Xanax Side Effects and Long-Term Risks

Xanax side effects can be hard to read. Maybe you just filled a first prescription and feel heavier than you expected. Maybe you have taken it for years and keep losing parts of your evenings. Or maybe someone you love is slurring words at dinner. The common effects and the dangerous ones can look alike at first.

Xanax (alprazolam) is one of the most prescribed benzodiazepines in the United States. The FDA estimates that 92 million benzodiazepine prescriptions were dispensed from U.S. outpatient retail and mail-order pharmacies in 2019, and alprazolam was the most common at 38%, ahead of clonazepam (24%) and lorazepam (20%). If you are comparing medications, our guide to lorazepam (Ativan) side effects covers the third drug on that list.

How common are Xanax side effects?

The FDA label reports how often trial participants had each effect on Xanax and on a placebo (a sugar pill). Anxiety itself causes fatigue and appetite changes, so the honest measure is the gap between the two.

Source: XANAX prescribing information, Table 2 (1,388 people on Xanax, 1,231 on placebo, up to 10 mg a day). The 4-week generalized anxiety trials (up to 4 mg a day) showed lower rates: drowsiness 41% vs 22%. The “Does it ease over time?” column draws on the label and an 8-week controlled alprazolam trial (O’Sullivan 1994).

Does Xanax make you sleepy?

Yes. Drowsiness is the most common Xanax side effect: 77% of people in panic disorder trials vs 43% on placebo, and 41% vs 22% at the lower anxiety-trial doses.

Alprazolam peaks in your blood 1 to 2 hours after a dose, which is when you may feel it most. In one 8-week trial, sedation tended to lessen but was still present at week 8. If it does not ease, your prescriber may want to look at the dose or timing.

Why you may feel foggy the next morning

Alprazolam’s average half-life (the time your body takes to clear half the drug) is about 11.2 hours in healthy adults, ranging from 6.3 to 26.9. Take a dose at 10 p.m. and, if you clear it slowly, a meaningful amount is still on board at breakfast. Some people describe it as a hangover: slow thinking, heavy limbs, a short fuse. Tell your prescriber, especially if you drive mornings.

Can Xanax affect your coordination and balance?

Impaired coordination showed up in 40% of people on Xanax vs 18% on placebo. It feels like clumsiness, missing a step, or misjudging distance while parking.

This is the side effect that turns into injuries. A fall at 35 is usually a bruise. A fall at 75 can be a broken hip. If you are stumbling, tell your prescriber before the next refill.

Does Xanax cause dizziness or lightheadedness?

Lightheadedness hit 21% in the anxiety trials, but 19% on placebo, so much of it may be anxiety itself. Low blood pressure (hypotension) was less common in those trials, 5% vs 2%, and can make you feel faint when you stand quickly. Rise slowly, and call your prescriber if you pass out.

Can Xanax cause memory problems?

Memory impairment was reported by 33% of people on Xanax vs 22% on placebo. The label also lists transient amnesia as a benzodiazepine reaction. In practice, it looks like gaps: a phone call you do not remember, or the end of a movie you cannot recall.

Long-term effects are harder to pin down. A 2018 meta-analysis by Crowe and Stranks found long-term benzodiazepine users scored lower on working memory, processing speed and attention, and some deficits remained after people stopped. The label adds that little tolerance develops to these memory and thinking effects. If you are losing pieces of your day, call your prescriber.

Why does Xanax cause slurred speech?

Slurred speech, or dysarthria, has one of the widest gaps in the label: 23% on Xanax vs 6% on placebo. Alprazolam amplifies the brain’s main braking signal (GABA), which can blunt the fine muscle control speech needs.

Sudden slurring, or slurring with confusion, can mean the dose is too high or Xanax was mixed with alcohol or another sedative. MedlinePlus lists speech problems among effects to report to a doctor right away. Family members may notice it before you do.

Can Xanax change your mood?

Irritability was reported by 33% of people on Xanax in the panic trials, though 30% on placebo reported it too. The less common reactions deserve attention:

• Paradoxical reactions. The label notes rare reports of agitation, rage, aggression and hallucinations, the opposite of what the drug is meant to do.
• Worsening depression. The label warns that benzodiazepines may worsen depression.
• Hypomania or mania. Episodes have been reported in people with depression who take Xanax.

If you notice darker moods, thoughts of suicide, or sudden anger that feels out of character, contact your prescriber right away. If you are in crisis, call or text the 988 Suicide and Crisis Lifeline, available 24 hours a day.

Does Xanax affect sex drive?

It can go either direction. Decreased libido was reported by 14% on Xanax vs 8% on placebo, but increased libido showed up too (8% vs 4%). Sexual dysfunction was reported by 7% vs 4%. Your prescriber has heard it before, and it is a fair reason to revisit your plan.

Can Xanax cause weight gain or appetite changes?

Appetite moved in both directions in the panic trials:

• Increased appetite: 33% on Xanax vs 23% on placebo
• Decreased appetite: 28% vs 24%
• Weight gain: 27% vs 18%
• Weight loss: 23% vs 17%

Increased appetite and weight gain show the clearer gaps. If your clothes fit differently after a few months, mention it.

Does Xanax cause constipation or dry mouth?

Constipation: 26% on Xanax vs 15% on placebo. Dry mouth, in the anxiety trials: 15% vs 13%, nearly a wash. Water, fiber and movement help. Constipation lasting more than a few days, or with belly pain, is worth a call.

What are the serious side effects of Xanax?

Serious reactions are less common. Call 911 if you or someone with you has:

• Slow, shallow or labored breathing, or shortness of breath
• Extreme drowsiness or cannot be woken up
• A seizure
• Swelling of the face, lips, tongue or throat, or hives with trouble breathing

Seizures can also follow stopping suddenly, covered below.

What happens if you mix Xanax and alcohol?

Alcohol and Xanax both slow your central nervous system, and together they stack, deepening sedation and slowing breathing more than either alone. The label cautions patients against using alcohol and other sedating drugs while taking Xanax.

Opioids carry the strongest warning. The first boxed warning on the Xanax label, the FDA’s most serious type, covers use with opioids, which can cause profound sedation, respiratory depression, coma and death. That includes prescription painkillers and illicit fentanyl.

There is a slower interaction too. In people with alcohol-related liver disease, alprazolam’s average half-life rises to 19.7 hours (ranging from 5.8 to 65.3), so each dose lingers.

What are the long-term side effects of Xanax?

Tolerance. Over time, the same dose may calm you less, which tempts you to take more. Dependence. The FDA says physical dependence can develop when benzodiazepines are taken steadily for several days to weeks, even as prescribed. The label adds that risk and severity appear greater above 4 mg a day and beyond 12 weeks. Interdose anxiety. The label notes anxiety returning between doses, or early in the morning, in some people with panic disorder, which can make the next dose feel necessary.

Real-world reports tell a different story. A 2024 Scientific Reports study analyzed 23,575 reports to the FDA Adverse Event Reporting System (FAERS) naming alprazolam as the main suspect drug, 2004 to mid-2023. “Drug abuse” led with 3,836 reports, followed by “toxicity to various agents” with 1,943. Somnolence, the trial headline, had 1,340, and “drug dependence” 1,133. Voluntary reports cannot tell you how often a problem happens, but misuse, toxicity and dependence filled the top of the list, not drowsiness alone.

Are Xanax side effects different for women and men?

The label does not report rates by sex. In the FAERS reports, 56.53% involved women and 35.84% involved men (the rest did not say). Women are prescribed benzodiazepines more often (34 vs 20 office visits per 100 people in a 2014 to 2016 CDC analysis), so this is not proof that women react worse.

Pregnancy and breastfeeding raise specific concerns. Using Xanax late in pregnancy can cause sedation, breathing problems or withdrawal symptoms in the newborn, and the label does not recommend breastfeeding during treatment. If you are pregnant or nursing, talk with your prescriber. Do not stop on your own.

Why are older adults at higher risk?

Older bodies clear alprazolam more slowly: average half-life was 16.3 hours in healthy older adults vs 11.0 in younger adults, and the label recommends lower doses.

The American Geriatrics Society’s 2023 Beers Criteria, a widely used list of medications to avoid after 65, rates benzodiazepines “avoid,” with a strong recommendation. Its reasoning: all benzodiazepines increase the risk of cognitive impairment, delirium, falls, fractures and car crashes in older adults. If your parent takes Xanax, ask their prescriber whether it still fits, especially after a fall.

Do Xanax side effects go away?

Some lessen, often not completely. In one 8-week trial, sedation, poor coordination, memory problems and irritability eased but were still significant at week 8. Little tolerance develops to memory and thinking effects, the label says, so those can last as long as you take it. Slurred speech or new confusion may mean the dose is too high. Anything that lingers, worsens, or appears after a dose increase belongs with your prescriber.

Side effects at low doses

The anxiety trials (up to 4 mg a day) showed lower rates than the panic trials (up to 10 mg), though they also differed in patients and length. A lower dose does not mean zero risk. The label states some risk of dependence exists even after relatively short-term use at 4 mg a day or less.

What happens when you stop taking Xanax?

After regular use, stopping suddenly is the dangerous part. The label warns that abrupt discontinuation or a rapid dose cut can trigger life-threatening withdrawal reactions, including seizures.

Come off Xanax only with your prescriber, through a gradual taper. Our guide on Xanax withdrawal symptoms and safe tapering walks through what to expect.

When do Xanax side effects signal a bigger problem?

Sometimes side effects signal that use has drifted into a benzodiazepine use disorder, a medical condition in which a person keeps using despite harm. Watch for:

• Taking more than prescribed, or taking doses closer together
• Running out early or seeing several prescribers
• Drinking or using opioids while on Xanax
• Trying to cut back and not being able to

For family members: write down what you have seen, with dates, before you talk. Lead with worry. Offer to go to their next prescriber appointment. Do not push them to quit suddenly, because stopping cold can cause seizures. If breathing slows or you cannot wake them, call 911.

Getting help for Xanax dependence in Massachusetts

Xanax dependence is treatable, and it is not a character flaw. Many people started it exactly as prescribed for real anxiety, and that anxiety still needs care.

Rockland Recovery provides Xanax addiction treatment in Massachusetts through outpatient programs in Braintree, Quincy, Sharon and Bedford. Options include a partial hospitalization program (PHP), day or evening intensive outpatient (IOP), and virtual IOP and PHP. We focus on treating anxiety and Xanax dependence together, including anxiety treatment built on CBT and exposure therapy. Our family program gives loved ones support of their own.

If you need medically supervised withdrawal first, we coordinate detox placement with accredited partner facilities in Massachusetts, then plan your handoff back into our PHP or IOP.

You can verify your insurance online. Rockland Recovery does not currently accept MassHealth, but our admissions team can share resources for MassHealth members. When you are ready, contact our admissions team. Feeling steady without counting down to the next dose is possible.

Frequently asked questions

What is the biggest side effect of Xanax?

Drowsiness is the most common. The most dangerous are slowed breathing when Xanax is combined with alcohol or opioids, and seizures if it is stopped suddenly after regular use.

Is it safe to take Xanax every day?

Some people take Xanax daily under a prescriber’s care, but daily use raises the risk of tolerance and physical dependence, which can develop within days to weeks even as prescribed. Ask your prescriber how long the plan should last and how you will come off it.

Can you drive after taking Xanax?

The label cautions against driving or operating machinery while taking Xanax, since it impairs alertness and coordination. Never drive if you feel drowsy or slowed down, including the morning after a dose.

Is it bad to take Xanax for anxiety?

Xanax is FDA-approved for acute treatment of generalized anxiety disorder and for panic disorder, and it eases anxiety quickly. The tradeoff is dependence risk, which is why many prescribers use it short term or alongside longer-term treatment. Your prescriber can help you weigh it.

What is replacing Xanax for anxiety?

Nothing replaces it one for one. The National Institute of Mental Health calls cognitive behavioral therapy (CBT) the gold standard psychotherapy for generalized anxiety disorder. Medication options include SSRI and SNRI antidepressants, which take weeks to work, and buspirone, which is not a sedative and has less potential to be addictive.

Can Xanax be addictive if you take it as prescribed?

Yes. Physical dependence can develop at prescribed doses, and the label carries a boxed warning about abuse, misuse and addiction. Dependence is not the same as addiction, but the label warns about both. If you take more than prescribed or cannot cut back, talk to your prescriber or a treatment provider.