Alprazolam: uses, side effects and safety
Alprazolam (Xanax) is a benzodiazepine. It is a US Schedule IV controlled substance. It is prescription only (rx) and remains on the US market.
What is Alprazolam?
Alprazolam is the generic name for Xanax, and belongs to the Benzodiazepine class.
| Generic name | alprazolam |
|---|---|
| Brand name(s) | Xanax |
| Drug class | Benzodiazepine |
| US legal status | US Schedule IV · Prescription only (Rx) |
| Route | Oral |
| Prescription required | Yes |
| Elimination half-life | Mean plasma elimination half-life approximately 11.2 hours (range 6.3-26.9 hours) in healthy adults; mean 16.3 hours (range 9.0-26.9 hours) in healthy elderly subjects |
| Time to peak concentration | 1-2 (peak plasma concentration occurs in 1 to 2 hours post dose) |
| Metabolism | Extensively metabolized in humans, primarily by cytochrome P450 3A4 (CYP3A4), to inactive metabolites |
What is Alprazolam used for?
Alprazolam is approved by the FDA for the following uses. Approval is granted per indication, and a specific product may not be approved for all of them.
- Acute treatment of generalized anxiety disorder
- Panic disorder (with or without agoraphobia)
How does Alprazolam work?
Binds to the benzodiazepine site of gamma-aminobutyric acid-A (GABA-A) receptors in the brain and enhances GABA-mediated synaptic inhibition.
It is metabolised primarily by Extensively metabolized in humans, primarily by cytochrome P450 3A4 (CYP3A4), to inactive metabolites.
The elimination half-life is roughly Mean plasma elimination half-life approximately 11.2 hours (range 6.3-26.9 hours) in healthy adults; mean 16.3 hours (range 9.0-26.9 hours) in healthy elderly subjects. Longer half-lives mean the drug and its active metabolites persist in the body for longer after the last dose.
Common side effects of Alprazolam
These are the side effects people report most often. Many diminish after the body adjusts, usually within one to two weeks.
- Panic disorder trials: drowsiness 77%, fatigue and tiredness 49%, impaired coordination 40%, irritability 33%, memory impairment 33%, cognitive disorder 29%, dysarthria 23%, confusional state 10%
- Generalized anxiety trials: drowsiness 41%, light-headedness 21%, dry mouth 15%, increased salivation 4%, hypotension 5%, dizziness 2%
- Discontinuation-emergent symptoms (alprazolam n=641): insomnia 29.5%, light-headedness 19.3%, anxiety 19.2%, fatigue and tiredness 18.4%, abnormal involuntary movement 17.3%, headache 17.0%, nausea/vomiting 16.5%, sweating 14.4%
What does Alprazolam interact with?
Interactions matter because two safe medicines can become dangerous together. The entries below are the ones most likely to cause harm.
- Opioids (boxed warning: profound sedation, respiratory depression, coma, death)
- Alcohol and other CNS depressants
- CYP3A4 inhibitors (e.g., ketoconazole, itraconazole) can increase alprazolam exposure
- Digoxin: increased digoxin concentrations reported, especially in patients over 65 years of age
Use our drug interaction checker before combining any two prescriptions.
Serious side effects and warning signs
Seek emergency care for any of these
- Boxed warning: concomitant use with opioids may result in profound sedation, respiratory depression, coma, and death
- Withdrawal seizures with abrupt discontinuation or rapid dose reduction
- Transient amnesia and memory impairment
- Suicidal behavior and ideation (antiepileptic class warning)
- Paradoxical reactions such as stimulation, agitation, or increased spasticity
Suspected overdose or a bad reaction should be reported to Poison Control on 1-800-222-1222. That is staffed around the clock and is free.
Legal status of Alprazolam
Alprazolam is a Schedule IV controlled substance in the United States. That placement is set out in Title 21 of the Code of Federal Regulations, Part 1308, and enforced by the Drug Enforcement Administration. It carries restrictions on prescribing, storage, record-keeping and transfer.
Statutory reference: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a23063c0-099a-4256-b95f-3a857bbf704b.
Can you get Alprazolam without a prescription?
Short answer: no. Alprazolam is a prescription medication. Sites advertising it without one are either operating illegally or selling something other than what they claim. We explain the legal routes, the counterfeit problem and how to check a source in detail.
Read the full answer: Alprazolam without a prescription →
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What is Alprazolam used for?
Acute treatment of generalized anxiety disorder Panic disorder (with or without agoraphobia)
What schedule is Alprazolam in the United States?
Alprazolam is a Schedule IV controlled substance in the US, listed at 21 CFR Part 1308. Schedule IV means the drug has a defined potential for abuse and is subject to federal record-keeping, storage and prescribing restrictions.
What are the common side effects of Alprazolam?
The most frequently reported side effects are panic disorder trials: drowsiness 77%, fatigue and tiredness 49%, impaired coordination 40%, irritability 33%, memory impairment 33%, cognitive disorder 29%, dysarthria 23%, confusional state 10%, generalized anxiety trials: drowsiness 41%, light-headedness 21%, dry mouth 15%, increased salivation 4%, hypotension 5%, dizziness 2%, discontinuation-emergent symptoms (alprazolam n=641): insomnia 29.5%, light-headedness 19.3%, anxiety 19.2%, fatigue and tiredness 18.4%, abnormal involuntary movement 17.3%, headache 17.0%, nausea/vomiting 16.5%, sweating 14.4%. Many lessen over the first week or two of treatment.
What should not be combined with Alprazolam?
The most clinically important interactions are with opioids (boxed warning: profound sedation, respiratory depression, coma, death), alcohol and other cns depressants, cyp3a4 inhibitors (e.g., ketoconazole, itraconazole) can increase alprazolam exposure, digoxin: increased digoxin concentrations reported, especially in patients over 65 years of age. Always give a pharmacist or prescriber a complete list of everything you take, including over-the-counter drugs and supplements.
Sources & references
Important
This site provides educational information only and does not sell, prescribe or dispense medications. Always consult a licensed healthcare provider. This page is not medical advice.