Alprazolam (Xanax / Solanax)

What is alprazolam?

Alprazolam is known as Xanax in the United States and many other countries, and as Solanax or Constan in Japan (ソラナックス／コンスタン on Japanese packaging; two brands, same medicine). It's an anti-anxiety medicine in the benzodiazepine group: it calms an overactive nervous system, easing anxiety and tension, and it works within an hour or so. It's used for short-term relief, often just when needed.

How is it different from other anxiety medicines?

• Fast: it calms within an hour or so, not the weeks an antidepressant needs
• Works as needed: it can be taken only when anxiety spikes, rather than every day
• A useful bridge: it can be prescribed alongside a daily antidepressant while that slower medicine takes hold
• Also eases the body side of stress: in Japan it is approved for the physical symptoms of stress-related conditions as well as the anxiety

What is it used for in Japan?

In Japan, alprazolam is approved for the symptoms that come with stress-related physical (psychosomatic) conditions, such as stomach ulcers and irritable bowel syndrome:

• Anxiety and tension
• Low mood
• Sleep difficulty
• The physical symptoms of those conditions

In the US, Xanax is best known as a panic-disorder medicine; in Japan the approvals for panic disorder belong to certain antidepressants, and alprazolam plays a supporting role. Where alprazolam helps most is when fast, short-lived relief matters: calming a panic attack as it builds, getting through a flight or an MRI scan, or covering the weeks before an antidepressant starts to work.

How does it help?

It quietens the nervous system, so anxiety and tension ease off within an hour or so of taking it. It can also cause dependence with regular use, so whether to use it, and for how long, is decided by weighing the benefit against that risk. Used for a limited period, with an end point agreed in advance, the benefit can outweigh the risk. If it has been taken every day for a long time, the usual plan is to discuss reducing it with your doctor.

What should I tell my doctor before starting?

A few situations rule it out entirely; your doctor will choose something else if any of these apply:

• A past allergic reaction to alprazolam
• Acute narrow-angle glaucoma
• Myasthenia gravis (a muscle-weakness condition)

And tell your doctor first if any of these apply; these usually just need adjustments or a closer eye:

• HIV medicines containing ritonavir (also part of the COVID treatment Paxlovid), the COVID medicine ensitrelvir (Xocova), some antifungals, and the antidepressant fluvoxamine; the dose may need adjusting, and the label says the antifungal posaconazole is avoided unless the benefit outweighs the risk
• Moderate or severe breathing problems
• Other sedating medicines, or regular alcohol use
• Being older: a lower dose is usual, as unsteadiness and falls are more likely
• Pregnant, planning to be, or breastfeeding (see the section below)

How do I take it?

Your doctor will set the pattern: either only when needed, or on a regular short-term schedule.

• Don't raise the dose or add extra tablets on your own: even on a bad day, if it feels like it's not enough, that's a conversation, not a second tablet
• If you miss a dose on a regular schedule: just skip it if the next one is close. Never double up
• Alcohol: avoid it, since it stacks with the drowsiness

What side effects should I expect?

Most are mild. Not everyone gets them.

• Drowsiness
• Dizziness or unsteadiness: take care on your feet
• Headache
• Dry mouth
• Tiredness or a feeling of weakness

If anything is bothering you, tell your doctor; there's often a way to adjust.

Finally, one thing that is rare, and avoidable:

• Combined with alcohol or other sedatives, the drowsiness can run deeper than expected; if you ever feel unusually heavily sedated or your breathing feels slowed, call us the same day. Taken as prescribed, without alcohol, this is very unlikely

Will I become dependent? How do I stop safely?

It can be habit-forming with regular use, even within the approved dose, which is why it is used at the lowest helpful dose, for an agreed period, with a plan for stopping. The body gets used to benzodiazepines, the same dose can gradually do less, and stopping suddenly after regular use can cause withdrawal: rebound anxiety, sleeplessness, tremor, and, in some cases, seizures. So never stop suddenly on your own; your doctor lowers it gradually, in small steps, and as-needed use (rather than daily) keeps the risk low. Used as planned, it is a useful bridge, and the aim is that the longer-term treatment takes over.

Can I bring it into Japan?

Yes, within limits, because it's a controlled medicine here. Alprazolam is a scheduled (psychotropic) medicine in Japan: a personal supply of roughly up to a month travels with you without any advance paperwork, larger amounts need paperwork arranged before you travel, and mailing it to Japan is prohibited. It also cannot be prescribed online, at a first visit or a follow-up, until a doctor in Japan has examined you in person for that condition, so plan an in-person visit. The extended-release form (Xanax XR) isn't sold in Japan; the regular tablets are.

Can I drive while taking it?

No; avoid driving while you're taking it. Alprazolam can cause drowsiness and slow your attention and reactions, and the Japanese label instructs that patients taking it should not drive or operate dangerous machinery. This applies while the medicine is in your system, including the day after an evening dose if you feel dulled.

What about pregnancy and breastfeeding?

Avoided where possible in pregnancy, and the Japanese label says to avoid breastfeeding while taking it; tell your doctor early and we'll find the safest plan together. The label allows alprazolam in pregnancy only when the expected benefit outweighs the risk, and benzodiazepines taken regularly up to delivery can cause withdrawal symptoms in the newborn. If you're on alprazolam and planning a pregnancy, don't stop suddenly; the plan is a gradual, supported change. Our guides to medication in pregnancy and medication while breastfeeding cover the wider picture.