What Is Alprazolam?

Alprazolam is a prescription benzodiazepine medication used to treat generalized anxiety disorder (GAD) and panic disorder.

You probably know it by its most famous brand name: Xanax. Originally developed by Upjohn (now part of Pfizer), Alprazolam was first approved by the FDA in 1981 and has been one of the most prescribed psychiatric medications in the United States ever since.

Alprazolam is classified as a Schedule IV controlled substance by the DEA, meaning it has a recognized medical use but also carries a risk of dependence and misuse. It's available as a generic — manufactured by companies including Greenstone, Mylan, Sandoz, Teva, and Aurobindo — as well as the brand-name products Xanax, Xanax XR, and Niravam.

What Is Alprazolam Used For?

Alprazolam is FDA-approved for two conditions:

• Generalized anxiety disorder (GAD) — Persistent, excessive worry that interferes with daily life.
• Panic disorder — Recurrent, unexpected panic attacks, with or without agoraphobia (fear of situations where escape might be difficult).

Doctors sometimes prescribe Alprazolam off-label for other conditions, including:

• Insomnia (short-term)
• Anticipatory anxiety (before medical procedures or flights)
• Premenstrual syndrome
• Depression (as an adjunct to other medications)
• Chemotherapy-induced nausea

For a detailed look at how Alprazolam works in the brain, see our article on Alprazolam's mechanism of action.

How Is Alprazolam Taken?

Alprazolam comes in several forms:

• Immediate-release tablets — 0.25 mg, 0.5 mg, 1 mg, and 2 mg. These work quickly (usually within 15 to 30 minutes) and are typically taken two to three times per day.
• Extended-release tablets (Xanax XR) — 0.5 mg, 1 mg, 2 mg, and 3 mg. Taken once daily, usually in the morning. Swallow whole — do not crush, chew, or split.
• Orally disintegrating tablets (Niravam) — 0.25 mg, 0.5 mg, 1 mg, and 2 mg. Place on the tongue and let it dissolve. Convenient if you have trouble swallowing pills.
• Oral solution — Available as 0.5 mg/5 mL and 1 mg/mL concentrations. Used when precise dose adjustments are needed.

Typical Dosing

Dosing depends on the condition being treated:

• Anxiety: Starting dose is usually 0.25 to 0.5 mg three times daily. Your doctor may increase gradually. Maximum dose is typically 4 mg per day.
• Panic disorder: Starting dose is 0.5 mg three times daily (immediate-release) or 0.5 to 1 mg once daily (extended-release). Maximum dose can reach up to 10 mg per day in severe cases, though most patients need far less.

Alprazolam can be taken with or without food. The most important rule: never stop taking Alprazolam suddenly. Abrupt discontinuation can cause withdrawal symptoms including seizures. Always taper gradually under your doctor's supervision.

Who Should Not Take Alprazolam?

Alprazolam is not safe for everyone. You should not take it if you have:

• A known allergy to Alprazolam or other benzodiazepines
• Acute narrow-angle glaucoma
• Severe respiratory insufficiency
• Severe liver disease

You should also avoid Alprazolam if you're taking strong CYP3A4 inhibitors like Ketoconazole or Itraconazole — these drugs prevent your body from breaking down Alprazolam properly, leading to dangerously high levels.

The FDA's boxed warning highlights the risks of combining Alprazolam with opioids, which can cause profound sedation, respiratory depression, coma, and death. For a complete list of drug interactions, see our dedicated guide.

Special Populations

• Elderly patients: Start at lower doses (0.25 mg two to three times daily) due to increased sensitivity.
• Pregnant women: Alprazolam is Pregnancy Category D — there is evidence of risk to the fetus, including neonatal sedation and withdrawal.
• Breastfeeding: Alprazolam enters breast milk. Use is generally not recommended.
• Children: Safety and effectiveness have not been established in pediatric patients.

How Much Does Alprazolam Cost?

The cost of Alprazolam varies significantly depending on whether you're buying brand or generic, your dose, and where you fill your prescription:

• Generic Alprazolam with a coupon: Approximately $10 to $25 for 30 tablets (0.5 mg strength).
• Generic at retail cash price: Around $80 to $90 for 90 tablets (1 mg) without a coupon.
• Brand-name Xanax: Can run up to $335 depending on the strength and quantity.

Most insurance plans cover generic Alprazolam as a Tier 1 preferred generic, meaning your copay will be low. Some plans require prior authorization for brand-name Xanax or impose quantity limits.

If you're paying out of pocket, there are several ways to save:

• Discount cards from GoodRx, SingleCare, or RxSaver
• The Xanax Savings Card (for brand-name — eligible patients may pay as little as $4 per month)
• Patient assistance programs through NeedyMeds or RxAssist

For a full breakdown, check our guide to saving money on Alprazolam.

Final Thoughts

Alprazolam is a well-established, effective medication for anxiety and panic disorder. It works fast, it's affordable as a generic, and it's covered by most insurance plans. But it's also a controlled substance that carries real risks — including dependence, withdrawal, and dangerous interactions with opioids and alcohol.

If you've been prescribed Alprazolam and need to fill your prescription, Medfinder can help you find a pharmacy near you that has it in stock.