In this drug factsheet:
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- blurred vision or other changes in vision
- changes in sexual desire or ability
- clumsiness or unsteadiness
- dizziness or lightheadedness
- false sense of well-being
- increased appetite
- problems with urination
- unusual tiredness
Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- abnormal thinking (e.g., disorientation, delusions, or loss of sense of reality)
- behaviour changes (e.g., aggressive behaviour, bizarre behaviour, decreased inhibition, or outbursts of anger)
- loss of recent memory
- signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
- signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
- slurred speech
- symptoms of mania (e.g., decreased need for sleep, elevated or irritable mood, racing thoughts)
- trouble sleeping
Stop taking the medication and seek immediate medical attention if any of the following occur:
Some people may experience side effects other than those listed.
- signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
- signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
- signs of increased pressure in the eyes (e.g., sudden severe eye pain, changes in side vision, decreased or cloudy vision, seeing halos around lights, swollen eyes)
Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Dependence and withdrawal: Physical dependence (a need to take regular doses to prevent physical symptoms) has been associated with benzodiazepines such as alprazolam. Severe withdrawal symptoms may be experienced if the dose is significantly reduced or suddenly discontinued. These symptoms include seizures, irritability, nervousness, sleep problems, agitation, tremors, diarrhea, abdominal cramps, vomiting, memory impairment, headache, muscle pain, extreme anxiety, tension, restlessness, and confusion. Reducing the dose gradually, under medical supervision, can help prevent or decrease these withdrawal symptoms.
Because the treatment of panic disorder often requires the use of average daily doses of alprazolam above 3 mg, the risk of dependence among people with panic disorder may be higher than that among those treated for less severe anxiety.
Drowsiness/reduced alertness: Alprazolam may affect the mental or physical abilities needed to drive or operate machinery. Do not engage in activities requiring mental alertness, judgment, and physical coordination until you have established how alprazolam affects you. Alcohol can increase the drowsiness effects of alprazolam and should be avoided.
Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have kidney problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Mood changes: Anxiety disorders are often associated with mood changes, such as depression, mania, or ideas of suicide or self-harm. If you have depression or a history of depression, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
If you experience symptoms of depression such as poor concentration, changes in weight, changes in sleep, decreased interest in activities, or notice them in a family member who is taking this medication contact your doctor as soon as possible.
Pregnancy: Other benzodiazepine medications similar to alprazolam are known to increase the risk of birth defects when taken by a woman who is pregnant. The safety of alprazolam during pregnancy has not been established. It is not recommended for use by pregnant women.
Breast-feeding: Alprazolam may pass into breast milk. If you are a breast-feeding mother and are taking alprazolam, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children and adolescents: The safety and efficacy of alprazolam for children and adolescents under 18 years of age have not been established.
Seniors may be at increased risk of experiencing side effects such as sedation, reduced coordination, and dizziness. Use extra caution when rising from a sitting or lying position to reduce the risk of severe dizziness and falls.
What other drugs could interact with this medication?
There may be an interaction between alprazolam and any of the following:
- antihistamines (e.g,. cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
- antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
- antiseizure medications (e.g., clobazam, ethosuximide, felbamate, levetiracetam, phenobarbital, phenytoin, primidone, topiramate, valproic acid, zonisamide)
- "azole" antifungals (e.g., ketoconazole, itraconazole, fluconazole)
- barbiturates (e.g., butalbital, phenobarbital)
- benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
- birth control pills
- calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
- chloral hydrate
- general anesthetics (medications used to put people to sleep before surgery)
- HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delaviridine, efavirenz, etravirine, nevirapine)
- HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
- kava kava
- macrolide antibiotics (e.g., erythromycin, clarithromycin)
- magnesium sulfate
- muscle relaxants (e.g., cyclobenzaprine, methocarbamol, orphenadrine)
- narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
- St. John's wort
- selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
- tricyclic antidepressants (e.g., amitriptyline, desipramine, imipramine)
- tyrosine kinase inhibitors (e.g., dasatinib, imatinib)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.