Serious side effects of alprazolam
Along with its needed effects, alprazolam 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 side effects
- 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 in speaking
- trouble performing routine tasks
- trouble sleeping
- unsteadiness, trembling, or other problems with muscle control or coordination
- unusual tiredness or weakness
Less common side effects
- 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 moving
- difficulty in passing urine (dribbling)
- difficulty with concentration
- dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
- 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 eyes
- inability to sit still
- increased blinking or spasms of the eyelid
- irregular heartbeats
- itching
- 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
- rash
- restlessness
- runny nose
- seeing, hearing, or feeling things that are not there
- seizures
- sense of detachment from self or body
- shaking
- shivering
- shortness of breath
- sneezing
- sore throat
- sticking out of the tongue
- sweating
- swollen joints
- talkativeness
- tightness in the chest
- trouble in breathing, speaking, or swallowing
- 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
- wheezing
- yellow eyes or skin
Rare side effects
- actions that are out of control
- attack, assault, or force
- chest pain
- continuing ringing or buzzing or other unexplained noise in 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
- sleeplessness
- swelling
- talking, feeling, and acting with excitement
- thoughts of killing oneself
- unable to sleep
- uncaring
- unusual weak feeling
- voice changes
Incidence not known
Other side effects of alprazolam
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 side effects
- 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 mouth
- weight loss
Less common side effects
- abdominal 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 side effects
- acid or sour stomach
- belching
- bigger, dilated, or enlarged pupils (black part of 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 eyes to sunlight
- indigestion
- redness of skin
- runny nose
- sensation of spinning
- stomach discomfort, upset, or pain
- stuffy nose
Incidence not known
For healthcare professionals
Applies to alprazolam: compounding powder, oral concentrate, oral solution, oral tablet, oral tablet disintegrating, oral tablet extended release.
General adverse events
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. (2002) “Product Information. Xanax (alprazolam).” Pharmacia and Upjohn
2. (2005) “Product Information. Niravam (alprazolam).” Schwarz Pharma
3. (2005) “Product Information. Xanax XR (alprazolam).” Pfizer U.S. Pharmaceuticals Group
4. Cerner Multum, Inc. “UK Summary of Product Characteristics.”
5. Cerner Multum, Inc. “Australian Product Information.”
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