Alprazolam

Pronunciation: al-PRAY-zoh-lam.

Generic name
alprazolam
Drug class
Benzodiazepine (triazolobenzodiazepine); anxiolytic
Form
Tablet (immediate-release), 0.25 mg / 0.5 mg / 1 mg / 2 mg (strengths vary by country)
Route
Oral
Legal status
Prescription-only; Schedule IV controlled substance in the United States

Availability and supply rules vary by country

Trade names by country: United States · United Kingdom · Canada · Australia · New Zealand

Australia: Kalma (5) · Full directory

What alprazolam is and how it works

Alprazolam is a prescription benzodiazepine medicine used short-term for anxiety and for panic disorder. It calms the central nervous system and is a controlled substance because of its potential for misuse and dependence. (1) (2)

Take alprazolam exactly as your prescriber directs. Treatment is usually intended for short-term or clearly defined use, and any change to your dose -- including reducing or stopping it -- is planned and supervised by your prescriber, gradually, because stopping suddenly can be dangerous.

Mechanism of action: how alprazolam works

Alprazolam is a triazolobenzodiazepine that enhances the inhibitory effect of GABA at the GABA-A receptor, producing anxiolytic, sedative, and anticonvulsant effects. It is metabolised primarily via hepatic CYP3A4 to alpha-hydroxyalprazolam. (1) (4)

What alprazolam is used for

Generalized anxiety disorder

Used for the acute treatment of generalized anxiety disorder in adults, in the United States. In the United Kingdom and other markets it is indicated for short-term treatment of anxiety that is severe, disabling, or causing extreme distress. (1) (2)

Panic disorder

Used for the treatment of panic disorder, with or without agoraphobia (fear of places or situations that might cause panic), in adults. (1)

Before taking alprazolam

Do not take / not appropriate for

  • Do not take alprazolam if you have had an allergic reaction to alprazolam or any other benzodiazepine. (all countries) (1) (4)
  • Do not take alprazolam together with ketoconazole or itraconazole (antifungal medicines), as these significantly increase alprazolam levels in the body -- tell your prescriber about all antifungal medicines you use. (all countries) (1) (4)
  • Alprazolam is not used in myasthenia gravis, severe breathing problems, sleep apnoea, severe liver problems, or acute narrow-angle glaucoma, as recognised in the Canadian product monograph. (Canada (reflects a broader class caution relevant across markets)) (4)

Tell your clinician about

  • Any personal or family history of alcohol or drug misuse, or of depression, mania, or suicidal thoughts.
  • Any liver, kidney, or breathing problems, including sleep apnoea.
  • All other medicines you take, especially opioid painkillers, other sedatives, antifungal medicines, or anything affecting mood or breathing.
  • Pregnancy, plans for pregnancy, or breastfeeding.
  • If you are elderly, as sensitivity to sedative effects and fall risk are increased.
(1) (2) (4)

How to take alprazolam

  • Take alprazolam exactly as prescribed, at the times your prescriber advises.
  • Treatment is generally intended to be short-term; your prescriber will regularly reassess whether you still need it.
  • Do not take more than your prescribed dose or take it more often than directed.
(1) (2) (4)

Procedures and treatment changes

Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6)

Missed dose

If you miss a dose, take it as soon as you remember unless it is nearly time for your next dose, in which case skip the missed dose and continue your regular schedule -- do not take two doses together to make up for a missed one. Contact your prescriber or pharmacist if you are unsure.

Overdose

Seek emergency medical help immediately if you or someone else may have taken too much alprazolam, especially if combined with opioids, alcohol, or other sedatives, or if there are signs such as extreme drowsiness, confusion, slowed or difficult breathing, or loss of consciousness. (1)

Side effects

Side effects and their urgency vary; report severe, persistent, or concerning symptoms.

Drowsiness and light-headedness are the most common side effects.

What to notice: Drowsiness and light-headedness are the most common side effects.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)

Dry mouth.

What to notice: Dry mouth.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)

Fatigue, impaired coordination, and memory problems.

What to notice: Fatigue, impaired coordination, and memory problems.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)

Irritability, increased appetite, and weight gain.

What to notice: Irritability, increased appetite, and weight gain.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)

Constipation.

What to notice: Constipation.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (2)

Serious warnings

Severe sedation or slowed breathing, especially when combined with opioids or other sedatives — boxed_warning

Symptoms: Extreme drowsiness, slowed or shallow breathing, unresponsiveness, blue-tinged lips or fingertips.

Action: Seek emergency medical help immediately. Combining alprazolam with opioids or other sedatives is a recognised cause of profound sedation, respiratory depression, coma, and death. (1) (4)

Signs of misuse, abuse, or addiction developing — boxed_warning

Symptoms: Taking more than prescribed, strong cravings, needing more to get the same effect, or difficulty cutting down.

Action: Tell your prescriber promptly. Alprazolam carries a recognised risk of abuse, misuse, and addiction, which your prescriber monitors for throughout treatment. (1) (4)

Withdrawal reactions, including seizures, if the dose is reduced or treatment ends abruptly outside clinician guidance — boxed_warning

Symptoms: Anxiety rebound, tremor, sweating, confusion, or seizures.

Action: Any dose reduction or ending of treatment is planned and tapered gradually by your prescriber -- never change your dose on your own. Seek emergency medical help immediately if a seizure occurs. (1) (4)

Worsening mood, depression, or thoughts of suicide — emergency

Symptoms: Persistent low mood, hopelessness, or thoughts of harming yourself.

Action: Seek emergency help immediately for thoughts of self-harm, or contact your prescriber promptly for worsening mood -- alprazolam is not recommended as a sole treatment for depression. (2) (1)

Signs of a serious allergic reaction — emergency

Symptoms: Swelling of the face, lips, tongue, or throat; difficulty breathing; widespread rash or hives.

Action: Seek emergency medical help immediately. (1)

Interactions

  • Opioid pain medicines significantly increase the risk of profound sedation, slowed breathing, coma, and death when combined with alprazolam. (1) (4)
  • Alcohol and other central-nervous-system depressants (other sedatives, some antipsychotics, anticonvulsants) add to alprazolam's sedative and breathing-slowing effects. (1) (2)
  • Ketoconazole and itraconazole (antifungal medicines) are not used together with alprazolam because they substantially raise alprazolam levels; other CYP3A-affecting medicines (e.g. nefazodone, fluvoxamine, cimetidine, carbamazepine, phenytoin, ritonavir) can also raise or lower alprazolam levels and may need a prescriber to adjust monitoring. (1)
  • Alprazolam may increase digoxin levels, particularly in elderly patients -- monitoring may be needed if you take both. (1)

Pregnancy, breastfeeding, kidney/liver function, age

Pregnancy

Benzodiazepines cross the placenta. Use in late pregnancy has been associated with sedation and withdrawal symptoms in the newborn. Published data have not shown a clear link to major birth defects, but alprazolam is not recommended in pregnancy unless your prescriber judges it clinically necessary -- discuss the benefits and risks with your prescriber. (1) (2) (3) (4) (5) (6)

Breastfeeding

Alprazolam passes into breast milk and can cause sedation, poor feeding, or weight loss in a breastfed infant. Breastfeeding during treatment is not recommended -- discuss feeding options with your prescriber. (1) (2) (3) (4) (5) (6)

Children

Not recommended for patients under 18; safety and efficacy have not been established in this age group per UK labeling. (1) (2) (3) (4) (5) (6)

Elderly

Older adults may be more sensitive to sedative effects and have a higher risk of falls and fractures; a lower starting dose and closer monitoring are typically used. (1) (2) (3) (4) (5) (6)

Hepatic_impairment

Alprazolam is contraindicated in severe liver impairment; your prescriber will assess dosing carefully if you have any liver problems. (1) (2) (3) (4) (5) (6)

Renal_impairment

Tell your prescriber about any kidney problems, which can affect how alprazolam is monitored. (1) (2) (3) (4) (5) (6)

Source_ids

US-DAILYMED-XANAX-2026,UK-EMC-XANAX-2026,CA-HC-XANAX-2021 (1) (2) (3) (4) (5) (6)

Monitoring

Before starting

  • Assessment of risk for substance misuse, abuse, or addiction
  • Review of other sedating or opioid medicines
  • Screening for depression or suicidal thoughts
  • Liver and breathing status

During treatment

  • Regular reassessment of whether continued treatment is still needed.
  • Monitoring for signs of misuse, tolerance, or dependence.
  • Monitoring for excessive sedation, especially if other sedating medicines are also used.
  • Monitoring mood for signs of worsening depression.
(1) (2)

Storage

Store at controlled room temperature, 20-25C (68-77F). Keep securely to prevent theft or misuse by others, and out of reach of children.

Study the drug class: Benzodiazepines

Professional information

Clinician-facing context only, sourced from the current US FDA prescribing information and Health Canada product monograph; verify against the current full label before prescribing.

United States

Indication: Generalized anxiety disorder and panic disorder

Dose summary: GAD: 0.25-0.5 mg TID initially, titrated every 3-4 days to a maximum of 4 mg/day in divided doses. Panic disorder: 0.5 mg TID initially, titrated in increments of ≤1 mg/day every 3-4 days; trial range 1-10 mg/day (mean 5-6 mg/day). Taper by no more than 0.5 mg every 3 days when discontinuing; some patients require a slower taper.

Renal context: Not specifically established in the source reviewed; use with caution and individualise dosing. (1)

Canada

Indication: Anxiety disorders

Dose summary: Individualised dosing per product monograph; serious warnings and precautions box covers addiction/abuse/misuse, withdrawal, and concomitant opioid risk. Geriatric patients may need lower doses and closer monitoring for falls/fractures.

Renal context: Not specifically established in the source reviewed. (4)

Mechanism of action

Hepatic guidance

Contraindicated in severe hepatic insufficiency; use with caution and closer monitoring in milder hepatic impairment given reduced clearance.

Overdose note

Benzodiazepine overdose can cause somnolence, confusion, impaired coordination, and in severe cases (particularly with co-ingested opioids/alcohol) respiratory depression, coma, and death; management includes supportive care and monitoring, with flumazenil use requiring specialist judgement given seizure risk in dependent patients. (1) (4)

Frequently asked questions

Is alprazolam (Xanax) available in the US, UK, Europe, Canada, Australia, and New Zealand?

It is currently authorised and available in the US, UK, EU member states (nationally, not centrally through EMA), Canada, and Australia (as Kalma). In New Zealand, it was discontinued from commercial supply for commercial-viability reasons in 2016-2017 and is not currently marketed there. (1) (2) (3) (4) (5) (6)

Can I stop taking alprazolam on my own if I feel better?

No. Alprazolam carries a real risk of withdrawal reactions, including seizures, if the dose is reduced quickly or treatment stops abruptly outside clinician guidance. Any change to your dose, including stopping, is planned and tapered gradually with your prescriber. (1) (4)

Why shouldn't I take alprazolam with opioid painkillers?

Combining alprazolam with opioids carries a real, serious risk of profound sedation, slowed or stopped breathing, coma, and death. This combination is only used when a prescriber judges there is no safe alternative, at the lowest effective doses. (1) (4)

What is the mechanism of action of alprazolam?

Alprazolam is a triazolobenzodiazepine that enhances the inhibitory effect of GABA at the GABA-A receptor, producing anxiolytic, sedative, and anticonvulsant effects. It is metabolised primarily via hepatic CYP3A4 to alpha-hydroxyalprazolam. (1) (4)

What is the generic name of Alprazolam?

The generic name is alprazolam. (1)

What class of drug is alprazolam?

Alprazolam is classed as: Benzodiazepine (triazolobenzodiazepine); anxiolytic. (1)

References

  1. XANAX (alprazolam) tablets, USP, CIV -- full prescribing informationU.S. Food and Drug Administration / DailyMed (NIH), full prescribing information, Pharmacia & Upjohn Co (Division of Pfizer Inc.) · United States · accessed 2026-07-29 · source 1
  2. Xanax 500 microgram Tablets -- Summary of Product Characteristicselectronic medicines compendium (emc), United Kingdom -- Viatris · United Kingdom · accessed 2026-07-29 · source 2
  3. Alprazolam: list of nationally authorised medicinal products (PSUSA/00000109)European Medicines Agency (EMA) -- Periodic Safety Update Report Single Assessment (PSUSA), nationally authorised medicinal products list · European Union · accessed 2026-07-29 · source 3
  4. XANAX and XANAX TS (alprazolam tablets) -- Product Monograph, revised 2021-05-11Health Canada product monograph, Upjohn Canada ULC (Pfizer Canada) · Canada · accessed 2026-07-29 · source 4
  5. KALMA (alprazolam) tablets -- ARTG registrations (0.25mg/0.5mg/1mg/2mg)Therapeutic Goods Administration (TGA), Australia · Australia · accessed 2026-07-29 · source 5
  6. Upcoming changes to alprazolam -- Pharmaceutical Schedule update, November 2016PHARMAC (Pharmaceutical Management Agency of New Zealand) -- New Zealand Pharmaceutical Schedule update · New Zealand · accessed 2026-07-29 · source 6

Brand names by country

Single-ingredient alprazolam names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.

Priority countries

United States

  • Xanax2 mg, .25 mg, .5 mg, 3 mg, 1 mg · viatris specialty llc
  • Alprazolam C-IV.5 mg, 1 mg · direct_rx
  • Alprazolam ODT C-IV.5 mg · direct_rx

United Kingdom

  • Xanax (2)MHRA licensed emc smpc confirmed private prescription only · 250 microgram, 500 microgram · Viatris

Canada

  • XANAX
  • XANAX TS
  • APO-ALPRAZ
  • APO-ALPRAZ TS

Australia

  • Kalma (5)TGA ARTG registered confirmed · 0.25 mg, 0.5 mg, 1 mg, 2 mg · Alphapharm Pty Ltd (Mylan/Viatris)

New Zealand

  • Xanax (6)discontinued commercial supply 2016-2017 per Pharmac notice not currently marketed · 0.25 mg, 0.5 mg, 1 mg (historical) · historical -- Pfizer/Upjohn New Zealand
View brands in additional countries.

European Union

Xanax / national generic brands (3)

This page provides general reference information about alprazolam and is not a substitute for advice from the prescriber managing your treatment. All dosing and treatment decisions, including any change to your dose, should be made with your prescriber.

Related medicines

Related conditions