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Xanax

Last reviewed on RxList: 3/11/2021
Xanax Side Effects Center

Medical Editor: John P. Cunha, DO, FACOEP

What Is Xanax?

Xanax (alprazolam) is a benzodiazepine used as an anti-anxiety medication prescribed to treat panic attacks and anxiety disorders. Xanax is available in generic form.

What Are Side Effects of Xanax?

Common side effects of Xanax include:

  • Drowsiness
  • Tiredness
  • Dizziness
  • Sleep problems (insomnia)
  • Memory problems
  • Poor balance or coordination
  • Slurred speech
  • Trouble concentrating
  • Irritability
  • Diarrhea
  • Constipation
  • Increased sweating
  • Headache
  • Nausea
  • Vomiting
  • Upset stomach
  • Blurred vision
  • Appetite or weight changes
  • Swelling in your hands or feet
  • Muscle weakness
  • Dry mouth
  • Stuffy nose
  • Loss of interest in sex

Dosage for Xanax

Treatment for patients with anxiety should be initiated with a dose of 0.25 to 0.5 mg Xanax given three times daily. Treatment of many panic disorders in patients has required the use of Xanax at doses greater than 4 mg daily.

What Drugs, Substances, or Supplements Interact with Xanax?

Xanax may interact with alcohol, other medicines that make you sleepy (such as cold or allergy medicine, other sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety), birth control pills, cimetidine, cyclosporine, dexamethasone, ergotamine, imatinib, isoniazid, St. John's wort, antibiotics, antifungals, antidepressants, barbiturates, heart or blood pressure medications, HIV/AIDS medicines, seizure medications. Tell your doctor all medications and supplements you use.

Xanax During Pregnancy and Breastfeeding

Benzodiazepines, such as Xanax, can cause fetal abnormalities and should not be used in pregnancy or in nursing mothers. Xanax is excreted in human milk and can affect nursing infants. Breastfeeding while taking Xanax is not recommended.

Additional Information

Our Xanax Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

QUESTION

Panic attacks are repeated attacks of fear that can last for several minutes. See Answer
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Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Alprazolam can slow or stop your breathing, especially if you have recently used an opioid medication, alcohol, or other drugs that can slow your breathing. A person caring for you should seek emergency medical attention if you have weak or shallow breathing, if you are hard to wake up, or if you stop breathing.

Call your doctor at once if you have:

  • weak or shallow breathing;
  • a light-headed feeling, like you might pass out;
  • a seizure;
  • hallucinations, risk-taking behavior;
  • increased energy, decreased need for sleep;
  • racing thoughts, being agitated or talkative;
  • double vision; or
  • jaundice (yellowing of the skin or eyes).

The sedative effects of alprazolam may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury.

Common side effects may include:

  • drowsiness; or
  • feeling light-headed.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Xanax (Alprazolam)

SLIDESHOW

Anxiety Disorder Pictures: Symptoms, Panic Attacks, and More with Pictures See Slideshow
Xanax Professional Information

SIDE EFFECTS

Side effects to XANAX Tablets, if they occur, are generally observed at the beginning of therapy and usually disappear upon continued medication. In the usual patient, the most frequent side effects are likely to be an extension of the pharmacological activity of alprazolam, e.g., drowsiness or light-headedness.

The data cited in the two tables below are estimates of untoward clinical event incidence among patients who participated under the following clinical conditions: relatively short duration (i.e., four weeks) placebo-controlled clinical studies with dosages up to 4 mg/day of XANAX (for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety) and short-term (up to ten weeks) placebo-controlled clinical studies with dosages up to 10 mg/day of XANAX in patients with panic disorder, with or without agoraphobia.

These data cannot be used to predict precisely the incidence of untoward events in the course of usual medical practice where patient characteristics, and other factors often differ from those in clinical trials. These figures cannot be compared with those obtained from other clinical studies involving related drug products and placebo as each group of drug trials are conducted under a different set of conditions.

Comparison of the cited figures, however, can provide the prescriber with some basis for estimating the relative contributions of drug and non-drug factors to the untoward event incidence in the population studied. Even this use must be approached cautiously, as a drug may relieve a symptom in one patient but induce it in others. (For example, an anxiolytic drug may relieve dry mouth [a symptom of anxiety] in some subjects but induce it [an untoward event] in others.)

Additionally, for anxiety disorders the cited figures can provide the prescriber with an indication as to the frequency with which physician intervention (e.g., increased surveillance, decreased dosage or discontinuation of drug therapy) may be necessary because of the untoward clinical event.

Treatment-Emergent Adverse Events Reported in Placebo-Controlled Trials of Anxiety Disorders

Number of Patients
% of Patients Reporting:
ANXIETY DISORDERS
Treatment-Emergent Symptom IncidenceIncidence of Intervention Because of Symptom
XANAX
565
PLACEBO
505
XANAX
565
Central Nervous System
  Drowsiness41.021.615.1
  Light-headedness20.819.31.2
  Depression13.918.12.4
  Headache12.919.61.1
  Confusion9.910.00.9
  Insomnia8.918.41.3
  Nervousness4.110.31.1
  Syncope3.14.0*
  Dizziness1.80.82.5
  Akathisia1.61.2*
  Tiredness/Sleepiness**1.8
Gastrointestinal
  Dry Mouth14.713.30.7
  Constipation10.411.40.9
  Diarrhea10.110.31.2
  Nausea/Vomiting9.612.81.7
  Increased Salivation4.22.4*
Cardiovascular
  Tachycardia/Palpitations7.715.60.4
  Hypotension4.72.2*
Sensory
  Blurred Vision6.26.20.4
Musculoskeletal
  Rigidity4.25.3*
  Tremor4.08.80.4
Cutaneous
  Dermatitis/Allergy3.83.10.6
Other
  Nasal Congestion7.39.3*
  Weight Gain2.72.7*
  Weight Loss2.33.0*
*None reported
Events reported by 1% or more of XANAX patients are included.

In addition to the relatively common (i.e., greater than 1%) untoward events enumerated in the table above, the following adverse events have been reported in association with the use of benzodiazepines: dystonia, irritability, concentration difficulties, anorexia, transient amnesia or memory impairment, loss of coordination, fatigue, seizures, sedation, slurred speech, jaundice, musculoskeletal weakness, pruritus, diplopia, dysarthria, changes in libido, menstrual irregularities, incontinence and urinary retention.

Treatment-Emergent Adverse Events Reported in Placebo-Controlled Trials of Panic Disorder

PANIC DISORDER
Treatment-Emergent Symptom Incidence*
XANAXPLACEBO
Number of Patients % of Patients Reporting:13881231
Central Nervous System
  Drowsiness76.842.7
  Fatigue and Tiredness48.642.3
  Impaired Coordination40.117.9
  Irritability33.130.1
  Memory Impairment33.122.1
  Light-headedness/Dizziness29.836.9
  Insomnia29.441.8
  Headache29.235.6
  Cognitive Disorder28.820.5
  Dysarthria23.36.3
  Anxiety16.624.9
  Abnormal Involuntary Movement14.821.0
  Decreased Libido14.48.0
  Depression13.814.0
  Confusional State10.48.2
  Muscular Twitching7.911.8
  Increased Libido7.74.1
  Change in Libido (Not Specified)7.15.6
  Weakness7.18.4
  Muscle Tone Disorders6.37.5
  Syncope3.84.8
  Akathisia3.04.3
  Agitation2.92.6
  Disinhibition2.71.5
  Paresthesia2.43.2
  Talkativeness2.21.0
  Vasomotor Disturbances2.02.6
  Derealization1.91.2
  Dream Abnormalities1.81.5
  Fear1.41.0
  Feeling Warm1.30.5
Gastrointestinal
  Decreased Salivation32.834.2
  Constipation26.215.4
  Nausea/Vomiting22.031.8
  Diarrhea20.622.8
  Abdominal Distress18.321.5
  Increased Salivation5.64.4
Cardio-Respiratory
  Nasal Congestion17.416.5
  Tachycardia15.426.8
  Chest Pain10.618.1
  Hyperventilation9.714.5
  Upper Respiratory Infection4.33.7
Sensory
  Blurred Vision21.021.4
  Tinnitus6.610.4
Musculoskeletal
  Muscular Cramps2.42.4
  Muscle Stiffness2.23.3
Cutaneous
  Sweating115.123.5
  Rash10.88.1
Other
  Increased Appetite32.722.8
  Decreased Appetite27.824.1
  Weight Gain27.217.9
  Weight Loss22.616.5
  Micturition Difficulties12.28.6
  Menstrual Disorders10.48.7
  Sexual Dysfunction7.43.7
  Edema4.95.6
  Incontinence1.50.6
  Infection1.31.7
*Events reported by 1% or more of XANAX patients are included.

In addition to the relatively common (i.e., greater than 1%) untoward events enumerated in the table above, the following adverse events have been reported in association with the use of XANAX: seizures, hallucinations, depersonalization, taste alterations, diplopia, elevated bilirubin, elevated hepatic enzymes, and jaundice.

Panic disorder has been associated with primary and secondary major depressive disorders and increased reports of suicide among untreated patients (see PRECAUTIONS, General).

Adverse Events Reported as Reasons for Discontinuation in Treatment of Panic Disorder in Placebo-Controlled Trials

In a larger database comprised of both controlled and uncontrolled studies in which 641 patients received XANAX, discontinuation-emergent symptoms which occurred at a rate of over 5% in patients treated with XANAX and at a greater rate than the placebo treated group were as follows:

DISCONTINUATION-EMERGENT SYMPTOM INCIDENCE

Percentage of 641 XANAX-Treated Panic Disorder Patients Reporting Events
Body System/Event
NeurologicGastrointestinal
Insomnia29.5Nausea/Vomiting16.5
Light-headedness19.3Diarrhea13.6
Abnormal involuntary movement17.3Decreased salivation10.6
Headache17.0Metabolic-Nutritional
Muscular twitching6.9Weight loss13.3
Impaired coordination6.6Decreased appetite12.8
Muscle tone disorders5.9
Weakness5.8Dermatological
PsychiatricSweating14.4
Anxiety19.2
Fatigue and Tiredness18.4Cardiovascular
Irritability10.5Tachycardia12.2
Cognitive disorder10.3
Memory impairment5.5Special Senses
Depression5.1Blurred vision10.0
Confusional state5.0

From the studies cited, it has not been determined whether these symptoms are clearly related to the dose and duration of therapy with XANAX in patients with panic disorder. There have also been reports of withdrawal seizures upon rapid decrease or abrupt discontinuation of XANAX Tablets (see WARNINGS).

To discontinue treatment in patients taking XANAX, the dosage should be reduced slowly in keeping with good medical practice. It is suggested that the daily dosage of XANAX be decreased by no more than 0.5 mg every three days (see DOSAGE AND ADMINISTRATION). Some patients may benefit from an even slower dosage reduction. In a controlled postmarketing discontinuation study of panic disorder patients which compared this recommended taper schedule with a slower taper schedule, no difference was observed between the groups in the proportion of patients who tapered to zero dose; however, the slower schedule was associated with a reduction in symptoms associated with a withdrawal syndrome.

As with all benzodiazepines, paradoxical reactions such as stimulation, increased muscle spasticity, sleep disturbances, hallucinations and other adverse behavioral effects such as agitation, rage, irritability, and aggressive or hostile behavior have been reported rarely. In many of the spontaneous case reports of adverse behavioral effects, patients were receiving other CNS drugs concomitantly and/or were described as having underlying psychiatric conditions. Should any of the above events occur, alprazolam should be discontinued. Isolated published reports involving small numbers of patients have suggested that patients who have borderline personality disorder, a prior history of violent or aggressive behavior, or alcohol or substance abuse may be at risk for such events. Instances of irritability, hostility, and intrusive thoughts have been reported during discontinuation of alprazolam in patients with posttraumatic stress disorder.

Post Introduction Reports

Various adverse drug reactions have been reported in association with the use of XANAX since market introduction. The majority of these reactions were reported through the medical event voluntary reporting system. Because of the spontaneous nature of the reporting of medical events and the lack of controls, a causal relationship to the use of XANAX cannot be readily determined. Reported events include: gastrointestinal disorder, hypomania, mania, liver enzyme elevations, hepatitis, hepatic failure, Stevens-Johnson syndrome, angioedema, peripheral edema, hyperprolactinemia, gynecomastia, and galactorrhea (see PRECAUTIONS).

Read the entire FDA prescribing information for Xanax (Alprazolam)

Related Resources for Xanax

Read the Xanax User Reviews »

© Xanax Patient Information is supplied by Cerner Multum, Inc. and Xanax Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.

QUESTION

Panic attacks are repeated attacks of fear that can last for several minutes. See Answer

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