This sheet is about exposure to alprazolam in pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare providers.
What is alprazolam?
Alprazolam is a medication that has been used to treat anxiety and panic disorder, including anxiety associated with depression. Alprazolam is sold under different brand names, such as Xanax®, Niravam®, or Gabazolamine-0.5®. Alprazolam is in a class of medications called benzodiazepines.
Sometimes when people find out they are pregnant, they think about changing how they take their medication or stopping their medication altogether. However, it is important to talk with your healthcare providers before changing how you take this medication. If you take this medication regularly and then suddenly stop taking it, you could have withdrawal symptoms. Some of the withdrawal symptoms reported with suddenly stopping alprazolam have included seizures and rebound anxiety. It has been recommended to use the lowest dose that still works to treat your condition when needed in a pregnancy. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. Untreated anxiety and depression can affect a pregnancy. MotherToBaby has a fact sheet on anxiety at https://mothertobaby.org/fact-sheets/anxiety-fact/ and a fact sheet on depression at https://mothertobaby.org/fact-sheets/depression-pregnancy/.
I take alprazolam. Can it make it harder for me to get pregnant?
It is not known if alprazolam can make it harder to become pregnant.
Does taking alprazolam increase the chance for miscarriage?
Miscarriage can occur in any pregnancy. Alprazolam has not been well studied to see if it would increase the chance for miscarriage. Based on the studies reviewed, it is unlikely that alprazolam would significantly increase the chance for a miscarriage above the risk in the general population.
Does taking alprazolam increase the chance of birth defects?
Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Most studies on alprazolam use in the first trimester have not reported a greater chance for birth defects. One report that looked at prescription records reported a slightly higher chance for heart defects if a prescription for alprazolam was filled during pregnancy. However, this type of research cannot determine if the person took the medication once the prescription was picked up and is unable to review other factors in lifestyle or health that could be associated with these findings. Overall, an increased chance for birth defects has not been proven.
Does taking alprazolam in pregnancy increase the chance of other pregnancy-related problems?
Some studies have suggested that alprazolam might increase the chance of preterm delivery (birth before week 37) and low birth weight (less than 5 pounds, 8 ounces [2500g] at birth). However, not all studies have found this association. One study reported a higher chance of the baby being admitted to a special care nursery (NICU) if they were exposed to benzodiazepines, including alprazolam.
I need to take alprazolam throughout pregnancy. Will it cause withdrawal symptoms in my baby after birth?
Studies have reported a chance for withdrawal symptoms in the baby when alprazolam is used during pregnancy. These symptoms typically include difficulty regulating body temperature and breathing, low energy, poor feeding, and vomiting. Most often, symptoms start soon after birth and could last several days.
Does taking alprazolam in pregnancy cause long-term problems in behavior or learning for the baby?
Studies have not been done to see if alprazolam can cause behavior or learning issues for the child.
Breastfeeding while taking alprazolam:
Alprazolam has not been well studied for use while breastfeeding. Small amounts of alprazolam enter breast milk. Infants that are born preterm or are younger than one month of age have a stomach and intestines that are less mature than older babies. This might allow more medication to enter their blood stream.
There have been reports of sleepiness (hard to wake, low energy) in nursing infants as well as a report of withdrawal-like irritability in a nursing infant when alprazolam was taken during pregnancy and breastfeeding. If any of these symptoms are seen, discuss them with your child’s healthcare provider.
The product label for alprazolam recommends people who are breastfeeding not use this medication. But, the benefit of using alprazolam may outweigh possible risks. Your healthcare providers can talk with you about using alprazolam and what treatment is best for you. You can also talk with your healthcare provider about the option of shorter acting benzodiazepines that might work to treat your medical condition while breastfeeding. Be sure to talk to your healthcare provider about all of your breastfeeding questions.
If a male takes alprazolam, could it affect fertility (ability to get partner pregnant) or increase the chance of birth defects?
One small study looked at the effects of alprazolam and other psychotropic medications on semen. This study found decreased sperm motility (movement) in those taking psychotropic medications compared to the sperm of individuals who did not take any psychotropic medications. Decreased sperm motility can make it harder for a couple to conceive. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.
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OTIS/MotherToBaby encourages inclusive and person-centered language. While our name still contains a reference to mothers, we are updating our resources with more inclusive terms. Use of the term mother or maternal refers to a person who is pregnant. Use of the term father or paternal refers to a person who contributes sperm.
