How Long Does Alprazolam Stay in Your System?

Published August 31st, 2020 by Chris Riley
Fact Checked by
Camille Freking
Medically Reviewed:
Dr. Angel Rivera
Updated Date: Jun 14th, 2022

More than 20 percent of the United States population is currently suffering from some form of an anxiety disorder, which means that there is a large market for anxiety medications as people seek to relieve their symptoms. 

Anxiety disorders are the most common mental illness in the country, with an estimated 40 million adults currently diagnosed with a form of the condition.

Unfortunately, less than 40 percent of those with anxiety receive treatment for their condition due to stigmas that continue to surround mental illness.

One option for treatment,  alprazolam, is a generic,  fast-acting prescription drug used to treat anxiety and panic disorder on a short term basis. How long does alprazolam stay in your system?

What is alprazolam?

Alprazolam is a short-acting tranquilizing medication that is sometimes referred to as an anxiolytic medication or sedative-hypnotic.

Alprazolam is part of a class of medications called benzodiazepines, which also includes medications like Ativan (lorazepam), Valium (diazepam), and Klonopin (clonazepam). Alprazolam is sold under the brand name Xanax or Niravam, and the medication is available in oral tablets of varying strengths, including extended release tablets.

Alprazolam is available in both an immediate-release and extended release formulas.

What is alprazolam used to treat?

Alprazolam is FDA-approved for the treatment of anxiety disorders, anxiety associated with depression, short-term relief of anxiety symptoms, and panic disorder.

While other benzodiazepines, such as Ativan, are approved for treatment of insomnia, alprazolam is not used for this purpose. 

The most common application of alprazolam is the treatment of anxiety, including generalized anxiety disorder. Although alprazolam is approved by the FDA for the short-term treatment of anxiety, it should not be used for longer than six weeks because of its tendency to be addictive and habit-forming.

Although the medication is not recommended for long-term use, some doctors still prescribe alprazolam to certain patients for an extended period of time, which can lead to physical and psychological dependence and substance abuse.

Alprazolam is a fast-acting and highly effective medication, which makes it most appropriate for use as a “rescue” or “emergency” medication during a difficult time, such as after the death of a loved one or during an unexpected divorce.

However, alprazolam can also be used to treat panic attacks with no obvious cause that occur on an acute basis.

When the medication is used for an extended period of time or stopped abruptly, some patients experience withdrawal symptoms due to physical and psychological dependence. 

What is anxiety and what causes it?

The natural response of the body to stress is anxiety, which is defined by fear or apprehension about what is to come.

Everyone experiences anxiety at various points in their lives, but the condition becomes a problem when it begins to affect a person’s quality of life, involves extreme feelings, and lasts longer than six months.

There are eight main types of anxiety disorders, including:

  • Generalized anxiety disorder
  • Panic disorder
  • Phobia
  • Illness anxiety disorder
  • Post-traumatic stress disorder
  • Social anxiety disorder
  • Obsessive-compulsive disorder
  • Separation anxiety disorder

Generalized anxiety disorder, the most common type of anxiety, includes symptoms like rapid breathing, restlessness, an increased heart rate, trouble concentrating, and difficulty falling asleep.

Anxiety attacks, which are an acute form of anxiety, have symptoms that include dry mouth, sweating, chills or hot flashes, apprehension and worry, feeling faint or dizzy, shortness of breath, restlessness, distress, fear, numbness or tingling.

How long does alprazolam stay in your system?

In general, alprazolam is a fast-acting medication, but exactly how long alprazolam stays in your body varies tremendously based on the form of the medication taken, since the drug is available in both immediate-release and extended-release forms.

Regardless of which form of the drug you take, you can expect both the immediate-release and extended-release forms of alprazolam to begin working in about an hour.

Patients will notice the calming effects of the immediate-release version of alprazolam for about five hours, while the extended-release form of the medication will work for about eleven hours. 

What are the benefits of using alprazolam?

Although alprazolam use does have some disadvantages, there are also benefits to using the medication.

Alprazolam is capable of producing anti-anxiety effects very quickly, which can make a substantial difference in a person’s anxiety levels during the first week of treatment.

This can be extremely beneficial for patients who are going through an anxiety crisis and cannot wait for long-term anti-anxiety medications, such as Lexapro, to start working.

Alprazolam is a great choice for patients seeking to manage acute anxiety symptoms or particularly severe symptoms requiring rapid relief, but only when used correctly and only when patients and healthcare professionals take the proper steps to avoid dependency.

Alprazolam is occasionally prescribed alongside a more long-term antidepressant or anti-anxiety medication. 

How do I use alprazolam to treat anxiety?

Because alprazolam has great potential for abuse and dependence, it should only be taken for short-term use.

Like Ativan, alprazolam can be habit-forming, so while it is an important and powerful tool to treat anxiety, it should be used with caution.

In situations where patients are waiting for a longer-term anxiety medication to kick in, such as Lexapro, alprazolam can provide immediate short-term relief of anxiety symptoms. 

Are there any side effects associated with alprazolam?

Side effects of alprazolam are generally divided into three categories and include common, less common, and serious side effects. Common side effects include:

  • Constipation
  • Difficulty in micturition
  • Ataxia
  • Cognitive dysfunction
  • Memory impairment
  • Skin rash
  • Weight gain
  • Drowsiness
  • Dysarthria
  • Fatigue
  • Diarrhea
  • Insomnia 
  • Decreased libido
  • Weight loss
  • Anxiety 
  • Blurred vision
  • Increased appetite
  • Decreased appetite

Less common side effects include:

  • Muscle twitching
  • Hypotension
  • Sexual disorder
  • Increased libido

Serious side effects include:

  • Serious allergic reaction (antihistamines may be needed)
  • Slowed breathing
  • Respiratory failure
  • Psychological and physical dependence
  • Suicidal thoughts

Patients should be aware of the signs of psychological and/or physical dependence on alprazolam. Symptoms of dependence may include:

  • Nightmares
  • Body aches
  • Anxiety
  • Depression 
  • Muscle weakness
  • Sweating
  • Nausea
  • Vomiting 

If you experience an allergic reaction to alprazolam, you should seek medical attention immediately. Symptoms of an allergic reaction include:

  • Swelling of lips, tongue, or face
  • Rash or hives
  • Trouble breathing or swallowing
  • Rapid heartbeat

Additionally, the following drugs may have possible side effects and negative adverse effect drug interactions when taken with alprazolam: cimetidine, fluvoxamine, nefazodone, fluoxetine, erythromycin, clarithromycin, St. John's Wort, sertraline, ritonavir, birth control pills, anticonvulsants, grapefruit, and antifungals.

Always take the time to review drug information and medication guides with a healthcare professional, especially with higher doses, older adults/elderly patients, and patients with narrow-angle glaucoma. 

Does alprazolam come with any warnings for use?

Alprazolam comes with several warnings for use due to its high potential for psychological and physical dependence and because the medication can easily become habit forming.

First, patients with a history of alcohol or drug abuse or alcohol withdrawal are more likely to abuse alprazolam.

Therefore, people with addictive tendencies or a history of addiction should be careful when using alprazolam and similar medications.

Some patients with existing depression experience a worsening of their symptoms when using alprazolam, so it is important to communicate with your healthcare professional immediately if you notice your depression worsening or begin experiencing suicidal thoughts. 

Alprazolam should not be combined with other central nervous system depressants like itraconazole or ketoconazole, as the medication can cause fatal respiratory depression as a result of drug interactions.

Therefore, it is extremely important that patients communicate with their doctors about any prescriptions, over-the-counter medications, supplements, vitamins, or herbs they are taking for appropriate medical advice. 

Alprazolam should only be prescribed and used for short periods of time, as continuous long term use heightens the potential for abuse.

Pregnant or breast-feeding mothers should not use alprazolam due to the potential for serious birth defects and life-threatening withdrawal symptoms for the infant, as alprazolam can pass into breast milk.

Are there any withdrawal symptoms associated with alprazolam?

Alprazolam carries a high risk of physical and psychological dependence and is known to be habit-forming.

As a result, stopping the medication abruptly can cause psychological and physical withdrawal symptoms to occur during the detoxification process.

Patients who have been taking alprazolam regularly for more than two weeks should wean gradually off the medication under a doctor’s supervision in order to prevent withdrawal symptoms from occurring.

The longer you have taken alprazolam, the more likely you are to experience withdrawal. Common withdrawal symptoms include:

  • Convulsions
  • Tremor
  • Cramps
  • Vomiting
  • Sweating
  • Insomnia

Serious withdrawal symptoms can occur in patients who are severely dependent on alprazolam, particularly when stopping the medication abruptly. These serious symptoms include:

  • Tremors
  • Panic attacks
  • Hallucinations
  • Seizures

Is it possible to overdose on alprazolam?

It is possible to overdose on alprazolam, especially when the medication is used while drinking alcohol or taking opioid medications.

Alprazolam carries a high risk of dependence, so it is common for Individuals who become dependent on the drug to start taking more and more of the medication in order to achieve the same calming effect that they first experienced.

As a patient continually increases their dose to achieve the desired effect, they can eventually overdose on the medication, which is why it is so important to take alprazolam only as prescribed and only for a short length of time.

Signs of an alprazolam overdose include: 

  • Slurred speech
  • Feeling restless
  • Extreme drowsiness
  • Confusion
  • Lightheadedness
  • Slow heartbeats
  • Muscle weakness
  • Loss of balance or coordination
  • Weak or shallow breathing 
  • Coma

Medical attention should immediately be sought in the event of an overdose or possible overdose of alprazolam.