Does alprazolam (Xanax) cause sedation?

From the Guidelines

Yes, Xanax (alprazolam) causes sedation as one of its primary effects, as it enhances the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity, resulting in a calming effect on the central nervous system. This is supported by the most recent evidence from 1, which highlights the sedative-hypnotic effects of benzodiazepines, including Xanax. The sedative properties of Xanax typically begin within 30 minutes to an hour after taking it and can last for several hours depending on the dose.

Key Points to Consider

• The sedation from Xanax can range from mild relaxation to pronounced drowsiness, which is why patients are advised not to drive or operate machinery until they know how the medication affects them.
• This sedative effect is dose-dependent, meaning higher doses produce stronger sedation, as noted in 2.
• Tolerance to the sedative effects can develop with regular use, sometimes leading patients to increase their dose, which can contribute to dependence.
• If you're prescribed Xanax, it's essential to take it exactly as directed by your healthcare provider and be aware that combining it with alcohol or other central nervous system depressants can dangerously increase sedation, as warned by 1 and 2.

Important Considerations for Patient Care

• Patients with a history of substance abuse or those taking other CNS depressants should be closely monitored due to the increased risk of dependence and respiratory depression.
• Elderly patients are significantly more sensitive to the sedative effects of benzodiazepines, as mentioned in 2, and therefore require careful dose adjustment and monitoring.
• The potential for benzodiazepine overdose and the importance of having reversal agents like flumazenil available, as discussed in 1, should always be considered in the management of patients on Xanax.

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 benzodiazepines: ... sedation, ... Treatment-Emergent Adverse Events Reported in Placebo-Controlled Trials of Anxiety Disorders ... Central Nervous System Drowsiness 41.0 Light-headedness 20.8 ... Treatment-Emergent Adverse Events Reported in Placebo-Controlled Trials of Panic Disorders ... Central Nervous System Drowsiness 76.8

Yes, Xanax (alprazolam) can cause sedation. The drug label reports sedation as an adverse event associated with the use of benzodiazepines, and drowsiness is a common untoward event in both anxiety disorders and panic disorders trials, with incidence rates of 41.0% and 76.8%, respectively 3.

From the Research

Sedation Effects of Xanax

• Xanax, also known as alprazolam, is a benzodiazepine that is commonly prescribed for the treatment of anxiety and panic disorders 4.
• The drug has been shown to cause sedation as a side effect, which is consistent with its primary benzodiazepine agonist action 4.
• The sedative effects of Xanax increase in frequency with higher steady-state plasma concentrations 4.

Comparison with Other Benzodiazepines

• Benzodiazepines, as a class of drugs, have similar effects, including anxiolytic and sedative properties 5.
• The main distinguishing features between different benzodiazepines are their plasma half-lives and the presence or absence of pharmacologically active metabolites 5.
• Xanax has been compared to other benzodiazepines, such as diazepam, in terms of its sedative effects, and has been shown to have a similar profile 6.

Pharmacodynamic Response Profiles

• The pharmacodynamic response profiles of Xanax and other anxiolytic and sedative drugs have been studied, and it has been shown that Xanax causes a significant reduction in saccadic peak velocity (SPV) and smooth pursuit, which is correlated with its anxiolytic and sedative effects 6.
• The study also found that Xanax caused a larger SPV reduction compared to diphenhydramine, an antihistaminergic sedative, which suggests that Xanax has a more pronounced sedative effect 6.

Clinical Use and Misuse

• Xanax is commonly prescribed for the treatment of generalized anxiety disorder and panic disorder, but its clinical use has been a point of contention due to its potential for misuse and addiction 7.
• The drug has been shown to have a high misuse liability, and its withdrawal syndrome can be severe 7.
• Clinicians are advised to use Xanax with caution and to monitor patients closely for signs of misuse and addiction 7.