Alternatives to Alprazolam: What to Know

If you've been prescribed Alprazolam (Xanax) for anxiety or panic disorder and can't find it at your pharmacy, you may be wondering: are there alternatives? The short answer is yes — there are several medications that treat similar conditions and may be easier to find.

However, switching medications is a decision that should always be made with your doctor or prescriber. Never stop taking Alprazolam on your own or substitute another medication without medical guidance. Benzodiazepine withdrawal can be dangerous, and your provider needs to manage any transition safely.

What Is Alprazolam and How Does It Work?

Alprazolam is a benzodiazepine — a class of medications that work by enhancing the activity of gamma-aminobutyric acid (GABA) in the brain. GABA is the brain's main calming neurotransmitter. When Alprazolam binds to GABA-A receptors, it increases GABA's inhibitory effects, which reduces anxiety, slows racing thoughts, and can stop panic attacks relatively quickly.

Alprazolam is FDA-approved for:

• Generalized anxiety disorder (GAD)
• Panic disorder with or without agoraphobia

It's known for its fast onset of action — most patients feel the effects within 15 to 30 minutes — and its relatively short half-life of about 11 hours. This makes it effective for acute anxiety but also means it needs to be taken multiple times per day.

Why Might You Need an Alternative?

There are several reasons your doctor might recommend switching from Alprazolam:

• Availability issues: Alprazolam can be hard to find due to controlled substance distribution limits and pharmacy stocking policies.
• Dependence concerns: Long-term benzodiazepine use carries a risk of physical dependence, and your provider may want to transition you to a non-addictive option.
• Side effects: Drowsiness, memory issues, or coordination problems may warrant trying a different medication.
• Drug interactions: Alprazolam interacts with opioids, certain antifungals, and other medications that may be necessary for your care.

Alternative 1: Lorazepam (Ativan)

Lorazepam is another benzodiazepine commonly used for anxiety. Like Alprazolam, it enhances GABA activity to produce a calming effect.

Key differences from Alprazolam:

• Lorazepam is metabolized by glucuronidation (not CYP3A4), making it a better choice for patients taking medications that affect liver enzymes.
• It has a slightly longer onset but similar duration of action.
• Available as tablets, oral solution, and injectable forms.
• Also a Schedule IV controlled substance.

Lorazepam is commonly prescribed for anxiety, insomnia, and as a pre-procedural sedative. It may be easier to find because of different stocking patterns at pharmacies.

Alternative 2: Clonazepam (Klonopin)

Clonazepam is a longer-acting benzodiazepine FDA-approved for panic disorder and certain seizure disorders.

Key differences from Alprazolam:

• Longer half-life (18-50 hours vs. ~11 hours for Alprazolam), meaning fewer daily doses.
• Slower onset of action, so it's less effective for acute panic attacks but provides steadier, longer-lasting anxiety relief.
• Available as tablets and orally disintegrating tablets.
• Also a Schedule IV controlled substance.

Your doctor might consider Clonazepam if you need longer-lasting anxiety coverage or if taking medication multiple times a day is difficult for you.

Alternative 3: Buspirone (BuSpar)

Buspirone is fundamentally different from Alprazolam. It's not a benzodiazepine and is not a controlled substance, which means it's much easier to find and has no risk of physical dependence.

Key differences from Alprazolam:

• Works on serotonin (5-HT1A) receptors rather than GABA receptors.
• Takes 2 to 4 weeks to reach full effectiveness — it's not useful for acute panic attacks.
• No sedation, no risk of dependence, no withdrawal syndrome.
• FDA-approved for generalized anxiety disorder.

Buspirone is a strong option if your doctor is looking to move you away from benzodiazepines entirely, especially for long-term anxiety management.

Alternative 4: Hydroxyzine (Vistaril/Atarax)

Hydroxyzine is an antihistamine that's used off-label for anxiety relief. It's not a controlled substance and is widely available.

Key differences from Alprazolam:

• Works by blocking histamine receptors, producing a calming and mildly sedating effect.
• Fast-acting (30-60 minutes) but not as potent as benzodiazepines.
• No risk of dependence or addiction.
• Available as capsules, tablets, oral syrup, and injectable forms.

Hydroxyzine can be helpful for situational anxiety — for example, before a stressful event — and is often prescribed when benzodiazepines are not appropriate.

Other Options Worth Discussing With Your Doctor

Beyond these four alternatives, other medication classes may help:

• SSRIs (Sertraline, Escitalopram): First-line medications for long-term anxiety and panic disorder treatment. Non-addictive but take weeks to work.
• SNRIs (Venlafaxine, Duloxetine): Similar to SSRIs, effective for generalized anxiety and panic disorder.
• Propranolol: A beta-blocker that helps with physical symptoms of anxiety like rapid heartbeat, sweating, and trembling. Often used for performance anxiety.

Final Thoughts

If you can't find Alprazolam at your pharmacy, alternatives exist — but the transition should always be supervised by your healthcare provider. Never stop Alprazolam abruptly or switch to a different medication on your own.

Start by trying to locate Alprazolam using Medfinder or checking our guide to finding it in stock. If it's genuinely unavailable in your area, schedule a conversation with your prescriber about which alternative makes the most sense for your situation.

For more about how Alprazolam works, see our detailed guide on Alprazolam's mechanism of action.