Is Xanax (Alprazolam) Associated with Liver Cancer?
No, there is no evidence linking Xanax (alprazolam) use to liver cancer. The available research and clinical guidelines do not identify benzodiazepines, including alprazolam, as hepatotoxic agents or carcinogens affecting the liver.
Evidence from Hepatotoxicity Studies
A comprehensive study of 201 benzodiazepine mono-abusers taking high doses (average 307 mg diazepam-equivalents daily for 7 years) found no significant drug-induced liver injury, with no patients showing clinically meaningful elevations in transaminases, alkaline phosphatase, or bilirubin 1
Benzodiazepines are not listed among occupational or environmental hepatotoxic chemicals associated with liver cancer in the European Association for the Study of the Liver guidelines on occupational liver diseases 2
Pharmacokinetic Considerations in Liver Disease
While alprazolam metabolism is slowed in patients with existing alcoholic liver disease (elimination half-life increases from 11.4 to 19.7 hours, and clearance decreases from 1.2 to 0.6 ml/min/kg), this reflects altered drug handling rather than hepatotoxicity 3
Alprazolam clearance is reduced in cirrhotic patients, requiring dose adjustments, but this is a consequence of impaired hepatic function rather than evidence of drug-induced liver damage 4
Important Clinical Distinctions
The primary concern with benzodiazepines in liver disease is precipitation or worsening of hepatic encephalopathy, not hepatotoxicity or carcinogenesis 5
Clinical guidelines recommend avoiding benzodiazepines in patients with liver impairment due to their deleterious effects on mental status and encephalopathy risk, not because of cancer or direct liver toxicity 5
Contrast with Known Hepatotoxic Agents
Established occupational liver carcinogens include vinyl chloride monomer (causing hepatocellular carcinoma and angiosarcoma), certain pesticides, and industrial solvents—none of which are benzodiazepines 2
NSAIDs, in contrast to benzodiazepines, are responsible for approximately 10% of drug-induced hepatitis cases and must be avoided in liver disease 6
Clinical Bottom Line
Alprazolam does not cause liver cancer. The medication requires dose reduction in patients with pre-existing cirrhosis due to altered pharmacokinetics and should be avoided to prevent hepatic encephalopathy, but there is no carcinogenic risk to the liver from its use 3, 4, 1.