Can Xanax (alprazolam) cause elevated liver enzymes?

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From the Guidelines

Xanax can cause elevations in liver enzymes, although significant liver damage is rare with normal therapeutic use. The medication is metabolized by the liver through the cytochrome P450 enzyme system, which may lead to mild, transient elevations in liver enzymes in some individuals 1. These elevations are typically not clinically significant for most patients taking prescribed doses. However, people with pre-existing liver disease should use Xanax cautiously, as their ability to metabolize the medication may be impaired, potentially leading to higher blood levels and increased side effects 1.

Some key points to consider when taking Xanax include:

  • The medication can cause mild, transient elevations in liver enzymes
  • People with pre-existing liver disease should use Xanax with caution
  • Long-term use of Xanax may require occasional liver function monitoring, especially in individuals with risk factors for liver problems or those taking other medications that affect liver function 1
  • Symptoms such as yellowing of the skin or eyes, dark urine, persistent nausea, or abdominal pain may indicate liver issues requiring medical attention 1

It is essential to note that the risk of liver damage from Xanax is generally low, and the benefits of the medication often outweigh the risks for individuals with anxiety disorders or other conditions for which Xanax is prescribed. However, patients should be aware of the potential for liver enzyme elevations and monitor their liver function regularly, especially if they have pre-existing liver disease or are taking other medications that may affect the liver 1.

From the FDA Drug Label

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 alprazolam tablets: seizures, hallucinations, depersonalization, taste alterations, diplopia, elevated bilirubin, elevated hepatic enzymes, and jaundice

  • Elevated hepatic enzymes have been reported in association with the use of alprazolam tablets. Xanax can cause liver enzymes to be elevated, as indicated by reports of elevated hepatic enzymes in patients taking the medication 2.

From the Research

Liver Enzyme Effects of Xanax

  • There is no direct evidence in the provided studies that Xanax causes liver enzymes to elevate or be affected in any way 3, 4, 5.
  • The studies primarily focus on the effects of antidepressants on liver function, with no mention of Xanax, which is a benzodiazepine used to treat anxiety disorders.
  • One study mentions alprazolam, which is the generic name for Xanax, but it discusses its effects on cognitive performance in elderly subjects, not its impact on liver enzymes 5.
  • Another study discusses the potential for benzodiazepines to cause hepatotoxicity, but it does not specifically mention Xanax or alprazolam 4.
  • Overall, there is limited information available in the provided studies to determine the effects of Xanax on liver enzymes.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Liver injury associated with antidepressants.

Current drug safety, 2013

Research

Antidepressant-induced liver injury: a review for clinicians.

The American journal of psychiatry, 2014

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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