Reviewed by the HeyPsych Medical Review Board
Board-certified psychiatrists and mental health professionals
Clinical summary for Alprazolam (Xanax): Xanax relieves severe anxiety and panic within an hour. Side effects include drowsiness and unsteadiness. Physical dependence can develop with regular use. Never mix with alcohol or opioids—this can be fatal. Best used short-term or as-needed.
Everyone responds differently, but these are the most common experiences:
Relief (30-60 min)
"My panic melted away within 30 minutes."
Xanax is one of the fastest anxiety medications available, but the effects don't last very long.
Xanax is FDA-approved to treat generalized anxiety disorder (GAD) and panic disorder. It provides rapid relief of severe anxiety and panic attacks, typically within 30-60 minutes. Due to dependence risk, it's usually used short-term (2-4 weeks) or as-needed while longer-term treatments like SSRIs or therapy take effect.
Xanax works in 30-60 minutes. Effects peak at 1-2 hours and last 4-6 hours (immediate-release) or 10-12 hours (extended-release). It's one of the fastest-acting anxiety medications available.
Xanax has a half-life of about 11 hours (range 6-27 hours). This means half the dose is eliminated in ~11 hours. It takes 2-4 days for Xanax to be fully cleared from your body. However, it can be detected in urine for 1-7 days (longer with chronic use) and in hair for up to 90 days.
Yes. Xanax is a Schedule IV controlled substance with high dependence and addiction risk, even when taken exactly as prescribed. Physical dependence can develop in as little as 2-4 weeks of daily use. Stopping suddenly can cause dangerous withdrawal symptoms, including seizures. About 17% of people misuse prescription benzodiazepines.
No. NEVER combine Xanax with alcohol. This is an absolute contraindication. The combination causes severe respiratory depression and can be fatal. Even small amounts of alcohol (1-2 drinks) can be dangerous when combined with Xanax. The FDA issued a black box warning specifically about this interaction.
Never stop Xanax suddenly after regular use—this can cause life-threatening seizures. Tapering must be gradual and medically supervised, typically reducing dose by 10-25% every 1-2 weeks over several weeks to months. Many doctors switch to a longer-acting benzodiazepine (like clonazepam or diazepam) to make tapering smoother. Work closely with your prescriber.
The most common side effects are drowsiness/sedation (40-70%), cognitive slowing and poor concentration (20-40%), impaired coordination and unsteadiness (15-30%), and memory gaps for events after taking the dose (10-25%). These effects are dose-dependent and worsen when combined with alcohol or other sedatives.
Yes. Xanax commonly causes anterograde amnesia—difficulty forming new memories for hours after taking a dose. You may not recall conversations, activities, or decisions made during peak effects (1-4 hours post-dose). This is more common at doses above 2mg. Long-term use may also impair memory and cognition even after discontinuation.
No. Xanax is Pregnancy Category D (positive evidence of fetal risk). Use in the first trimester increases risk of birth defects, particularly oral clefts. Third trimester use can cause neonatal withdrawal, floppy infant syndrome, and respiratory depression. Use only if benefits clearly outweigh risks and no safer alternatives exist (CBT, certain SSRIs like sertraline have better safety profiles).
Xanax (immediate-release) works quickly (30-60 min) but wears off in 4-6 hours, requiring 2-4 doses daily. Xanax XR (extended-release) releases medication gradually over 10-12 hours, allowing once-daily dosing with smoother blood levels and less interdose anxiety. XR tablets cannot be crushed, chewed, or split.
Yes. Xanax overdose causes severe sedation, confusion, respiratory depression, coma, and death—especially when combined with opioids or alcohol. Signs include extreme drowsiness, slurred speech, slow/shallow breathing, blue lips or fingertips, and unresponsiveness. Call 911 immediately if overdose suspected. Flumazenil (antidote) can reverse effects but must be given by medical professionals.
Neither is universally 'better'—it depends on your needs. Xanax (alprazolam) works faster (30-60 min) but lasts shorter (4-6 hrs), requiring multiple daily doses. Ativan (lorazepam) takes slightly longer to work (60-90 min) but lasts longer (8-12 hrs). Ativan is not metabolized by CYP450 enzymes, making it safer with fewer drug interactions. Both carry similar dependence risks. Your doctor will choose based on symptom pattern and other medications.
This medication information is for educational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider before starting, stopping, or changing any medication. Never take medication without a prescription from a licensed healthcare provider.
This information is for educational purposes. Always consult with a qualified healthcare provider before starting any new treatment.