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Alprazolam oral tablet side effects: A detailed guide

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Alprazolam oral tablet is prescribed for anxiety and panic disorder. It’s a benzodiazepine drug that may cause mild or serious side effects, including weight gain and hallucinations.
Medically reviewed by Rosanna Sutherby, PharmD
Updated on February 13, 2023

Specifically, the Food and Drug Administration (FDA) has approved alprazolam oral tablet to treat the following conditions in adults:

This article describes possible side effects (also known as adverse effects) of alprazolam oral tablet. You’ll also find information on cost savings and coupon options for alprazolam.

Alprazolam oral tablet is a generic version of the brand-name drug Xanax. Alprazolam also comes in other forms taken by mouth, but these forms aren’t described in this article. To learn more about these forms, talk with your doctor.

You can explore this overview article to learn more about alprazolam oral tablet, including the drug’s uses, dosage, ways to save on cost, and more.

Boxed warnings

Alprazolam has a boxed warning about the risk of use with opioids. It also has boxed warnings about the risk of misuse, addiction, dependence, and withdrawal. Boxed warnings are serious warnings from the Food and Drug Administration (FDA).

For details about the risk of use with opioids, see the “Side effects of alprazolam in detail” section below. To learn more about the risk of misuse, addiction, dependence, and withdrawal, see the “Withdrawal, dependence, misuse, and alprazolam” section below.

More common side effects of alprazolam

Alprazolam oral tablet may cause mild or serious side effects. Below are some of the more common side effects of this medication.

Commonly reported side effects of alprazolam oral tablet include:

  • drowsiness
  • fatigue (low energy)
  • dizziness or lightheadedness
  • difficulty with balance and coordination
  • memory loss

Mild side effects of alprazolam

Alprazolam may cause certain mild side effects. Often, mild side effects are temporary and can be easily managed. Tell your doctor or pharmacist if you have side effects that don’t go away or become bothersome.

Mild side effects of alprazolam oral tablet that occurred in studies include:

* To learn more about this side effect, see the “Side effects of alprazolam in detail” section below.

Alprazolam oral tablet may cause more mild side effects than those listed above. For details, see the drug’s prescribing information.

Serious side effects of alprazolam

Alprazolam may cause certain serious side effects. If you have any serious side effects from alprazolam oral tablet, call your doctor right away. But if you think you’re having a medical emergency or your side effects feel life threatening, take immediate action. Call 911, or a local emergency number, or go to the nearest emergency room.

After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. Visit MedWatch’s website if you’d like to notify the FDA about a side effect you’ve had with alprazolam oral tablet.

Serious side effects of alprazolam oral tablet that occurred in studies include:

* To learn more about this side effect, see the “Side effects of alprazolam in detail” section below.
Alprazolam oral tablet has a boxed warning for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effects of alprazolam in detail” section below.
Alprazolam oral tablet has a boxed warning for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Withdrawal, dependence, misuse, and alprazolam” section below.

Suicide prevention

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.

Common questions about side effects of alprazolam

Here are answers to some common questions about side effects of alprazolam oral tablet. If you have other questions, talk with your doctor or pharmacist.

How do side effects of alprazolam in older adults compare with those in younger adults?

Side effects caused by alprazolam are expected to be the same in younger and older adults. However, older adults are generally at higher risk for having side effects from alprazolam. (Older adults generally refers to people ages 65 years and older.)

Specifically, older adults have a higher risk for the following side effects of alprazolam:

Older adults who have drowsiness or coordination problems are at increased risk for falls.

Because of these risks, doctors typically prescribe a lower alprazolam dosage to adults ages 65 years and older. This helps reduce their risk for side effects. Doctors may also closely monitor older adults for side effects during alprazolam treatment.

Do different strengths of alprazolam, including 0.5 mg, 0.25 mg, and 1 mg, cause different side effects?

No, different alprazolam strengths do not cause different side effects. Alprazolam strengths are written in milligrams (mg).

That said, the risk of having side effects from alprazolam can vary with different dosages. For example, taking a higher dose is more likely to cause dependence* compared with taking a lower dose.

Talk with your doctor or pharmacist if you’d like to know more about your risk of side effects based on your alprazolam dosage.

* Alprazolam oral tablet has a boxed warning for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Withdrawal, dependence, misuse, and alprazolam” section below.

Can alprazolam cause kidney-related side effects?

No, it’s not likely. Kidney-related side effects weren’t reported in alprazolam’s studies. The drug isn’t known to cause these side effects.

However, if you have kidney problems, you may have a higher risk for side effects from alprazolam. This is because your body relies on your kidneys to clear alprazolam after you take a dose. If you have a kidney problem, such as chronic kidney disease, the level of alprazolam in your body may become too high.

If you’d like to know more about alprazolam and kidney issues, ask your doctor or pharmacist.

If I take alprazolam with melatonin, will I experience certain side effects?

Taking alprazolam with melatonin can cause certain side effects. Combining the two can raise your risk of central nervous system (CNS) depression and drowsiness, as well as other side effects.

Due to this risk, your doctor or pharmacist may recommend that you don’t take melatonin with alprazolam.

Be sure to tell your doctor and pharmacist about all medications you take, including any over-the-counter drugs. You should also mention any supplements you take, including melatonin. Your pharmacist and doctor can check to see whether any of them interact with alprazolam.

Does alprazolam cause long-term side effects?

Yes, alprazolam can cause long-term side effects, although they’re rare.

Long-term side effects reported with alprazolam include:

  • weight changes
  • liver problems
  • inability to safely perform dangerous activities that require coordination, such as driving or operating machinery
  • depression, which may lead to thoughts of suicide
  • depersonalization (feeling detached from yourself, such as if you’re in a dream or movie)
  • risk of misuse, addiction, dependence, and withdrawal*

These side effects may occur at any point while you’re taking alprazolam, even if you’ve taken it for a long time without any problems. The side effects may also linger after you stop taking alprazolam.

Talk with your doctor or pharmacist if you have more questions about alprazolam and long-term side effects.

* Alprazolam oral tablet has a boxed warning for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Withdrawal, dependence, misuse, and alprazolam” section below.

Withdrawal, dependence, misuse, and alprazolam

Alprazolam has a boxed warning about the risk of misuse, addiction, dependence, and withdrawal. Boxed warnings are serious warnings from the Food and Drug Administration (FDA). These risks are described below.

Alprazolam also has a boxed warning about the risk of use with opioids. To learn more about this risk, see the “Side effects of alprazolam in detail” section below.

Alprazolam and risk of misuse and addiction

Alprazolam carries a risk of misuse. Misuse means a drug is taken in a way other than how it’s prescribed. For example, taking a drug to get “high” is considered misuse.

Misusing alprazolam can also lead to addiction, which may involve any of the following:

  • continuing to take a drug even if doing so causes harmful outcomes
  • being unable to stop taking the drug
  • neglecting work, school, or social obligations because of the drug

It’s important to note that drug addiction is different from drug dependence. To learn more, see below.

Misusing alprazolam can result in serious central nervous system (CNS) depression. The CNS consists of your brain and spinal cord and controls many activities in your body.

CNS depression can lead to:

CNS depression can cause other serious side effects, and it may even be fatal in rare cases. Taking alprazolam together with other medications that depress your CNS raises the risk of serious CNS depression.

Due to these risks, alprazolam is a controlled substance in the United States. This means that healthcare professionals must follow strict guidelines and regulations from federal and state governments to help prevent misuse of the drug.

Talk with your doctor if you have questions or concerns about alprazolam and misuse or addiction. If you have symptoms of CNS depression, you or someone else should immediately call 911 or your local emergency number.

Alprazolam and risk of dependence and withdrawal

Taking alprazolam can result in drug dependence. With dependence, your body needs a drug to function like usual. It’s possible to be dependent on a drug without being addicted to it.

Because alprazolam can cause dependence, stopping treatment with the drug can cause withdrawal symptoms. These are side effects that occur when you stop taking a drug your body is dependent on.

Withdrawal symptoms from alprazolam can be mild or serious. Some examples include:

Due to this risk, you should not stop taking alprazolam unless your doctor specifically advises doing so. Also, do not change your alprazolam dosage or take the medication in any way that differs from your doctor’s instructions. Missing doses of the drug can also result in withdrawal symptoms.

If your doctor recommends that you stop treatment with alprazolam, they’ll recommend slowly decreasing your dosage over time. This is known as drug tapering. It can help lower your risk of withdrawal symptoms when you stop taking alprazolam.

Talk with your doctor if you have questions or concerns about alprazolam and dependence or withdrawal.

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Side effects of alprazolam in detail

Below you’ll find details on some of the side effects of alprazolam oral tablet.

Risk of use with opioids

Alprazolam has a boxed warning about the risk of use with opioids. Boxed warnings are serious warnings from the Food and Drug Administration (FDA).

Both alprazolam and opioids depress activity of your central nervous system (CNS). Your CNS consists of your brain and spinal cord and controls many activities in your body.

CNS depression caused by taking alprazolam with an opioid can lead to:

It can also lead to other serious side effects, and in some cases, may be fatal.

Examples of opioid medications include:

Note: Alprazolam also has a boxed warning about the risk of misuse, addiction, dependence, and withdrawal. To learn more, see the “Withdrawal, dependence, misuse, and alprazolam” section above.

Ways to manage

Because of this risk, your doctor will avoid prescribing alprazolam and an opioid together unless there are no other suitable treatment options. In this case, they’ll prescribe the lowest possible dose of alprazolam and opioid needed to treat your condition. They’ll also monitor you closely for side effects throughout treatment.

If you have symptoms of CNS depression, you or someone else should immediately call 911 or your local emergency number.  

Weight gain

Weight gain is a possible side effect of alprazolam. It was more common in people taking the drug for panic disorder, according to the drug’s studies. Weight gain wasn’t common in people taking alprazolam for anxiety disorder.

Weight loss was also reported as a side effect in some people in the studies. Based on these studies, it’s known that alprazolam can cause appetite changes. And this can lead to weight gain or weight loss.

Ways to manage

Talk with your doctor if you experience weight gain, appetite changes, or are concerned about your weight while taking alprazolam. Your doctor can discuss ways to maintain a body weight that’s healthy for you.

Hallucinations

In rare cases, alprazolam can cause hallucinations. With hallucinations, you have sensory experiences that seem real, but are created by your mind. Examples include seeing or hearing things that aren’t actually there.

This risk increases if you take alprazolam with other medications or consume certain substances, such as alcohol, that can cause central nervous system (CNS) depression. The CNS consists of your brain and spinal cord and controls many activities in your body.

Hallucinations can also be caused by suddenly stopping alprazolam. For more information, see the “Withdrawal, dependence, misuse, and alprazolam” section above.

Ways to manage

If you have hallucinations while taking alprazolam, immediately call your doctor. They’ll likely have you stop taking the medication. That said, do not suddenly stop taking alprazolam. Your doctor will slowly decrease your dosage over time to help lower your risk of withdrawal symptoms.

Your doctor can also recommend other treatment options for your condition if you stop taking alprazolam.

Allergic reaction

For some people, alprazolam oral tablet can cause an allergic reaction.

Symptoms can be mild or serious and they may include:

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

Ways to manage

For mild allergic reaction symptoms, such as a mild rash, call your doctor right away. They may recommend treatments to help manage your symptoms. They’ll also let you know whether you should keep taking the medication.

For severe allergic reaction symptoms, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms require immediate medical care because they can become life threatening. If you’ve had a serious allergic reaction to alprazolam oral tablet, your doctor may recommend you take a different medication instead.

Warnings for alprazolam

Below are some factors you may want to discuss with your doctor before taking alprazolam oral tablet.

Boxed warnings

Alprazolam has a boxed warning about the risk of use with opioids. It also has boxed warnings about the risk of misuse, addiction, dependence, and withdrawal. Boxed warnings are serious warnings from the Food and Drug Administration (FDA).

For details about the risk of use with opioids, see the “Side effects of alprazolam in detail” section above. To learn more about the risk of misuse, addiction, dependence, and withdrawal, see the “Withdrawal, dependence, misuse, and alprazolam” section above.

Other warnings

It may not be safe for you to take alprazolam oral tablet if you have specific health conditions. These are sometimes called drug-condition interactions. Other things may also affect whether alprazolam oral tablet is a safe treatment option for you.

Before taking alprazolam oral tablet, tell your doctor about your health and medications you take. Things to consider include those listed below.

Breathing or lung problems. Having a breathing or lung problem increases your risk for serious breathing issues with alprazolam. Examples include asthma and chronic obstructive pulmonary disease (COPD). Your doctor can help determine whether alprazolam is safe for you to take based on your condition and symptoms.

Bipolar disorder, depression, or mania. In rare cases, some people with depression have developed mania while taking alprazolam. Your risk may be higher if you already have a condition that could cause mania, such as bipolar disorder.

Additionally, stopping treatment with alprazolam can worsen depression and even cause thoughts of suicide. Be sure to let your doctor know about any mental health conditions you have before starting treatment with alprazolam. They can determine whether the drug is safe for you to take.

Kidney or liver problems. Having a kidney or liver problem can cause alprazolam to build up in your body. This increases your risk of side effects from the drug. Your doctor may prescribe a lower alprazolam dosage if you have a kidney or liver problem, such as chronic kidney disease or chronic liver failure.

Using either ketoconazole or itraconazole. You should not take alprazolam while using the antifungals ketoconazole or itraconazole (Sporanox, Tolsura). These antifungal drugs stop your body from breaking down alprazolam like usual after you take a dose of alprazolam. This can increase your risk of side effects from alprazolam, including serious ones such as central nervous system (CNS) depression. Talk with your doctor about treatments that are safer to use with either ketoconazole or itraconazole.

Allergic reaction. If you’ve had an allergic reaction to alprazolam oral tablet or any of its ingredients, your doctor will likely not prescribe this medication. Ask them about other treatment options that may be better for you.

Alprazolam and pregnancy

Taking alprazolam during pregnancy may result in problems with fetal development (commonly known as birth defects).

Taking the drug during pregnancy can also cause side effects in an infant following delivery. These side effects can include:

  • floppiness
  • excessive sleepiness
  • breathing or feeding difficulties

Due to these risks, doctors typically only prescribe alprazolam during pregnancy if no other suitable treatments are available. They’ll consider whether the benefits of treatment outweigh the risks.

Talk with your doctor about the risks and benefits of taking alprazolam if you’re pregnant or can become pregnant.

Alprazolam and breastfeeding

Breastfeeding is not recommended while taking alprazolam. There are reports of side effects in children breastfed by people taking alprazolam. Examples include fatigue (low energy) and weight loss.

Your doctor can recommend safe ways to feed your child during your treatment with alprazolam.

Alprazolam and alcohol

If you drink alcohol, you should not drink it during alprazolam treatment.

Both alprazolam and alcohol slow down the activity of your central nervous system (CNS), which can be serious. CNS depression can result in trouble breathing, coma, and other serious side effects. It can even be fatal in rare cases.

Talk with your doctor if you have questions about the risks of combining alcohol and alprazolam.

What to ask your doctor

This article describes common and serious side effects of alprazolam oral tablet. If your doctor prescribes this medication, they can discuss possible side effects with you. Let your doctor know if you have concerns or questions about treatment with this medication.

Here’s a list of some possible questions you may want to ask your doctor:

  • If I experience hallucinations while taking alprazolam, how will the side effect be treated?
  • Should my alprazolam dosage be lowered if I have side effects while taking the drug?
  • Does my medical history increase my risk for side effects from alprazolam?
  • As an older adult, are there ways to lower my risk of side effects from alprazolam?

Disclaimer: Optum Perks 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.

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