Alprazolam Side Effects: What You Need to Know

Alprazolam (brand name Xanax) is one of the most commonly prescribed benzodiazepines in the United States, used to treat generalized anxiety disorder and panic disorder. Like any medication, it comes with potential side effects — some mild, some serious.

Understanding what's normal and what's not can help you feel more confident about your treatment and know when to reach out to your doctor.

What Is Alprazolam?

Alprazolam is a Schedule IV controlled substance in the benzodiazepine class. It works by enhancing the effects of GABA, a calming neurotransmitter in your brain. It's available as immediate-release tablets, extended-release tablets (Xanax XR), orally disintegrating tablets (Niravam), and an oral solution. For a deeper look at what Alprazolam is and how it's used, see our full guide.

Common Side Effects

Most people who take Alprazolam experience at least some side effects, especially when starting the medication or increasing the dose. These are typically mild and often improve as your body adjusts:

• Drowsiness — The most commonly reported side effect. It affects a significant percentage of patients and is usually most noticeable in the first few days.
• Fatigue — Feeling more tired than usual, especially in the afternoon.
• Dizziness or light-headedness — Particularly when standing up quickly.
• Impaired coordination — You may feel clumsy or unsteady on your feet.
• Memory problems — Some people report difficulty forming new memories while the medication is active.
• Difficulty concentrating — Mental sharpness may be reduced.
• Irritability — Some patients notice increased irritability, especially between doses.
• Dry mouth — A frequent but manageable complaint.
• Changes in appetite — Either increased or decreased appetite.
• Constipation — Usually mild.
• Weight changes — Can go in either direction.

These side effects are listed in the FDA-approved labeling for Alprazolam and are well-documented in clinical studies.

Serious Side Effects

While less common, some side effects require immediate medical attention. Contact your doctor or go to the emergency room if you experience:

• Respiratory depression — Slow, shallow, or difficult breathing. This risk is significantly higher if you're also taking opioids or drinking alcohol. The FDA has issued a boxed warning about combining benzodiazepines with opioids due to the risk of coma and death.
• Severe allergic reactions — Swelling of the face, lips, tongue, or throat; difficulty breathing; hives.
• Suicidal thoughts — If you notice new or worsening depression, thoughts of self-harm, or unusual behavior changes, seek help immediately.
• Paradoxical reactions — In rare cases, Alprazolam can cause the opposite of what you'd expect: increased agitation, rage, hallucinations, or aggressive behavior.
• Seizures — This typically occurs when the medication is stopped abruptly rather than tapered. Never stop Alprazolam suddenly without medical supervision.

Specific Populations at Higher Risk

Certain groups need extra monitoring when taking Alprazolam:

Older Adults

Seniors are more sensitive to benzodiazepines. They're at higher risk for falls, excessive sedation, and cognitive impairment. Doctors typically start older patients at a lower dose — 0.25 mg two to three times daily — and increase slowly.

People with Liver Problems

Alprazolam is metabolized by the liver. If your liver isn't working well, the drug stays in your system longer and side effects become more pronounced. Dose reductions are standard for patients with hepatic impairment.

Pregnant and Breastfeeding Women

Alprazolam is classified as Pregnancy Category D, meaning there's evidence of risk to the fetus. Babies exposed to benzodiazepines late in pregnancy may experience sedation and withdrawal symptoms after birth. Alprazolam also passes into breast milk, so breastfeeding while taking it is generally not recommended.

People Taking Opioids

The combination of Alprazolam and opioid painkillers is one of the most dangerous drug interactions — the FDA's boxed warning specifically addresses this risk.

How to Manage Common Side Effects

Here are practical strategies for dealing with the most common side effects:

• Drowsiness and fatigue: Take your dose at bedtime if your doctor allows it. Avoid driving or operating machinery until you know how Alprazolam affects you.
• Dizziness: Stand up slowly from sitting or lying positions. Stay hydrated.
• Memory issues: Use reminders, notes, and alarms for important tasks. This side effect often improves over time.
• Dry mouth: Sip water frequently, chew sugar-free gum, or use a saliva substitute.
• Constipation: Increase fiber and water intake. A mild over-the-counter laxative can help if needed.
• Appetite changes: Maintain regular meal times even if you don't feel hungry.

If any side effect feels unmanageable, talk to your doctor. They may adjust your dose, switch you to a different formulation like the extended-release tablet, or consider an alternative medication.

A Note About Dependence and Withdrawal

Alprazolam can cause physical dependence, even when taken as prescribed. This means your body adapts to the medication, and stopping suddenly can trigger withdrawal symptoms including anxiety, insomnia, tremors, and in severe cases, seizures.

This is not the same as addiction, though addiction is also a risk. The key to safe use is:

1. Take only the dose your doctor prescribed.
2. Don't stop abruptly — always taper under medical supervision.
3. Keep your follow-up appointments so your doctor can monitor you.

Final Thoughts

Alprazolam is effective for anxiety and panic disorder, but it's not without risks. Most side effects are mild and manageable, especially at lower doses. The serious risks — respiratory depression, dependence, and dangerous interactions — are real but largely preventable with proper medical supervision.

If you're currently taking Alprazolam and need to fill your prescription, Medfinder can help you find a pharmacy with it in stock near you.