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. It is in a class of medications called benzodiazepines. Alprazolam is sold under the brand names Xanax®, Niravam®, or Gabazolamine-0.5®.
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 making any changes to how you take this medication. If you take this medication regularly and then suddenly stop taking it, you could have withdrawal symptoms. Some reported withdrawal symptoms include seizures and rebound anxiety. Also, untreated anxiety and depression can increase risks to a pregnancy. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.
MotherToBaby has a fact sheets on anxiety https://mothertobaby.org/fact-sheets/anxiety-fact/ and depression 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 get pregnant.
Does taking alprazolam increase the chance of miscarriage?
Miscarriage is common and can occur in any pregnancy for many different reasons. Based on the studies reviewed, it is unlikely that alprazolam would greatly increase the chance of miscarriage.
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 an increased chance for birth defects above the background risk. Two reports that looked at prescription records reported a higher chance for heart defects if a prescription for alprazolam was filled during pregnancy. Studies based on prescription records cannot tell if a person took the medication, so it is hard to know if the outcomes are related to the medication or other factors. Overall, an increased chance of 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). Other studies have not found this association.
I need to take alprazolam throughout my entire pregnancy. Will it cause withdrawal symptoms in my baby after birth?
The use of benzodiazepines (including alprazolam) during pregnancy can cause temporary symptoms in newborns soon after birth. These symptoms are sometimes referred to as withdrawal and can include trouble regulating body temperature, trouble breathing, low energy, poor feeding, and vomiting. Most often, symptoms start soon after birth and could last several days. Not all babies exposed to alprazolam will have symptoms. It is important that your healthcare providers know you are taking alprazolam so that if symptoms occur your baby can get the care that is best for them.
Does taking alprazolam in pregnancy affect future behavior or learning for the child?
Studies have not been done to see if alprazolam can cause behavior or learning issues for the child.
Breastfeeding while taking alprazolam:
Alprazolam passes into breast milk. While it is possible to breastfeed while taking alprazolam, a different medication may be preferred. If you suspect the baby has any symptoms (being too sleepy, poor feeding, and poor weight gain), contact the child’s healthcare provider. After a single dose of alprazolam, there is usually no need to wait to breastfeed.
The product label for alprazolam recommends people who are breastfeeding not use this medication. But the benefit of using alprazolam may outweigh the possible risks. Your healthcare providers can talk with you about using alprazolam and what treatment is best for you. 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?
There is one report of a male who had delayed ejaculation and impotence (trouble with getting and keeping an erection) while taking alprazolam. One small study found lower sperm motility (movement) in those taking psychotropic medications (including alprazolam) compared to males who did not take psychotropic medications. These issues may make it harder to conceive a pregnancy. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.
Please click here for references.
National Pregnancy Registry for Psychiatric Medications: There is a pregnancy registry for women who take psychiatric medications, such as midazolam. For more information you can look at their website: https://womensmentalhealth.org/research/pregnancyregistry/.
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.