drowsiness, coordination problems, and lightheadedness. You may also experience short-term memory problems, though benzodiazepines haven’t been proven to cause long-term memory issues like dementia. Severe effects like falls, misuse, and overdose are also possible. People who have overdosed on alprazolam need immediate medical care.
Be sure to take alprazolam exactly as prescribed. This can help ensure your doses are safe and help you avoid severe side effects. Don’t stop taking this medication suddenly without talking to your prescriber first, as it can lead to withdrawal symptoms
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References
2023 American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society.
American Speech-Language-Hearing Association. (n.d.). Dysarthria.
Crowe, S. F., et al. (2017). The residual medium and long-term cognitive effects of benzodiazepine use: An updated meta-analysis. Archives of Clinical Neuropsychology.
George, T. T., et al. (2023). Alprazolam. StatPearls.
Isbister, G. K., et al. (2004). Alprazolam is relatively more toxic than other benzodiazepines in overdose. British Journal of Clinical Pharmacology.
NuCare Pharmaceuticals. (2024). Alprazolam- alprazolam tablet [package insert].
Solanki, B., et al. (2023). Benzodiazepines reduce blood pressure in short term: A systematic review and meta-analysis. Current Hypertension Reports.
U.S. Department of Justice Drug Enforcement Administration. (n.d.). Drug scheduling.
U.S. Food and Drug Administration. (2022). FDA requiring boxed warning updated to improve safe use of benzodiazepine drug class.
Yilmaz, S., et al. (2011). Comparison of alprazolam versus captopril in high blood pressure: a randomized controlled trial. Blood Pressure.
Zoroufchi, B. H., et al. (2021). Benzodiazepines related sexual dysfunctions: A critical review on pharmacology and mechanism of actionDisfunciones sexuales relacionadas con las benzodiazepinas: una revisión crítica sobre farmacología y mecanismo de acción. Revista Internacional de Andrología.
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