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Xanax Side Effects

Generic Name: alprazolam

Note: This document contains side effect information about alprazolam. Some of the dosage forms listed on this page may not apply to the brand name Xanax.

In Summary

Common side effects of Xanax include: ataxia, cognitive dysfunction, constipation, difficulty in micturition, drowsiness, dysarthria, fatigue, memory impairment, skin rash, weight gain, weight loss, anxiety, blurred vision, diarrhea, insomnia, decreased libido, increased appetite, and decreased appetite. Other side effects include: hypotension, sexual disorder, muscle twitching, and increased libido. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to alprazolam: oral solution, oral tablet, oral tablet disintegrating, oral tablet extended release

Along with its needed effects, alprazolam (the active ingredient contained in Xanax) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking alprazolam:

More common
  • Being forgetful
  • changes in patterns and rhythms of speech
  • clumsiness or unsteadiness
  • difficulty with coordination
  • discouragement
  • drowsiness
  • feeling sad or empty
  • irritability
  • lack of appetite
  • lightheadedness
  • loss of interest or pleasure
  • relaxed and calm
  • shakiness and unsteady walk
  • sleepiness or unusual drowsiness
  • slurred speech
  • tiredness
  • trouble concentrating
  • trouble performing routine tasks
  • trouble sleeping
  • trouble speaking
  • unsteadiness, trembling, or other problems with muscle control or coordination
  • unusual tiredness or weakness
Less common
  • Abdominal or stomach pain
  • blurred vision
  • body aches or pain
  • burning, crawling, itching, numbness, prickling, "pins and needles, or tingling feelings
  • changes in behavior
  • chills
  • clay-colored stools
  • confusion about identity, place, and time
  • cough
  • dark urine
  • decrease in frequency of urination
  • decrease in urine volume
  • diarrhea
  • difficult or labored breathing
  • difficulty in passing urine (dribbling)
  • difficulty with concentration
  • difficulty with moving
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • dry mouth
  • ear congestion
  • environment seems unreal
  • fainting
  • fear or nervousness
  • feeling of unreality
  • feeling warm
  • fever
  • general feeling of discomfort or illness
  • headache
  • hyperventilation
  • inability to move the eyes
  • inability to sit still
  • increased blinking or spasms of the eyelid
  • irregular heartbeats
  • itching or rash
  • joint pain
  • lack or loss of self-control
  • loss of bladder control
  • loss of coordination
  • loss of memory
  • loss of voice
  • mood or mental changes
  • muscle aching or cramping
  • muscle pain or stiffness
  • muscle weakness
  • nasal congestion
  • nausea
  • need to keep moving
  • painful urination
  • problems with memory
  • restlessness
  • runny nose
  • seeing, hearing, or feeling things that are not there
  • seizures
  • sense of detachment from self or body
  • shaking
  • shivering
  • sneezing
  • sore throat
  • sticking out of the tongue
  • sweating
  • swollen joints
  • talkativeness
  • tightness in the chest
  • trouble with balance
  • twitching, twisting, or uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
  • uncontrolled twisting movements of the neck, trunk, arms, or legs
  • unpleasant breath odor
  • unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
  • unusual facial expressions
  • unusually deep sleep
  • unusually long duration of sleep
  • vomiting of blood
  • yellow eyes or skin
Rare
  • Actions that are out of control
  • attack, assault, or force
  • chest pain
  • continuing ringing or buzzing or other unexplained noise in the ears
  • decreased awareness or responsiveness
  • deep or fast breathing with dizziness
  • ear pain
  • false or unusual sense of well-being
  • fast, irregular, pounding, or racing heartbeat or pulse
  • feeling jittery
  • feeling unusually cold
  • generalized slowing of mental and physical activity
  • hearing loss
  • hoarseness
  • lack of feeling or emotion
  • loss of control of the legs
  • loss of strength or energy
  • nightmares
  • numbness of the feet, hands, and around mouth
  • severe sleepiness
  • shakiness in the legs, arms, hands, or feet
  • sleep talking
  • swelling
  • talking, feeling, and acting with excitement
  • thoughts of killing oneself
  • uncaring
  • unusual weak feeling
  • voice changes
Incidence not known
  • General tiredness and weakness
  • light-colored stools
  • stomach pain, continuing
  • upper right abdominal or stomach pain

Some side effects of alprazolam may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Absent, missed, or irregular menstrual periods
  • decreased appetite
  • decreased interest in sexual intercourse
  • decreased sexual performance or desire abnormal ejaculation
  • difficulty having a bowel movement (stool)
  • inability to have or keep an erection
  • increased appetite
  • increased in sexual ability, desire, drive, or performance
  • increased interest in sexual intercourse
  • increased weight
  • loss in sexual ability, desire, drive, or performance
  • stopping of menstrual bleeding
  • watering of the mouth
  • weight loss
Less common
  • Abdominal or bloating and cramping
  • blistering, crusting, irritation, itching, or reddening of the skin
  • change in taste bad unusual or unpleasant (after) taste
  • cracked, dry, or scaly skin
  • cramps
  • double vision
  • feeling of warmth
  • heavy bleeding
  • menstrual changes
  • pain
  • pelvic pain
  • redness of the face, neck, arms, and occasionally, upper chest
  • seeing double
  • sudden sweating
  • unexplained runny nose or sneezing
Rare
  • Acid or sour stomach
  • belching
  • bigger, dilated, or enlarged pupils (black part of the eye)
  • change in color vision
  • difficulty seeing at night
  • feeling of constant movement of self or surroundings
  • feeling of relaxation
  • heartburn
  • hives or welts
  • increased sensitivity of the eyes to sunlight
  • indigestion
  • redness of the skin
  • runny nose
  • sensation of spinning
  • stomach discomfort, upset, or pain
  • stuffy nose
Incidence not known
  • Blistering, peeling, or loosening of the skin
  • red, irritated eyes
  • red skin lesions, often with a purple center
  • sores, ulcers, or white spots in the mouth or on the lips
  • swelling of the breasts or breast soreness in both females and males
  • unexpected or excess milk flow from the breasts

For Healthcare Professionals

Applies to alprazolam: compounding powder, oral concentrate, oral solution, oral tablet, oral tablet disintegrating, oral tablet extended release

General

Immediate-release formulations: The most commonly reported side effects included drowsiness/sedation, fatigue and tiredness, impaired coordination, memory impairment, and irritability.

Extended-release tablets: The most commonly reported side effects included sedation, tremor, headache, insomnia, and somnolence.[Ref]

Nervous system

Immediate-release formulations:
Very common (10% or more): Sedation (up to 77%), drowsiness (up to 76.8%), impaired coordination (up to 40.1%), memory impairment (up to 33.1%), dizziness (up to 29.8%), lightheadedness (up to 29.8%), headache (up to 29.2%), cognitive disorder (up to 29%), dysarthria (up to 23.3%), abnormal voluntary movement (up to 17.3%)
Common (1% to 10%): Abnormal coordination, akathisia, ataxia, attention disturbance, balance disorder, hypersomnia, lethargy, paresthesia, somnolence, syncope, tremor, vasomotor disturbances
Uncommon (0.1% to 1%): Amnesia, autonomic manifestations, coordination disorders, intellectual impairment, stimulation
Frequency not reported: Concentration difficulties, convulsions, dystonia, loss of coordination, seizures, sleepiness, slurred speech, taste alterations, transient amnesia, withdrawal seizures
Postmarketing reports: Autonomic nervous system imbalance, psychomotor hyperactivity

Extended-release tablets:
Very common (10% or more): Sedation (up to 45.2%), tremor (up to 28.2%), headache (up to 26.5%), somnolence (up to 23%), memory impairment (up to 15.4%), dysarthria (up to 10.9%)
Common (1% to 10%): Abnormal coordination, ataxia, balance impaired, disturbance in attention, dizziness, dyskinesia, hypersomnia, hypoesthesia, lethargy, mental impairment, paresthesia, vertigo
Uncommon (0.1% to 1%): Amnesia, clumsiness, depressed level of consciousness, hangover, hypotonia, stupor, syncope
Frequency not reported: Stimulation, withdrawal seizures[Ref]

Other

Immediate-release formulations:
Very common (10% or more): Fatigue and tiredness (up to 49%)
Common (1% to 10%): Feeling warm, tinnitus, weakness
Frequency not reported: Rebound phenomena

Extended-release tablets:
Very common (10% or more): Fatigue (up to 13.9%)
Common (1% to 10%): Malaise, road traffic accident, weakness
Uncommon (0.1% to 1%): Asthenia, ear pain, fall, feeling drunk, feeling hot and cold, feeling jittery, feeling of relaxation, increased energy, loss of control of legs, pyrexia, rigors, sluggishness, tinnitus
Frequency not reported: Paradoxical reactions[Ref]

Psychiatric

Immediate-release formulations:
Very common (10% or more): Irritability (up to 33.1%), insomnia (up to 29.5%), anxiety (up to 19.2%), decreased libido (up to 14%), depression (up to 13.9%), confusional state (up to 10.4%)
Common (1% to 10%): Agitation, change in libido (not specified), confusion, derealization, disinhibition, disorientation, dream abnormalities, fear, increased libido, nervousness, talkativeness
Uncommon (0.1% to 1%): Adverse behavioral effects, altered mood, concentration difficulties, hallucinations
Rare (0.01% to 0.1%): Hypomania, mania, other adverse behavioral effects
Frequency not reported: Abuse, aggressive or hostile behavior, aggressiveness/aggression, anterograde amnesia, delusion, depersonalization, dysphoria/mild dysphoria, hostility, inappropriate behavior, intrusive thoughts, nightmares, physical dependence, primary/secondary major depressive disorders, psychic dependence, psychoses, rage, restlessness, suicide, withdrawal symptoms
Postmarketing reports: Abnormal thinking, anger, libido disorder

Extended-release tablets:
Very common (10% or more): Insomnia (up to 24.2%), nervousness (up to 21.8%), depression (up to 12.1%)
Common (1% to 10%): Agitation, anxiety, confusion, depersonalization, depressed mood, derealization, disorientation, irritability, libido decreased/increased, nightmare, restlessness
Uncommon (0.1% to 1%): Abnormal dreams, aggression, anger, apathy, bradyphrenia, euphoric mood, hallucination, homicidal ideation, hypomania, impulse control, logorrhea, mania, mood swings, psychomotor retardation, sleep talking, suicidal ideation
Frequency not reported: Adverse behavioral effects, aggressive/hostile behavior, hostility, intrusive thoughts, other adverse behavioral effects, sleep disturbances, rage, withdrawal syndrome[Ref]

Gastrointestinal

Immediate-release formulations:
Very common (10% or more): Decreased salivation (up to 32.8%), constipation (up to 26.2%), nausea (up to 22%), vomiting (up to 22%), diarrhea (up to 20.6%), abdominal distress (up to 18.3%), dry mouth (up to 15%)
Common (1% to 10%): Increased salivation
Uncommon (0.1% to 1%): Gastrointestinal symptoms/various gastrointestinal symptoms
Frequency not reported: Abdominal cramps
Postmarketing reports: Gastrointestinal disorder

Extended-release tablets:
Very common (10% or more): Diarrhea (up to 12.1%), dry mouth (up to 10.2%)
Common (1% to 10%): Abdominal pain, constipation, dyspepsia, nausea, vomiting
Uncommon (0.1% to 1%): Dysphagia, salivary hypersecretion
Postmarketing reports: Gastrointestinal disorder[Ref]

Metabolic

Immediate-release formulations:
Very common (10% or more): Increased appetite (up to 33%), decreased appetite (up to 28%), weight gain (up to 27%), weight loss (up to 23%)
Frequency not reported: Anorexia

Extended-release tablets:
Common (1% to 10%): Anorexia, appetite decreased/increased, weight decreased/increased
Uncommon (0.1% to 1%): Thirst[Ref]

Cardiovascular

Immediate-release formulations:
Very common (10% or more): Tachycardia (up to 15.4%), chest pain (up to 10.6%)
Common (1% to 10%): Edema, hypotension, palpitations
Postmarketing reports: Peripheral edema

Extended-release tablets:
Common (1% to 10%): Chest pain, hot flush, palpitations
Uncommon (0.1% to 1%): Chest tightness, edema, hypotension, sinus tachycardia
Postmarketing reports: Peripheral edema[Ref]

Genitourinary

Immediate-release formulations:
Very common (10% or more): Micturition difficulties (up to 12.2%), menstrual disorders (up to 10.4%)
Common (1% to 10%): Incontinence, sexual dysfunction
Frequency not reported: Menstrual irregularities, urinary retention
Postmarketing reports: Galactorrhea

Extended-release tablets:
Common (1% to 10%): Difficulty in micturition, dysmenorrhea, premenstrual syndrome, sexual dysfunction
Uncommon (0.1% to 1%): Urinary frequency, urinary incontinence
Postmarketing reports: Galactorrhea[Ref]

Dermatologic

Immediate-release formulations:
Very common (10% or more): Sweating (up to 15.1%), rash (up to 11%)
Common (1% to 10%): Dermatitis
Frequency not reported: Pruritus
Postmarketing reports: Photosensitivity reaction, Stevens-Johnson syndrome

Extended-release tablets:
Common (1% to 10%): Pruritus, sweating increased
Uncommon (0.1% to 1%): Clamminess, rash, urticaria
Postmarketing reports: Stevens-Johnson syndrome[Ref]

Respiratory

Immediate-release formulations:
Very common (10% or more): Nasal congestion (up to 17.4%)
Common (1% to 10%): Hyperventilation, upper respiratory tract infection

Extended-release tablets:
Common (1% to 10%): Allergic rhinitis, dyspnea, hyperventilation, nasal congestion, pharyngolaryngeal pain, upper respiratory tract infections
Uncommon (0.1% to 1%): Choking sensation, dysphonia, epistaxis, rhinorrhea, sleep apnea syndrome[Ref]

Ocular

Immediate-release formulations:
Very common (10% or more): Blurred vision (up to 21%)
Rare (0.01% to 0.1%): Increased intraocular pressure
Frequency not reported: Diplopia

Extended-release tablets:
Common (1% to 10%): Blurred vision
Uncommon (0.1% to 1%): Mydriasis, photophobia[Ref]

Musculoskeletal

Immediate-release formulations:
Common (1% to 10%): Muscle stiffness, muscle tone disorders, muscular cramps, muscular twitching, rigidity
Uncommon (0.1% to 1%): Muscular weakness
Frequency not reported: Musculoskeletal weakness

Extended-release tablets:
Common (1% to 10%): Arthralgia, back pain, muscle cramps, muscle twitching, myalgia, pain in limb
Frequency not reported: Increased muscle spasticity[Ref]

Immunologic

Immediate-release formulations:
Common (1% to 10%): Infection

Extended-release tablets:
Common (1% to 10%): Influenza[Ref]

Hypersensitivity

Immediate-release formulations:
Common (1% to 10%): Allergy
Postmarketing reports: Angioedema

Extended-release tablets:
Postmarketing reports: Angioedema[Ref]

Hepatic

Immediate-release formulations:
Rare (0.01% to 0.1%): Abnormal hepatic function tests, jaundice
Frequency not reported: Elevated bilirubin, elevated hepatic enzymes
Postmarketing reports: Hepatic failure, hepatitis

Extended-release tablets:
Postmarketing reports: Hepatic failure, hepatitis, liver enzyme elevations[Ref]

Endocrine

Immediate-release formulations:
Postmarketing reports: Gynecomastia, hyperprolactinemia

Extended-release tablets:
Postmarketing reports: Gynecomastia, hyperprolactinemia[Ref]

References

1. Cerner Multum, Inc. "Australian Product Information." O 0

2. "Product Information. Xanax XR (alprazolam)." Pfizer U.S. Pharmaceuticals Group, New York, NY.

3. "Product Information. Niravam (alprazolam)." Schwarz Pharma, Mequon, WI.

4. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn, Kalamazoo, MI.

5. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

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