Xanax (Alprazolam): A Quick Guide

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In this article, we will discuss the various aspects of alprazolam including its mechanism of action, important information you should know before taking it, specific concerns about alprazolam and pregnancy, how it is administered, how it is available, dosage instructions, possible side effects, and risks for taking alprazolam for long periods.

Understanding Xanax (Alprazolam)

Alprazolam is a benzodiazepine drug that is used to treat anxiety and panic disorders. It belongs to a class of drugs known as anxiolytics (central nervous system depressants), which work by decreasing abnormal electrical activity in the brain.

Anxiolytics are often used to treat anxiety disorders and conditions, such as:

NOTE: Anxiolytics may also be prescribed for other uses as determined by your doctor. You should always follow the instructions of your physician when taking any drug.

Action Mechanism of Xanax (Alprazolam)

Alprazolam works by increasing the levels of a neurotransmitter called GABA in the brain. GABA is responsible for slowing down nerve activity and calming the mind and body. Alprazolam also blocks certain receptors in the brain that are associated with anxiety and panic disorders.

Important Information I Should Know About Xanax (Alprazolam)

Before taking Alprazolam, you should be aware of some important information. This includes:

  • Alprazolam can cause birth defects if taken during the first trimester of pregnancy. If you are pregnant or planning to become pregnant, do not take alprazolam unless your doctor finds it necessary and has discussed the risks and benefits with you.
  • Alprazolam may also cause withdrawal symptoms in newborns if taken during the third trimester of pregnancy. If you are pregnant or planning to become pregnant, notify your doctor immediately if you take alprazolam so that he/she can monitor your baby’s condition.
  • Alprazolam may cause drowsiness and dizziness and impair your ability to operate heavy machinery or drive a car. Be careful when doing these activities until you know how alprazolam affects you.
  • It is important not to drink alcohol while taking alprazolam, as this can increase the risk of side effects.
  • Do not stop taking alprazolam abruptly without talking to your doctor, as this may cause withdrawal symptoms.

Specific Concerns About Xanax (Alprazolam) And Pregnancy

Pregnant women should avoid taking alprazolam unless it is deemed necessary by their healthcare provider. Alprazolam has been classified as a Pregnancy Category D drug, which means that it may cause harm to an unborn baby if taken during pregnancy. There is evidence of an increased risk of birth defects in children exposed to alprazolam or other benzodiazepines in utero (in the womb).

The FDA recommends that women avoid taking alprazolam during the first trimester of pregnancy, as this is when a baby’s major organs and body parts develop. Alprazolam may cause birth defects if taken during the first trimester. Taking it later in pregnancy may increase the risk for withdrawal symptoms and other complications in newborns.

If you become pregnant while taking alprazolam, contact your healthcare provider immediately. There may be an alternative medication that is safe for you to take during pregnancy. However, do not stop taking alprazolam abruptly or without talking to your doctor first. Because this can cause serious withdrawal symptoms and seizures. Your doctor can help you wean off of alprazolam safely.

Things Should I Discuss With My Doctor Before Taking Xanax (Alprazolam)

Before taking Alprazolam, tell your doctor if you have or ever had any of the following conditions:

  • Breathing Problems
  • Glaucoma (Closed-Angle)
  • Kidney or Liver Disease (Liver Cirrhosis)
  • If you are allergic to any medications
  • Drug or alcohol addiction/abuse history. You should not take alprazolam due to the risk of physical dependence.
  • All of your medical conditions, including any mental health disorders you may have
  • The other medications you are currently taking, including over-the-counter and prescription drugs, as well as dietary supplements and herbal remedies

NOTE: This is not a complete list of conditions that may affect your ability to take alprazolam. You should always consult with your doctor about any health concerns you have before taking any drug, including alprazolam.

Administering Xanax (Alprazolam)

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Xanax is available as tablets and oral concentrate. The following dosages are available:

  • 0.25 mg
  • 0.50 mg
  • 0.75 mg

Alprazolam is also available as an extended-release tablet, which is marketed under the brand name Xanax XR. The following dosages are available for Xanax XR:

  • 0.50 mg (contains alprazolam equivalent of 0.50 mg of an immediate-release tablet)
  • 0.75 mg (contains alprazolam equivalent of 0.75 mg of an immediate-release tablet)
  •  l.0 mg (contains alprazolam equivalent of l.0 mg of an immediate-release tablet)
  •  l.50 mg (contains alprazolam equivalent of l.50 mg of an immediate-release tablet)

NOTE: Swallow the tablet whole. Do not break, chew, or crush it. If you are taking the extended-release tablet, do not split it into smaller doses.

How Should I Take Xanax (Alprazolam)?

Take Xanax exactly as it was prescribed for you by your doctor. Follow all directions on the prescription label. Do not take this medication in larger or smaller amounts, or for longer than recommended.

Alprazolam may be habit-forming and should only be used for short-term relief of anxiety symptoms. Never share this medication with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

NOTE: Alprazolam begins working within 30 minutes. However, it may take up to two weeks for the full effects of this medication to be noticed.

What Happens If I Miss A Dose Of Xanax (Alprazolam)?

If you miss a dose of alprazolam, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not take two doses at once.

NOTE: If you overdose on alprazolam, call 911 or seek emergency medical attention.

Evaluating Xanax (Alprazolam)

There are several factors to consider when evaluating the appropriateness of alprazolam for a particular individual, including:

  • The severity of the person’s anxiety symptoms
  • The duration of the person’s symptoms
  • Whether the person has already tried other medications for their anxiety symptoms
  • The person’s medical history, including any underlying health conditions or other mental health disorders
  • Whether the person is taking any other medications that could impact how alprazolam works

NOTE: Make sure to discuss any medications you are currently taking with your doctor before starting alprazolam. This will help ensure that it is a safe option for you and will not interact negatively with other drugs you may be taking.

Possible Side Effects Of Xanax (Alprazolam)

Common side effects

The most common side effects of alprazolam include:

  • Headaches
  • Drowsiness
  • Fatigue
  • Nausea
  • Weight loss
  • Diarrhea
  • Irritability or hostility
  • Decreased appetite
  • Weakness or tiredness
  • Restlessness or feeling jittery

NOTE: These symptoms usually go away after a few days. If they do not, talk to your doctor about them.

Rare side effects

NOTE: If you experience any of these symptoms, talk to your doctor immediately.

Risks For Taking Xanax (Alprazolam) For Long Time

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There are some risks associated with taking alprazolam for long periods, including:

  • The potential for addiction or dependence on alprazolam
  • The development of withdrawal symptoms if alprazolam is discontinued abruptly
  • The potential development of tolerance to the medication may lead to a need for increasingly higher doses to achieve the desired effects

NOTE: If you experience any of these symptoms, talk to your doctor immediately. Do not stop taking alprazolam without first talking to your doctor. They may be able to help you slowly taper off the medication so that you do not experience any withdrawal symptoms.

Medications That May Interact With Xanax (Alprazolam)

Some medications that may interact with alprazolam include:

  • Antihistamines such as diphenhydramine (Benadryl)
  • Beta-blockers such as propranolol (Inderal) or metoprolol (Lopressor)
  • Other anti-anxiety medications such as diazepam (Valium) or clonazepam (Klonopin)
  • Alcohol, which can increase the side effects of alprazolam. You should avoid drinking alcohol while taking alprazolam for your anxiety symptoms.

Possible Interactions With Other Substances

Alprazolam can have serious interactions with other substances, including:

CNS depressants: Alprazolam can increase the effects of other CNS depressants, including but not limited to:

  • Barbiturates
  • Benzodiazepines such as diazepam (Valium) or clonazepam (Klonopin)
  • Opioids such as codeine or hydrocodone (Vicodin)

Herbal supplements: Alprazolam can increase the effects of certain herbal supplements, including but not limited to:

  • St. John’s Wort
  • Ginseng
  • Kava-kava
  • Passionflower

Valerian root extract: Alprazolam can increase the effects of valerian root extract and should be used with caution in people taking this supplement.

NOTE: It is important to talk with your doctor about all other substances you are taking before starting alprazolam. This will help ensure that it is a safe option for you and will not interact negatively with other drugs you may be taking.

Summary of FDA Black Box Warnings

The FDA requires the following black box warnings on all alprazolam prescriptions:

  • The potential for abuse and drug tolerance with alprazolam
  • An increased risk of suicidal thoughts or behavior in children and young adults
  • People who take alprazolam for anxiety or depression may be at an increased risk of suicide
  • Alprazolam can cause physical and psychological dependence, as well as withdrawal symptoms if a patient discontinues it abruptly. Thus, you should not stop it suddenly unless under medical supervision.
  • Alprazolam may impair a person’s ability to drive a car safely, operate machinery or engage in hazardous activities. This can lead to accidental injuries including falls that could result in serious injuries or death.
  • Alprazolam can be habit-forming and should only be used as directed by your doctor. Do not take more of this medication than prescribed, and do not use it for longer periods than directed. Furthermore, withdrawal symptoms may occur if alprazolam if patients discontinue it abruptly.

NOTE: It is important to discuss these risks with your doctor before taking alprazolam, as they can help you weigh the benefits and risks of treatment. They can also help you create a plan for safely using this medication.

Managing Side-effects of Xanax (Alprazolam)

The side effects of alprazolam can be managed by:

General Tips

  • Drinking plenty of fluids to avoid dehydration, which can cause headaches and constipation.
  • Eating a healthy diet that includes plenty of fruits and vegetables helps minimize stomach upset.
  • Exercising regularly to help reduce tension and anxiety.

Additional Tips

If possible, try to take alprazolam at the same time each day. This can help minimize side effects.

  • Avoid drinking alcohol while taking alprazolam, as it can increase the side effects of the medication.
  • Talk to your doctor about the best options for managing these side effects. They may recommend an alternative medication or help you find ways to cope with the side effects so that they are less bothersome.
  • Take breaks from using alprazolam if you are experiencing severe side effects. Your doctor may recommend that you stop taking the medication for a short time and then resume at a lower dose.
  • Some people find that relaxation techniques such as yoga, tai chi, or meditation can also help reduce anxiety and stress. If you have an interest in trying one of these techniques, talk to your doctor for guidance.

NOTE: If you experience any side effects when taking alprazolam that are severe, persistent, or worrisome, talk to your doctor immediately. They may be able to help you manage them or change your dose to make them more tolerable. Furthermore, they can determine if it is safe for you to continue using the medication.

Experts’ Opinion About Xanax (Alprazolam)

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Journal of Clinical Psychiatry

In an article for the Journal of Clinical Psychiatry, Dr. Mark H. Pollack and colleagues note that alprazolam is a good option for treating generalized anxiety disorder (GAD) in people who find other benzodiazepines such as diazepam ineffective or intolerable.

“According to research, Alprazolam is effective in the short-term treatment of the panic disorder. In a study published in the journal Psychopharmacology, researchers found that alprazolam was superior to placebo and as effective as imipramine (a tricyclic antidepressant) in reducing symptoms of panic disorder.”

CNS Drugs Journal

A review article published in the journal CNS Drugs states that alprazolam is among the most effective benzodiazepines for treating anxiety disorders. It has a fast onset of action, which can make it more beneficial than other benzodiazepines such as diazepam (Valium).

“However, alprazolam carries an increased risk of dependence and abuse due to its rapid onset and short duration of action. It also has a high potential for misuse, which can lead to addiction.”

Case Study

What Happened to the Man Who Took Xanax (Alprazolam)

In April 2016, a 42-year-old man with no prior medical history was admitted to an emergency department after suffering from a seizure. He was also experiencing drowsiness and slurred speech at the time of admission. The patient’s friend told hospital staff that the man had been drinking alcohol and taking Xanax (alprazolam) for about two weeks before admission. The patient underwent treatment with activated charcoal and fluids, and he got discharged from the hospital later that day. The cause of his seizure is unknown, but alprazolam likely played a role in causing it.

The Key Message

It is important to speak with your doctor about all of the medications you are taking before starting alprazolam, as it can interact negatively with other drugs.


Xanax (Alprazolam) is one of the most prescribed drugs in the world, with approximately 30 million prescriptions filled every year. It is effective for treating anxiety disorders and panic attacks, but it also comes with some risks such as dependence and abuse potential. The best way to use this medication safely is by speaking with your doctor about potential side effects and benefits.

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