Alprazolam

XANAX

Open Alprazolam in the interactive console ↗

Pronunciation: al-PRAY-zoe-lam (ZAN-ax)

Alprazolam ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Alprazolam ballicule

Alprazolam XANAX mascot mnemonic cartoon — Visual mnemonic: Alprazolam mascot
**“Lil’ Xan, Alp-raised lamb”**
No fear → benzos are anxiolytic drugs
Pill bottle → symbol for benzodiazepine class

What it isHigh-potency GABA-A positive allosteric modulator; panic disorder and anxiety.

Why this oneRapid onset and short duration relieve panic quickly but create more interdose rebound than longer-acting benzodiazepines.

What limits itDependence can develop quickly; taper slowly to avoid severe withdrawal. Opioids and other sedatives can cause fatal respiratory depression.

Alprazolam molecular structure (skeletal formula) — Molecular structure: Alprazolam

Alprazolam prescription history

Animated chart of estimated U.S. prescriptions per year, Benzodiazepines (1961–2026). Alprazolam enters in 1981 (estimated).

FDA-approved for

anxiety (1981)
panic disorder (1990)

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger3 / 4

Weight-gain liability0 / 4

Sedation liability2 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryD

Defining liabilityRapid dependence and severe withdrawal; overdose becomes dangerous with opioids or other depressants.

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Concomitant opioids may cause profound sedation, respiratory depression, coma, death. Benzodiazepine abuse/misuse/addiction can lead to overdose or death. Dependence and life-threatening withdrawal—taper gradually.

FDA dosing	Population	Start	Target	Max
Generalized anxiety disorder	Adult	0.25–0.5 mg TID	—	4 mg/day divided
Panic disorder	Adult	0.5 mg TID	5–6 mg/day	10 mg/day
Anxiety / panic	Geriatric	0.25 mg BID–TID	—	—

Titration GAD: adjust every 3–4 days. Panic: increase every 3–4 days by ≤1 mg/day.

Renal Undefined

Hepatic Start 0.25 mg 2–3×/day; reduce dose.

Instructions

Taper to discontinue: decrease by ≤0.5 mg every 3 days (slower if needed).
Avoid alcohol and other CNS depressants.
With ritonavir, halve dose initially then increase after 10–14 days; contraindicated with other strong CYP3A inhibitors.

Available strengths

tab 0.25, 0.5, 1, 2 mg
ER tab 0.5, 1, 2, 3 mg
ODT 0.25, 0.5, 1, 2 mg
sol 1 mg/mL

Contraindications

Concomitant strong CYP3A inhibitors (e.g., ketoconazole, itraconazole), except ritonavir

Cautions

Concomitant opioid use (respiratory depression)
Abuse, misuse, addiction
Dependence and withdrawal (life-threatening; taper)
Impairs driving/operating machinery
May worsen depression; suicidality risk
Hypomania/mania reported
Neonatal sedation and withdrawal with late-pregnancy use
Deaths reported in severe pulmonary disease—monitor impaired respiratory function

Adverse reactions

Drowsiness
Fatigue
Impaired coordination
Memory impairment / cognitive disorder
Dysarthria
Light-headedness
Dry mouth
Constipation
Changes in libido
Appetite/weight changes

Pregnancy Neonatal sedation and/or withdrawal with late-pregnancy use; observational data show no clear association with major birth defects.

Lactation Present in breast milk; breastfeeding not recommended (sedation, poor feeding, poor weight gain reported).

Cost

Alprazolam (XANAX)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
0.25 mg	tab	90 TID	$2.12	not offered
0.5 mg	tab	90 TID	$2.02	not offered
1 mg	tab	90 TID	$2.19	not offered
2 mg	tab	90 TID	$4.39	not offered

Other forms: Alprazolam XR (XANAX XR)

Generic entry1993

Active metabolites

α-hydroxyalprazolam

Open Alprazolam in the interactive console ↗

Memory aids: interaction avatars

CYP3A4 substrate

Open Alprazolam in the interactive console ↗

Self-check

Why does alprazolam produce more interdose rebound than longer-acting benzodiazepines?
Rapid onset and short duration.
How should alprazolam be withdrawn?
Taper slowly to avoid severe withdrawal.