Alprazolam Use, Side Effects, and Risks

Reading Time: 7 minutes

Individuals experiencing debilitating anxiety may use medication to manage their symptoms. One popular medication, alprazolam, has received approval from the U.S. Food and Drug Administration (FDA) to treat symptoms of anxiety and panic.1

Despite the benefits, researchers have noticed a dangerous trend in how people use this medication. With heightened stress and anxiety associated with the pandemic, some people may avoid seeing their doctor and turn to illicit markets for substances to treat their anxiety.2

The rise in counterfeit medications poses a threat to public health. Illegally marketed alprazolam may have a higher potency or become laced with other substances during the manufacturing process.2

Alprazolam Use

Manufacturers developed this medication from a class of substances known as benzodiazepines. Currently, physicians prescribed alprazolam under the brand name Xanax.1

This medication works to slow down or block processes in the brain related to anxiety.1 These effects make alprazolam a sedative-hypnotic substance. Though these sedative effects result in drowsiness, research has shown a weaker effect in alprazolam than other benzodiazepines.

FDA-approved uses of alprazolam include anxiety and panic disorders.3 Dosages for treating these disorders will vary depending on the condition treated, age of the recipient and the medication prescribed.3 Prescription alprazolam can come in many different forms such as:

  • Tablets
  • Extended-release tablets
  • Tablets that disintegrate orally
  • Liquid solution

Though the FDA approved this medication for anxiety-based disorders, some research has shown alprazolam may have other benefits.3 Some of the reported non-FDA approved benefits include:

  • Lack of sleep
  • Depressed mood
  • Symptoms of premenstrual syndrome

Some professionals have questioned the studies which promote off-label alprazolam use. Researchers noted the poor quality of the studies, potential bias in favor of alprazolam use, and concerns for the sources of funding that supported the studies.4

You may have considered using alprazolam recreationally. Many people misuse this medication for its sedative, euphoric, and relaxing effects.4 Using this medication beyond its prescription purpose or obtaining it from illicit markets increases your likelihood of experiencing the health risks associated with alprazolam use.

Alprazolam Side Effects

While you may benefit from prescription use, you may also experience some alprazolam side effects.5 Some unwanted effects of alprazolam use include:3,5

  • Dizziness
  • Drowsiness
  • Insomnia
  • Difficulty concentrating
  • Depressed mood
  • Irritable mood
  • Headache
  • Memory issues
  • Sweatiness
  • Changes in vision
  • Changes in speech
  • Changes in sex drive
  • Changes in blood pressure
  • Sleep loss
  • Loss of balance
  • Diarrhea
  • Vomiting
  • Nausea
  • Changes in appetite or weight
  • Swelling in hands or feet

If you have a prescription, review documentation and talk to a medical professional to learn more about alprazolam warnings that may affect you. Your doctor may want to monitor your breathing and heart functioning when you begin taking this medication.3

Effects of Taking Alprazolam with Other Medications

Taking this medication alongside other medications can have risks.5 Other drugs and substances that can interact with alprazolam include:1

  • Grapefruit or grapefruit juice
  • Anti-fungal medications, which can lead to severe effects
  • Carbamazepine, which can reduce the effects of alprazolam
  • Other medications such as fluoxetine which can amplify alprazolam’s effects

Talk with your doctor about potential interactions or side effects. Some interactions can be fatal.5

Safety Concerns

Alprazolam use can lead to other severe safety concerns. Drowsiness associated with alprazolam use may make it unsafe for you to drive or operate heavy machinery.3 Talk to your doctor immediately if you experience any of the following safety concerns while taking this medication:

  • Suicidal thoughts
  • Increased anxiety
  • Mood swings
  • Confusion
  • Shortness of breath
  • Extreme fatigue or tiredness
  • Severe dizziness or imbalance
  • Trouble speaking
  • Changes in your menstrual cycle
  • Problems with urination

Alprazolam Effects for Those with Other Conditions

If you have certain medical or personal conditions, you may have a higher risk of developing other health concerns while taking alprazolam. This medication may impact pregnant women by placing their unborn children at higher risk of experiencing adverse effects from alprazolam.5

If you experience depression, alprazolam may worsen your mood or increase your risk of manic symptoms.5 If you have a history of severe breathing issues, this medication may worsen breathing problems resulting in death.5 Manufacturer’s guidelines recommend you stop taking this medication if you develop certain health conditions such as these while using this medication.5 Check with a medical professional or seek emergency support if signs of severe side effects occur.

If you have a history of substance use disorders or actively use other substances, your risk of developing health concerns increases.5 Using alprazolam with other substances, such as opioids and alcohol, can increase your risk of severe side effects, including overdose and death.5

Treat respiratory depression and overdose as emergencies. Seek medical treatment immediately if those problems develop while using this medication.

Dependence, Withdrawal, and Overdose

If you have used alprazolam for an extended period, as prescribed or recreationally, your risk of dependence increases. Dependence on alprazolam or other benzodiazepine substances can create challenges when you attempt to stop using this medication.

Individuals with a higher sensitivity to benzodiazepines may have a higher risk of experiencing side effects or addiction.5 The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, describes substance use disorders, including those associated with benzodiazepine or alprazolam use.

Signs that you may experience a substance use disorder include:6

  • Using this medication for longer than you originally intended
  • Taking larger doses to get high or have a particular effect
  • Weakened effects of alprazolam at consistent dosages
  • Cravings to use the medication
  • Inability to cut back or quit using
  • Using despite adverse effects at home, work, school, or other areas of life
  • Giving up important activities due to use
  • Spending large amounts of time seeking the medication
  • Using in dangerous situations, such as driving or operating heavy machines
  • Using despite harmful physical or psychological effects

Symptoms that developed over 12 months may signal that you have developed a substance use disorder. Only a qualified professional can provide you with a diagnosis and offer the treatment that you need. Call 800-681-1058 (Info iconWho Answers?) to speak with a treatment specialist who can discuss options for substance use recovery.

Alprazolam Withdrawal

If you have used alprazolam for an extended period, recreational or prescribed, you may experience withdrawal symptoms when attempting to quit this medication.5 Withdrawal symptoms can have a stressful mental and physical effect making it hard for you to quit, even if you want to.6

Withdrawal symptoms can lead to “rebound anxiety” that can lead to panic attacks or worse anxiety.4 These symptoms may vary depending on how long the medication was taken, sensitivity to benzodiazepines, the amount of medication taken, and the symptoms present before starting the medication.6

Some symptoms of withdrawal include:5,6

  • Involuntary movements
  • Sweating
  • Tremors
  • Stiffness
  • Muscle pain
  • Panic attacks
  • Depressed mood
  • Changes in perception or connection with reality
  • Dissociative symptoms
  • Fatigue
  • Headaches
  • Stomach problems
  • Weight loss
  • Loss of appetite
  • Diarrhea
  • Vomiting
  • Nausea
  • Changes in blood pressure
  • Changes in heat rate
  • Dizziness
  • Sensitivity to sensory stimulation, especially loud noises
  • Irritable mood
  • Memory problems
  • Restlessness
  • Sleep problems
  • Nightmares

Severe, potentially fatal withdrawal symptoms include:5,6

  • Unintentional strange movements
  • A lack of movement
  • Convulsions
  • Delirium tremens
  • Symptoms of psychosis
  • Hallucinations, sensing things that are not there
  • Delusions, intense illogical or distorted thoughts or beliefs
  • Manic symptoms
  • Seizures
  • Rage
  • Violence
  • Suicidal thoughts
  • Homicidal thoughts

Withdrawal symptoms may start shortly after you stop using this medication, especially if you stop using it completely.5 Withdrawal symptoms can last from several weeks to over a year at a time.5 Doctors will attempt to taper off or gradually reduce dosages to manage potential symptoms of withdrawal.5 These symptoms, along with other psychiatric concerns, can further complicate treatment for withdrawal.

Your prescribing professional may recommend stopping the use of alprazolam if life-threatening thoughts or behaviors occur.5 If you or someone you know experiences severe symptoms of withdrawal, seek medical attention immediately.

Alprazolam Overdose Symptoms

Overdose presents another potentially fatal consequence you may experience, especially when misusing alprazolam.5 Overdose can occur when you have taken too much alprazolam. Alcohol, or other substances such as heroin, can slow brain functioning and increase your risk of overdose when taken with alprazolam.5

Signs of overdose can include:5

  • Confusion
  • Excessive drowsiness
  • Lowered coordination and reflexes
  • Coma
  • Death

If you experience an overdose, seek emergency medical attention immediately. Medical professionals will monitor your heart rate, blood pressure, and breathing for safety.5 Prescribers may recommend using flumazenil, a type of blocker for benzodiazepines, which can reverse the effects of alprazolam.3

Getting help when you need it can prevent lasting consequences from an overdose on alprazolam and other substances.

Treatment for Alprazolam Abuse, Addiction, and Overdose

Whether you have experienced an overdose, emergency, dependence, or episode of misuse with alprazolam, treatment may benefit you.

Some symptoms associated with alprazolam use might relate to a mental health disorder.6 A qualified health professional can offer you a diagnosis, guidance, and access to services to get you the help you need.

Seek medical attention immediately if you have experienced any of the severe symptoms listed above. Once you have achieved a basic level of balance in your physical and mental state, you can discuss treatment options with your provider.

You might want to consider residential or inpatient treatment services for a more severe alprazolam addiction.7 These levels of care can guide you safely through the process of withdrawal and early recovery. Individual, group, family, as well as medication-assisted therapies and treatments can help you manage your symptoms.7 Get connected with a treatment specialist today by calling 800-681-1058 (Info iconWho Answers?) to discuss the best care options for you.


  1. Hamidovic, A., PharmD. (2019). Alprazolam. In B. Narins (Ed.), The Gale Encyclopedia of Mental Health (4th ed., Vol. 1, pp. 60-61). Gale.
  2. U.S. National Library of Medicine. (2020, September 23). Alprazolam: MedlinePlus Drug Information.
  3. Islam, F. A., Choudhry, Z. U., & Choudhry, Z. (2020, August 1). Revisiting Xanax amid the coronavirus crisis. Clinical Psychiatry News, 48(8), 8.
  4. George, T. T., & Tripp, J. (2020, August 14). Alprazolam. StatPearls.
  5. Ait-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018). A Review of Alprazolam Use, Misuse, and Withdrawal. Journal of Addiction Medicine, 12(1), 4.
  6. U.S. Food and Drug Administration. (Revised March 2021). Xanax (alprazolam): package insert. Accessed March 29, 2021.
  7. American Psychiatric Association. (2013). Substance-related and addictive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.).
  8. Miller, W. R., Forcehimes, A. A., & Zweben, A. (2011). Treating addiction: A guide for professionals. The Guilford Press.
Pen iconAuthor
Ruben Bermea, LPC
Licensed Professional Counselor, Author
Ruben Bermea, LPC, is a Licensed Professional Counselor who has had the privilege of serving Texans as they navigate personal and mental health challenges. Ruben has provided therapy to clients in inpatient, residential, private practice, and community mental health settings. His personal and professional interests include the intersection between technology and mental health, the impact of misinf