If you have anxiety, you may be interested in learning about alprazolam. It’s a generic prescription drug used in adults for:

Alprazolam may be taken on a short-term or long-term basis. It comes as an oral tablet, an orally disintegrating tablet, and an oral extended-release tablet. The extended-release tablet is a long-acting form that releases the drug slowly into your system over time. This form is only used for panic disorder. Alprazolam also comes as a liquid solution, but this form is not covered in this article.

This article describes the drug’s side effects, also referred to as adverse effects. To learn more about alprazolam immediate-release tablets, including details about its uses, see this in-depth article. For more information about alprazolam orally disintegrating and extended-release tablets, or other forms of this drug, talk with your doctor or pharmacist.

Some people may experience mild to serious side effects during their alprazolam treatment. Examples of the drug’s more commonly reported side effects include:

Mild side effects have been reported with alprazolam. These include:

* To learn more about this side effect, see “Alprazolam’s side effects explained” below.

In most cases, these side effects should be temporary, and some may be easily managed. But if you have symptoms that are ongoing or bother you, talk with your doctor or pharmacist. And do not stop taking alprazolam unless your doctor recommends it.

Alprazolam may cause mild side effects other than those listed above. See the prescribing information for alprazolam tablets, orally disintegrating tablets, and extended-release tablets for details.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with alprazolam, visit MedWatch.

Serious side effects have been reported with alprazolam. These include:

If you develop serious side effects while taking alprazolam, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

* Alprazolam has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see “Alprazolam’s side effects explained” below.
† Alprazolam has a boxed warning for this side effect. This is the most serious warning from the FDA. To learn more, see the “Alprazolam and misuse” section below.
‡ To learn more about this side effect, see “Alprazolam’s side effects explained” below.

Get answers to some frequently asked questions about alprazolam’s side effects.

Do older people have a higher risk of side effects from taking alprazolam than younger people?

Yes, they might. In general, people ages 65 years and older are more likely to have side effects with alprazolam than younger people.

In particular, older people are more likely to have memory loss and concentration problems with alprazolam. They’re also more likely to have drowsiness and problems with coordination and balance. And these side effects can increase the risk of falls in older people.

Doctors usually prescribe a lower dosage of alprazolam for those ages 65 years and older to help reduce the risk of side effects.

Will I have less risk of dependence from taking a low dose of alprazolam (0.25 mg or 0.5 mg)?

You might, but other factors can also affect your risk of dependence. Alprazolam has a boxed warning* about the risk of dependence. With dependence, your body gets used to a drug and needs it for you to function as usual. Suddenly stopping a drug that you’re dependent on can cause withdrawal symptoms.

Taking a high dose of alprazolam is more likely to lead to dependence than taking a low dose, such as 0.25 milligrams (mg), 0.5 mg, or 1 mg. But the length of time you take alprazolam also affects your risk. The longer someone takes this drug, the more likely they are to become dependent on it. Other factors may also affect your risk of dependence.

If you’re concerned about your risk of dependence with the alprazolam dosage you’ve been prescribed, talk with your doctor.

* A boxed warning is a serious warning from the Food and Drug Administration (FDA). To read more about alprazolam dependence, see “Alprazolam’s side effects explained” below.

Does alprazolam cause kidney-related side effects?

No, kidney-related side effects weren’t reported in studies of alprazolam. Your kidneys help remove alprazolam from your body, so if you have kidney problems, the drug could build up in your system. This could increase your risk of side effects. But alprazolam isn’t known to damage your kidneys or affect how they work.

Is it possible to develop long-term side effects from alprazolam?

Yes, it’s possible to develop long-term side effects with alprazolam, but it’s rare. Most of alprazolam’s side effects are temporary and get better soon after you stop taking the drug.

Side effects that may last for a long time after you stop alprazolam treatment include liver problems and weight changes.

Some people may also have long-term withdrawal symptoms* after stopping alprazolam. Withdrawal symptoms are side effects that can occur if you suddenly stop taking a drug that your body depends on. (With dependence, your body gets used to a drug and needs it to function as usual.)

Some people have had withdrawal symptoms that lasted for weeks to longer than a year after stopping alprazolam. But this isn’t common.

If you’re concerned about long-term side effects with alprazolam, talk with your doctor.

* Alprazolam has a boxed warning about the risk of dependence and withdrawal. A boxed warning is a serious warning from the Food and Drug Administration (FDA). To read more about withdrawal symptoms when stopping alprazolam, see “Alprazolam’s side effects explained” just below.

Learn more about some of the side effects alprazolam may cause.

Risk of severe side effects when taken with opioids

Alprazolam has a boxed warning for the risk of severe side effects when taken with opioids.A boxed warning is a serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about side effects that can be dangerous.

Opioids are powerful drugs that include:

Both alprazolam and opioids slow activity in your central nervous system (brain and spinal cord). Taking alprazolam with opioids can cause severe side effects that can lead to coma and even death. These side effects include:

If you have any of these symptoms, you or another person should call 911 or your local emergency number immediately.

Due to the risks of taking alprazolam with opioids, your doctor will only prescribe these drugs together if there are no suitable options. And they’ll use the lowest possible dose of both drugs that work to treat your condition.

What might help

If your doctor recommends taking alprazolam with an opioid, there are a few things you can do to minimize the risks:

  • Tell your caregiver, the people you live with, and people close to you that you’re taking these drugs together.
  • Know what side effects to look out for and when you or another person should get emergency medical help.
  • Never drink alcohol with this combination of drugs.
  • Never take these drugs in a higher dose or more often than prescribed.
  • Talk with your doctor about keeping a supply of Narcan (naloxone), a nasal spray that can be used in an emergency to block the effects of opioids.

Risk of dependence and withdrawal symptoms

Alprazolam has a boxed warning for the risk of dependence and withdrawal symptoms.A boxed warning is a serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about side effects that can be dangerous.

Taking alprazolam can lead to dependence on the drug. This is when your body gets used to a drug and needs it to function as usual. Stopping alprazolam suddenly or having your dose lowered too quickly can cause withdrawal symptoms (sometimes called a withdrawal syndrome). These are side effects caused by suddenly stopping or taking too little of a drug.

These withdrawal symptoms can be mild, serious, or even life threatening. Examples include:

Withdrawal symptoms are more likely if you suddenly stop alprazolam after taking it at a high dose or for a long period of time. But in some cases, it’s also possible to have withdrawal symptoms after just missing a dose.

Rarely, some people have experienced withdrawal symptoms lasting weeks or longer than a year after stopping alprazolam.

What might help

To avoid withdrawal symptoms, do not suddenly stop taking alprazolam. When you and your doctor determine you should stop treatment, your doctor will usually reduce your dosage gradually over time. This is called a dose taper. It’s usually done over a few weeks and allows your body to adjust to being without the drug in your system.

If you have withdrawal symptoms during your dose taper, talk with your doctor. They may recommend increasing your dosage again and then decreasing it more slowly.

If you’re concerned about alprazolam dependence and withdrawal, talk with your doctor.

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you are not in the same household, stay on the phone with them until help arrives.

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Weight gain

Some people may have weight gain while taking alprazolam, but this side effect was rare in studies.

Alprazolam can also cause weight loss in some people.

This is because the drug can cause changes in your appetite that may lead to weight changes. And the anxiety disorders alprazolam is used to treat can also cause changes in your appetite and weight.

What might help

If you’re concerned about weight gain with alprazolam, talk with your doctor. They can recommend ways to maintain a weight that’s healthy for you.

Nausea

You may have nausea while taking alprazolam. This side effect was common in studies of the drug. But nausea can also be a symptom of anxiety, which alprazolam is used to treat.

What might help

If you have nausea with alprazolam, it may help to take it with food. It may also help to:

  • get plenty of fresh air
  • breathe deeply
  • drink ginger or peppermint tea
  • eat little and often rather than large main meals

If you have nausea that’s severe, bothersome, or doesn’t go away, talk with your doctor.

Hallucinations

Some people may have hallucinations while taking alprazolam. (With hallucinations, you may see, hear, smell, or sense things that aren’t really there.) But this side effect was rare in studies of the drug. Some people have also had hallucinations after suddenly stopping alprazolam. (For more information, see “Risk of dependence and withdrawal symptoms” above.)

You may have an increased risk of hallucinations if you take alprazolam with alcohol or other drugs that slow activity in your central nervous system. (This includes your brain and spinal cord.) People with certain mental health problems may also have an increased risk of hallucinations with alprazolam.

What might help

If you have hallucinations while taking alprazolam, talk with your doctor right away. They’ll likely recommend that you stop taking the drug. But do not suddenly stop taking alprazolam unless recommended by your doctor, as this could cause withdrawal symptoms. (See “Risk of dependence and withdrawal symptoms” above.)

Allergic reaction

Like most drugs, alprazolam can cause an allergic reaction in some people. Symptoms can be mild to serious and can include:

  • skin rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)
  • swelling under your skin, usually in your eyelids, lips, hands, or feet
  • swelling of your mouth, tongue, or throat, which can make it hard to breathe

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms. Examples include:

  • an antihistamine you swallow, such as Benadryl (diphenhydramine)
  • a product you apply to your skin, such as hydrocortisone cream

If your doctor confirms you’ve had a mild allergic reaction to alprazolam, they’ll decide whether you should continue using it.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you’ve had a serious allergic reaction to alprazolam, they’ll likely have you switch to a different treatment.

Keeping track of side effects

During your alprazolam treatment, consider taking notes on any side effects you’re having. You can then share this information with your doctor. This is especially helpful when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things such as:

  • what dose of the drug you were taking when you had the side effect
  • how soon you had the side effect after starting that dose
  • what your symptoms were
  • how it affected your daily activities
  • what other medications you were taking
  • any other information you feel is important

Keeping notes and sharing them with your doctor will help them learn more about how alprazolam affects you. They can then use this information to adjust your treatment plan if needed.

Alprazolam may not be right for you if you have certain medical conditions. These are known as drug-condition interactions. Other factors may also affect whether alprazolam is a good treatment option for you.

Talk with your doctor about your health history before taking alprazolam. Factors to consider include those described below.

Boxed warnings

Alprazolam has several boxed warnings, which are listed below. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

Risk of severe side effects when taken with opioids. Taking alprazolam with opioids can cause severe side effects or even death. For details, see “Alprazolam’s side effects explained” above.

Risk of dependence and withdrawal symptoms. It’s possible to become dependent on alprazolam. With dependence, your body gets used to a drug and needs it for you to function as usual. Suddenly stopping a drug you’re dependent on can cause withdrawal symptoms. For details, see “Alprazolam’s side effects explained” above.

Risk of misuse and addiction. Alprazolam is a controlled substance that has a risk of misuse. (With misuse, a drug is taken in a way other than how it’s prescribed.) Misuse of alprazolam can lead to addiction, which is when a drug is taken even if it’s causing harmful effects. For details, see the “Alprazolam and misuse” section below.

Other warnings

Alprazolam may not be right for you if you have certain medical conditions. (This is known as a drug-condition interaction.) Other factors may also affect whether this drug is a good treatment option for you. Talk with your doctor about your health history before starting alprazolam. Factors to consider include those described below.

Liver or kidney problems. If you have liver or kidney problems, alprazolam could build up in your body. This can increase your risk of side effects. If you have liver or kidney problems, your doctor may prescribe a dosage of alprazolam that’s lower than usual.

Lung or breathing problems. If you have certain lung or breathing problems, you may have an increased risk of serious breathing problems as a side effect from alprazolam. If you have lung or breathing problems, such as sleep apnea or chronic obstructive pulmonary disease (COPD), ask your doctor if alprazolam is safe for you.

Depression, mania, or bipolar disorder. Some people with depression have developed episodes of mania while taking alprazolam. And stopping alprazolam may sometimes worsen depression or cause suicidal thoughts. If you have depression, mania, or bipolar disorder, talk with your doctor about whether alprazolam is right for you.

Allergic reaction. If you’ve had an allergic reaction to alprazolam or any of its ingredients, your doctor will likely not prescribe it for you. Ask them about other medications that might be better options.

Alcohol and alprazolam

You should not take alprazolam with alcohol. Both alcohol and alprazolam slow activity in your central nervous system (brain and spinal cord). Taking them together can increase your risk of side effects such as:

Taking alprazolam with alcohol can also increase your risk of alprazolam misuse*, overdose, and even death. If you drink alcohol and you’re concerned about avoiding it with alprazolam, talk with your doctor.

* Alprazolam has a boxed warning for the risk of misuse and addiction. A boxed warning is a serious warning from the Food and Drug Administration (FDA). To learn more, see “Alprazolam and misuse” below.

Pregnancy and breastfeeding while taking alprazolam

Alprazolam is generally not recommended for use during pregnancy or while breastfeeding. Keep reading for more information.

Pregnancy

Alprazolam may cause problems with fetal development (commonly known as birth defects) if taken during pregnancy.

Taking alprazolam during pregnancy could also cause side effects in the child after delivery. The newborn may have problems, such as:

Because of these risks, doctors typically only prescribe alprazolam during pregnancy if no other treatments are available and the benefits outweigh the risks.

If you’re pregnant or planning to become pregnant, talk with your doctor about the pros and cons of taking alprazolam.

Breastfeeding

Your doctor will likely recommend that you do not breastfeed while taking alprazolam. The drug can pass into breast milk and may cause side effects in a child who’s breastfed. These side effects can include:

If you’re breastfeeding or planning to breastfeed, talk with your doctor about other treatment options for your condition. If your doctor prescribes alprazolam, talk with them about other healthy ways to feed your child.

Alprazolam has a boxed warning for the risk of misuse and addiction. A boxed warning is a serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about side effects that may be dangerous.

Alprazolam is a benzodiazepine drug that has calming and relaxing effects. Some people may misuse the drug for this reason. (With misuse, a person uses a drug in a way or for a reason other than how a doctor prescribes it.)

Misuse of alprazolam can cause serious side effects, overdose, and even death. It can also lead to addiction, in which the drug is taken even if it’s causing harmful effects.

Due to these risks, the federal government has classified alprazolam as a controlled substance. This means government agencies, doctors, and pharmacists may pay close attention to how the drug is prescribed and used.

You should only take alprazolam exactly as prescribed by your doctor. Do not take it in a higher dose, more often, or for a longer period of time than your doctor recommends. You should also be sure to keep the drug in a safe place to avoid it being misused by other people.

Alprazolam has some common side effects, which are usually mild. But there are some serious risks to consider with this drug. If you have questions about side effects that alprazolam can cause, talk with your doctor.

You can also ask them about Xanax, which is the brand-name version of alprazolam. A generic drug and its brand-name version are expected to have the same side effects because they contain the same active ingredient. An active ingredient is what makes a drug work.

Examples of questions you might want to ask your doctor include:

  • Do I have a high risk of becoming dependent on alprazolam?
  • Can alprazolam cause sexual side effects?
  • How long do the effects of alprazolam last?
  • Is it safe to take alprazolam with my other medications?

To learn more about alprazolam or Xanax, see these articles:

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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.