What are the side effects of Xanax (alprazolam)?

Side Effects of Xanax (Alprazolam)

Xanax (alprazolam) commonly causes drowsiness, light-headedness, memory impairment, and coordination problems, with more serious risks including physical dependence, withdrawal symptoms, and potential for abuse. 1

Common Side Effects

Alprazolam's FDA label identifies the following common side effects (occurring in >10% of patients):

• Central Nervous System Effects:

  • Drowsiness (76.8% in panic disorder patients, 41% in anxiety disorder patients)
  • Fatigue and tiredness (48.6% in panic disorder)
  • Impaired coordination (40.1% in panic disorder)
  • Light-headedness (29.8% in panic disorder, 20.8% in anxiety disorder)
  • Memory impairment (33.1% in panic disorder)
  • Headache (29.2% in panic disorder, 12.9% in anxiety disorder)
  • Cognitive disorder (28.8% in panic disorder)
  • Dysarthria/slurred speech (23.3% in panic disorder) 1

• Gastrointestinal Effects:

  • Decreased salivation (32.8% in panic disorder)
  • Dry mouth (14.7% in anxiety disorder)
  • Constipation (26.2% in panic disorder, 10.4% in anxiety disorder)
  • Nausea/vomiting (22% in panic disorder, 9.6% in anxiety disorder) 1

• Other Common Effects:

  • Changes in appetite (increased: 32.7%, decreased: 27.8% in panic disorder)
  • Weight changes (gain: 27.2%, loss: 22.6% in panic disorder)
  • Blurred vision (21% in panic disorder, 6.2% in anxiety disorder)
  • Sweating (15.1% in panic disorder) 1

Serious Side Effects and Risks

1. Dependence and Withdrawal

Alprazolam can cause physical dependence even with therapeutic doses. Abrupt discontinuation may lead to severe withdrawal symptoms including:

• Seizures
• Rebound anxiety
• Insomnia
• Irritability
• Tremors
• Muscle cramps
• Perceptual disturbances 1, 2

The FDA label emphasizes that to discontinue treatment, dosage should be reduced slowly, recommending no more than 0.5 mg reduction every three days to minimize withdrawal symptoms. 1

2. Respiratory Depression

Benzodiazepines like alprazolam can cause respiratory depression, especially when:

• Combined with opioids or other CNS depressants
• Used in patients with COPD or sleep apnea
• Used in elderly or debilitated patients 3

3. Cognitive Impairment

Alprazolam can cause significant cognitive effects including:

• Memory impairment (both short-term and potential for transient amnesia)
• Decreased concentration
• Impaired judgment
• Confusion (9.9% in anxiety disorder patients) 1

4. Paradoxical Reactions

Some patients may experience:

• Increased anxiety
• Agitation
• Irritability
• Aggression
• Hostility
• Impulsivity 1

5. Abuse Potential

Alprazolam has significant potential for abuse and addiction, possibly greater than some other benzodiazepines due to:

• Rapid absorption and brain penetration
• Shorter half-life (12-15 hours)
• Strong reinforcing properties 4, 2

Special Population Considerations

Elderly Patients

• Increased sensitivity to CNS effects
• Higher risk of falls and cognitive impairment
• Reduced clearance of the drug
• Recommended to use lower doses (e.g., starting with 0.25 mg) 1, 5

Patients with Hepatic Impairment

• Reduced clearance of alprazolam
• Higher plasma concentrations
• Dose reduction required 5

Pregnant Women

• Risk of neonatal withdrawal syndrome if used late in pregnancy
• Potential risk of congenital malformations 1

Drug Interactions

Alprazolam's metabolism can be significantly affected by:

• Cimetidine, fluoxetine, fluvoxamine, and propoxyphene (reduce clearance)
• Other CNS depressants (additive effects)
• Alcohol (enhanced sedative effects) 5

Monitoring Recommendations

When using alprazolam, monitor for:

• Signs of dependence or tolerance
• Cognitive impairment
• Changes in mood or behavior
• Respiratory status, especially when combined with other CNS depressants
• Falls risk, particularly in elderly patients 3

Remember that benzodiazepines like alprazolam should generally be used for short-term management of anxiety (typically 2-4 weeks) to minimize risks of dependence and adverse effects.