Drugs Q & A

What Are The Side Effects of Xanax (Alprazolam)?

Xanax is a brand of alprazolam, a fast-acting tranquilizer of medium duration in the triazolobenzodiazepine class, which are benzodiazepines fused with a triazole ring.

Xanax is used for the treatment of anxiety disorder (a condition corresponding most closely to the APA Diagnostic and Statistical Manual [DSM-III-R] diagnosis of generalized anxiety disorder), or the short-term relief of symptoms of anxiety. Generalized anxiety disorder (also anxiety) is characterized by unrealistic or excessive anxiety and worry over circumstances of life for a period of time. Anxiety or tension problems associated with the stress of everyday life usually do not require treatment with this drug. Alprazolam tablets are also indicated for the treatment of panic disorder, with or without agoraphobia. This drug is also used as a treatment for anxiety associated with depression.

•        This medication must be prescribed by a doctor and is available by prescription only.

•        This medication should not be used by patients who are pregnant. The use of this drug may affect the health of the baby.

•        Patients taking this drug or other benzodiazepines should not consume alcohol.

•        This drug may be habit-forming and has the potential to cause extreme dependence or abuse in some patients.

•        Side effects that are most commonly associated with this drug are drowsiness and lightheadedness.

•        Patients taking this drug should alert their doctors about any problems from the use of this medication and any troublesome side effects.

•        Read the information leaflet that accompanies the prescription as well as every time the prescription is refilled. There may be new health information.

Alprazolam is available under the following different brand names: Xanax, Niravam, and Xanax XR.

How should this medicine be used?

Alprazolam comes as a tablet, an extended-release tablet, an orally disintegrating tablet (tablet that dissolves quickly in the mouth), and a concentrated solution (liquid) to take by mouth. The tablet, orally disintegrating tablet and concentrated solution usually are taken two to four times a day. The extended-release tablet is taken once daily, usually in the morning. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take alprazolam exactly as directed.

To take the concentrated liquid, use only the dropper that came with your prescription. Draw into the dropper the amount prescribed for one dose. Squeeze the dropper contents into a liquid or semisolid food such as water, juice, soda, applesauce, or pudding. Stir the liquid or food gently for a few seconds. The concentrated liquid will blend completely with the food. Drink or eat the entire mixture immediately. Do not store for future use.

Remove the orally disintegrating tablet from the bottle just before it is time for your dose. With dry hands, open the bottle, remove the tablet, and immediately place it on your tongue. The tablet will dissolve and can be swallowed with saliva. The orally disintegrating tablet can be taken with or without water.

Swallow the extended-release tablets whole; do not chew, crush, or break them.

Your doctor will probably start you on a low dose of alprazolam and gradually increase your dose, not more than once every 3 or 4 days.

What are the side effects of Xanax?

Side effects of Xanax requiring immediate medical attention.

Along with its needed effects, alprazolam (the active ingredient contained in Xanax) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

According to drugs.com check with your doctor immediately if any of the following side effects occur while taking alprazolam:

More common

•        Being forgetful

•        changes in patterns and rhythms of speech

•        clumsiness or unsteadiness

•        difficulty with coordination

•        discouragement

•        drowsiness

•        feeling sad or empty

•        irritability

•        lack of appetite

•        lightheadedness

•        loss of interest or pleasure

•        relaxed and calm

•        shakiness and unsteady walk

•        sleepiness

•        slurred speech

•        tiredness

•        trouble concentrating

•        trouble performing routine tasks

•        trouble sleeping

•        trouble speaking

•        unsteadiness, trembling, or other problems with muscle control or coordination

•        unusual tiredness or weakness

Less common

•        Blurred vision

•        body aches or pain

•        burning, crawling, itching, numbness, prickling, “pins and needles, or tingling feelings

•        changes in behavior

•        chills

•        clay-colored stools

•        confusion about identity, place, and time

•        cough

•        dark urine

•        decrease in the frequency of urination

•        decrease in urine volume

•        diarrhea

•        difficult or labored breathing

•        difficulty in passing urine (dribbling)

•        difficulty with concentration

•        difficulty with moving

•        dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

•        dry mouth

•        ear congestion

•        environment seems unreal

•        fainting

•        feeling of unreality

•        feeling warm

•        fever

•        general feeling of discomfort or illness

•        headache

•        inability to move the eyes

•        inability to sit still

•        increased blinking or spasms of the eyelid

•        irregular heartbeats

•        itching or rash

•        joint pain

•        lack or loss of self-control

•        loss of bladder control

•        loss of coordination

•        loss of memory

•        loss of voice

•        mood or mental changes

•        muscle aches, cramps, pain, stiffness, or weakness

•        nausea

•        need to keep moving

•        painful urination

•        problems with memory

•        restlessness

•        runny or stuffy nose

•        seeing, hearing or feeling things that are not there

•        seizures

•        sense of detachment from self or body

•        shaking

•        shivering

•        sneezing

•        sore throat

•        sticking out of the tongue

•        stomach pain

•        sweating

•        swollen joints

•        talkativeness

•        tightness in the chest

•        trouble with balance

•        twitching, twisting, or uncontrolled repetitive movements of the tongue, lips, face, arms, or legs

•        uncontrolled twisting movements of the neck, trunk, arms, or legs

•        unpleasant breath odor

•        unusual dullness or feeling of sluggishness

•        unusual facial expressions

•        unusually deep sleep

•        unusually long duration of sleep

•        vomiting of blood

•        yellow eyes or skin


•        Actions that are out of control

•        attack, assault, or force

•        chest pain

•        continuing ringing or buzzing or other unexplained noise in the ears

•        decreased awareness or responsiveness

•        deep or fast breathing with dizziness

•        ear pain

•        false or unusual sense of well-being

•        fast, irregular, pounding, or racing heartbeat or pulse

•        feeling jittery

•        feeling unusually cold

•        generalized slowing of mental and physical activity

•        hearing loss

•        hoarseness

•        lack of feeling or emotion

•        loss of control of the legs

•        loss of strength or energy

•        nightmares

•        numbness of the feet, hands, and around the mouth

•        severe sleepiness

•        shakiness in the legs, arms, hands, or feet

•        sleep talking

•        swelling

•        talking, feeling, and acting with excitement

•        thoughts of killing oneself

•        uncaring

•        unusual weak feeling

•        voice changes

Incidence not known

•        Light-colored stools

•        upper right abdominal or stomach pain

Get emergency help immediately if any of the following symptoms of overdose occur while taking alprazolam:

Symptoms of overdose

•        Change in consciousness

•        confusion

•        lack of coordination

•        loss of consciousness

•        sleepiness or unusual drowsiness

Side effects not requiring immediate medical attention

Some side effects of alprazolam may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

•        Absent, missed, or irregular menstrual periods

•        decreased appetite

•        decreased interest in sexual intercourse

•        decreased sexual performance or desire abnormal ejaculation

•        difficulty having a bowel movement (stool)

•        inability to have or keep an erection

•        increased appetite

•        increase in sexual ability, desire, drive, or performance

•        increased interest in sexual intercourse

•        increased weight

•        loss in sexual ability, desire, drive, or performance

•        stopping of menstrual bleeding

•        watering of the mouth

•        weight loss

Less common

•        Blistering, crusting, irritation, itching, or reddening of the skin

•        change in taste bad unusual or unpleasant (after) taste

•        cracked, dry, or scaly skin

•        double vision

•        feeling of warmth

•        heavy bleeding

•        menstrual changes

•        pelvic pain

•        redness of the face, neck, arms, and occasionally, upper chest

•        seeing double

•        stomach bloating and cramping

•        sudden sweating

•        unexplained runny nose or sneezing


•        Acid or sour stomach

•        belching

•        bigger, dilated, or enlarged pupils (black part of the eye)

•        change in color vision

•        difficulty seeing at night

•        feeling of constant movement of self or surroundings

•        feeling of relaxation

•        heartburn

•        hives or welts

•        increased sensitivity of the eyes to sunlight

•        indigestion

•        redness of the skin

•        sensation of spinning

•        stomach discomfort or upset

Incidence not known

•        Blistering, peeling, or loosening of the skin

•        red, irritated eyes

•        red skin lesions, often with a purple center

•        sores, ulcers, or white spots in the mouth or on the lips

•        swelling of the breasts or breast soreness in both females and males

•        unexpected or excess milk flow from the breasts

Alprazolam Side Effects In The Elderly

Studies on drug-associated hospital admissions among older patients have shown that up to 10 percent may be due to benzodiazepines such as alprazolam. Adverse drug reactions may be experienced to a greater extent by alprazolam-dependent patients, who use the drug over a prolonged period and use them more frequently.

The use of alprazolam among elderly patients has been associated with intellectual and cognitive impairment. Cognitive impairment is characterized by anterograde amnesia, diminished short-term recall, and increased forgetfulness. These symptoms are consistent with the early stages of dementia but are also characteristic of normal aging. Cognitive impairment seems to develop insidiously as a late complication of benzodiazepine use. Elderly patients with cognitive impairment show improved functioning once alprazolam has been discontinued.


Dr. Oche Otorkpa PG Cert, MPH, PhD

Dr. Oche is a seasoned Public Health specialist who holds a post graduate certificate in Pharmacology and Therapeutics, an MPH, and a PhD both from Texila American University. He is a member of the International Society of Substance Use Professionals and a Fellow of the Royal Society for Public Health in the UK. He authored two books: "The Unseen Terrorist," published by AuthorHouse UK, and "The Night Before I Killed Addiction."
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