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Drug Info

Xanax side effects and how to avoid them

Xanax is a prescription sedative used to treat panic and anxiety
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By | Aug. 3, 2021 Medically reviewed by Josephine Bawab, Pharm.D.
Prescription pad with pill bottle: Xanax side effects

Key takeaways

  • Xanax (alprazolam) is an FDA-approved medication for generalized anxiety disorder and panic disorder. Common side effects include sleepiness and dizziness, and serious side effects may include dependency and seizures.

  • The drug belongs to a class of medications called benzodiazepines, which work by slowing brain activity, resulting in a calming and relaxing effect.

  • Xanax usage can lead to physical dependence and tolerance, with withdrawal symptoms that can be severe and potentially life-threatening if the drug is abruptly discontinued.

  • To minimize Xanax side effects, patients are advised to follow their prescription closely, inform their healthcare provider about all medical conditions and medications, avoid alcohol, and not engage in activities requiring full attention until they know how Xanax affects them.

Xanax side effects | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Xanax (alprazolam) is a popular prescription drug that is FDA-approved to treat generalized anxiety disorder (GAD) and panic disorder. It also may be prescribed off-label to treat short-term anxiety in children or premenstrual dysphoric disorder in women. 

Alprazolam, the active ingredient and generic name of Xanax, belongs to a class of drugs called benzodiazepines. These drugs slow down brain activity by amplifying the effects of a neurotransmitter called GABA, a chemical that blocks signals between nerves. 

As sedatives, both Xanax and Xanax XR (extended-release tablets) frequently cause side effects. Serious side effects are less common, but interactions with other drugs or existing medical conditions are possible. It is important for anyone taking Xanax to understand these potential problems and know how to manage them.

RELATED: What is Xanax? 

Xanax side effects

The most common side effects of Xanax are:

  • Sleepiness or fatigue
  • Dizziness or lightheadedness
  • Fainting
  • Memory problems
  • Slurred speech
  • Irritability
  • Confusion
  • Increased appetite or weight gain
  • Nausea
  • Constipation
  • Anxiety
  • Dry mouth or increased salivation
  • Decreased libido
  • Menstruation pain or irregularities
  • Low blood pressure
  • Impaired coordination and balance
  • Attention problems
  • Double vision
  • Liver problems
  • Loss of inhibitions

Serious side effects of Xanax

Serious side effects of Xanax include:

  • Dependency
  • Withdrawal
  • Substance abuse
  • Depression
  • Slowed breathing (respiratory depression)
  • Seizures
  • Suicidal thoughts and behaviors
  • Fast heartbeat (sinus tachycardia)
  • Severe allergic reactions such as angioedema and severe skin reactions

How long do side effects last?

The sedative side effects of Xanax—sleepiness, imbalance, coordination problems, and mental impairment—will go away as the drug is eliminated from the body. With a half-life of 11 hours, alprazolam is cleared from the body in about two days. However, alprazolam is metabolized into substances that work similarly to alprazolam, so it may take longer to fully recover mental sharpness.

Other common side effects on the nervous system, such as dry mouth, hypersalivation, fast heartbeat, and some of the paradoxical side effects (anxiety, irritation, agitation) will also go away within one to two days of taking the last dose.

Some side effects may require medical treatment such as fast heartbeat, respiratory depression, or severe allergic reactions. Some of these side effects, such as severe allergic reactions or withdrawal, may take days to weeks to resolve even with medical treatment. Xanax withdrawal typically lasts for 10–14 days, but in the most severe cases, Xanax withdrawal could persist for up to 12 months and could be fatal.

Xanax contraindications & warnings

There are risks when taking Xanax. Every person taking Xanax should be aware of potential pitfalls such as physical dependence, tolerance, substance abuse, withdrawal, and the possibility the drug will worsen existing medical conditions.

Abuse and dependence

Taking Xanax continuously can lead to physical dependence and tolerance. Taking prescription Xanax as directed also carries a risk of evolving into substance abuse. Benzodiazepines are commonly misused prescription drugs. About 1%–2% of people in the U.S. will at some point in their lives misuse benzodiazepines. Serious and even life-threatening overdoses and drug interactions are a common hazard when people abuse benzodiazepines. 

Abrupt discontinuation of Xanax can provoke withdrawal that can range from unpleasant to potentially life-threatening. Xanax withdrawal symptoms include:

  • Rebound anxiety
  • Panic attacks
  • Insomnia
  • Abnormal movements
  • Tremors
  • Blurred vision
  • Detachment from reality
  • Depression
  • Dizziness
  • Nausea
  • Vomiting
  • Diarrhea
  • Weight loss
  • High blood pressure
  • Fast heartbeat
  • Seizures
  • Delirium
  • Hallucinations
  • Psychosis
  • Suicidal thoughts and behaviors
  • Death

Withdrawal occurs suddenly when Xanax is abruptly discontinued and typically lasts for 10 to 14 days. Some people may experience protracted withdrawal (anxiety, impairment, insomnia, depression, creepy-crawly or prickling skin sensations, and weakness) that can last for up to 12 months. Long-term Xanax abuse or addiction may require specialized detox treatments to manage acute and protracted withdrawal.

Xanax must be discontinued in a gradually decreasing dose supervised by a healthcare provider to avoid withdrawal. Even with a tapered dose, some withdrawal symptoms may be experienced.

Overdose

Depending on the dose, too much Xanax will cause drowsiness, dizziness, impairment, loss of coordination, diminished reflexes, coma, and possibly death. Serious adverse effects or death are more likely when large doses of Xanax are combined with alcohol or opioids. If too much Xanax has been taken, immediately call a poison helpline or go to an emergency room.

Restrictions

Though Xanax is widely prescribed, some people may not be able to take this drug safely. Others may require lower doses or additional monitoring to avoid potential problems.

  • People who are allergic to alprazolam should never be prescribed Xanax. 
  • Because alprazolam is habit-forming, Xanax treatment carries the risk of growing into substance abuse. For this reason, Xanax is used cautiously in those with a history of drug or alcohol abuse.
  • People with depression will be monitored for any worsening of the depression. Some people with depression may experience mania when taking Xanax.
  • People with liver problems will receive a lower dose of alprazolam because their bodies metabolize the drug slowly, raising the risk of side effects. In addition, those with kidney dysfunction or who are overweight will need to be checked regularly to avoid too much drug accumulating in the body and causing side effects.
  • Because Xanax slows down breathing, caution will be used in any person with lung disease or sleep apnea. 
  • Xanax can worsen certain medical conditions including myasthenia gravis, Parkinson’s disease, and porphyria. 
  • People with a history of seizures have a higher risk of seizures—including severe and life-threatening seizures (status epilepticus)—when Xanax is discontinued too quickly. 

Pregnancy and nursing

Pregnant women should avoid taking Xanax. Alprazolam crosses the placenta and can affect unborn babies. In the first trimester, alprazolam may cause birth defects and other fetal development problems. When taken in the last trimester, alprazolam can cause sedation, breathing problems, and withdrawal symptoms in a newborn baby.

Women who are breastfeeding should also avoid Xanax. Alprazolam is present in breast milk. A nursing infant can be affected by the drug and become sedated, sleepy, and have problems feeding. 

Children

The Food and Drug Administration (FDA) has not approved the use of Xanax or generic alprazolam in children younger than 18 years. Although some doctors may prescribe a very short course of Xanax to treat anxiety in children, parents should be aware that children are more sensitive to the effects of Xanax than adults.

Seniors

Older adults metabolize alprazolam more slowly than younger adults. For this reason, doctors will start with a lower dose to prevent side effects. In general, healthcare providers are advised to avoid giving drugs like Xanax to the elderly because of the risk of mental impairment, falls, injuries, and driving accidents.

Xanax interactions

Xanax can cause problems with a number of over-the-counter and prescription drugs. Many of these drug interactions are minor, but some can be very serious and even life-threatening.

  • CYP3A4 inhibitors delay the elimination of Xanax. Many of these are commonly prescribed drugs such as clarithromycin (an antibiotic), ketoconazole (an antifungal), itraconazole (another antifungal), common HIV drugs, DHEA supplements, and grapefruit. 
  • Opioids. Xanax and other benzodiazepines come with a black-box warning to avoid combining opioid pain relievers with Xanax. The combination could cause sedation, slowed breathing, respiratory depression, and death. 
  • Central nervous system depressants. Because of the risk of sedation and respiratory depression, other drugs to avoid include other benzodiazepines, barbiturates, and sedatives. Xanax should be avoided or used with caution with other depressants such as antihistamines, antipsychotics, anxiety drugs, tricyclic antidepressants, monoamine oxidase inhibitors, and anticonvulsants. Some common over-the-counter supplements are also CNS depressants and should be avoided when taking benzodiazepines. These include licorice, melatonin, and kava.

How to avoid Xanax side effects

Many people taking Xanax will experience side effects. A few tips can help either avoid or manage side effects caused by Xanax.

1. Take Xanax as directed

Take the dose exactly as prescribed, usually 0.25–3 mg taken three times a day. A doctor or other healthcare provider may provide a dosing schedule. Don’t take extra medicine or skip a dose. 

2. Tell the doctor about all medical conditions

To avoid side effects, the doctor or other healthcare professional prescribing Xanax needs to be aware of all current and past mental health and medical conditions, especially:

  • Depression or mood problems
  • Suicidal thoughts or behaviors
  • Liver or kidney problems
  • Lung or breathing problems
  • Any history of seizures
  • Pregnancy or pregnancy plans
  • Breastfeeding or any plans to breastfeed
  • Any history of drug or alcohol abuse

3. Tell the doctor about all medications being taken

Some Xanax side effects are worsened by drug interactions. Many prescription drugs and supplements can dramatically worsen the side effects of alprazolam by blocking the liver’s ability to metabolize it. Before starting Xanax, make sure the doctor, healthcare provider, or pharmacist knows about Xanax before filling the prescription. Tell your healthcare provider about all prescriptions, over-the-counter drugs, and supplements that are taken regularly, particularly:

  • Opioids
  • Anxiety drugs
  • Sedatives or sleep aids
  • Any other drug that causes drowsiness or sleepiness

4. Be careful about driving and other risky activities

Most people taking Xanax will experience some form of mental impairment: drowsiness, bad coordination, balance problems, and trouble focusing. As a result, injuries, falls, and traffic accidents are commonly associated with prescription benzodiazepines. Driving, operating machinery, or engaging in any potentially hazardous activity that requires full attention and focus should be avoided when first taking Xanax. When the effects of Xanax on mental impairment are no longer experienced after a week or two, it may be possible to resume driving or other activities cautiously.

5. Remove hazards from the house

Falls and injuries due to mental impairment are possible when taking Xanax. Older adults are particularly vulnerable. Before starting Xanax, try to remove obstacles and tripping hazards around the house such as coffee tables. Some daily activities, such as using knives, may need to be curtailed if mental impairment is too pronounced.

6. Don’t drink alcohol

Do not drink alcohol while taking Xanax. The combination increases sedation, balance problems, and the risk for injury. The combination can also increase the risk of breathing problems. It’s a good idea to also avoid prescription or nonprescription drugs that cause sleepiness, like antihistamines. In particular, don’t combine Xanax with other benzodiazepines such as Ativan (lorazepam), Valium (diazepam), or Klonopin (clonazepam). 

7. Watch for signs of breathing problems

Some people will notice that Xanax slows down their breathing. This could be a serious problem in any person with lung problems or who is drinking alcohol or taking other depressants. When taking Xanax, watch for signs that breathing has become too slow and shallow to adequately supply the body with oxygen. These signs include blue lips, blue skin, shallow breathing, difficulty breathing, or changes in heart rate. Emergency medical attention is required in that situation.

8. Do not stop taking Xanax

Xanax can cause withdrawal when stopped suddenly. In some cases, the withdrawal can be severe and even life-threatening. In cases where the drug does not seem to be working or the side effects make it too difficult to take, get medical advice from a doctor or other healthcare professional before stopping the medicine. Whether or not there are other treatment options, a progressively tapered dose will be used to avoid withdrawal while stopping the medication.

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