Is Xanax Bad For Your Liver?

While medications help treat diseases and alleviate associated symptoms, many come with the risk of adverse side effects. 

Oftentimes, the kidneys and liver are particularly vulnerable to side effects, because they are the organs responsible for metabolizing and eliminating most drugs. For some individuals, reduced liver function, or even liver failure can be a risk of taking certain medications.

In addition, some people are more susceptible to medication side effects than others, due to risk factors like age, genetics, having other pre-existing health issues, or being on multiple medications at once.

Furthermore, misusing or taking medication in a way other than intended can heighten the risk of liver problems, also known as toxicity or drug-induced liver injury. 

Xanax (generic name, alprazolam) is metabolized by the liver, so you might reasonably have concerns about whether it could hurt your liver, or how you would recognize potential signs and symptoms of liver damage, were they to affect you. Here's what you need to know, including some general tips for optimal liver health. 

What Is Xanax?

Xanax is the brand name for a generic drug called alprazolam. It’s an FDA-approved medication for treating anxiety and panic attacks in adults and is available by prescription only. 

Xanax belongs to a group of drugs called benzodiazepines, which are a type of sedative. This class of medication increases the effects of the brain chemical gamma-aminobutyric acid (GABA), which helps control anxiety and reduces the severity and frequency of panic attacks. 

In the US, Xanax is available as an oral tablet, in 0.25mg, 0.5mg, 1mg, or 2mg strength.

Xanax (alprazolam) is a federally controlled substance because it has the potential for abuse and addiction (even when used as prescribed).

Misusing Xanax or disregarding your doctor’s precise instructions for taking it can cause very serious side effects, including slow, ineffective breathing, overdose, coma, and even death.¹

What are Xanax’s effects on the liver?

Xanax was first approved by the US Food and Drug Administration (US FDA) in 1981.²

In placebo-controlled clinical trials for panic disorder, Xanax was associated with elevated liver enzymes, elevated bilirubin levels, and jaundice.

Elevated liver enzymes can be a sign of liver inflammation or liver cell damage.³ Jaundice is a typical symptom of liver disease which causes yellowing of the skin and the whites of your eyes.

Since Xanax’s regulatory approval, there have been a low number of reports of hepatitis (inflammation of the liver) and liver injury.⁴

Ultimately, it is best to seek medical attention immediately if you exhibit any potential signs or symptoms of liver problems while using Xanax, such as jaundice, fever, nausea, or itching. 

Can Xanax cause liver damage?

Yes, on rare occasions, alprazolam has caused acute liver injury. “Acute” means sudden liver damage resulting in abrupt symptoms, which develop and worsen quickly, as opposed to slowly, over time.

However, educational resources from the US National Library of Medicine give alprazolam a score of “D,” meaning that liver toxicity is a possible, but rare cause of diagnosable liver injury.⁵

Liver injury from Xanax can occur when you first start taking it, after increasing the dosage, or after taking it for a length of time.

Reported cases of liver injury from Xanax have been mostly mild or moderate, with no known irreversible liver damage or liver failure as a result.⁶

For example, in 1986, a 32-year-old woman with a history of panic attacks was prescribed alprazolam and within a week had jaundice symptoms.⁷

By the second week, she was fatigued and had abdominal pain. 

Doctors evaluated her with blood work and tests for hepatitis A and B, as well as mononucleosis — all of which were negative. Nor did she have a prior history of liver disease. The blood tests came back indicating elevated liver enzymes and bilirubin. A month after stopping alprazolam, she recovered and all her follow-up labs returned to normal ranges.

The risk of serious liver damage may be higher in those who misuse Xanax, already have liver disease, or are taking Xanax alongside other medications that also affect the liver.

Consuming alcohol while taking Xanax can be dangerous for a number of reasons, including slowing down the body’s elimination of Xanax, which can lead to increased potential for liver (or kidney) damage.⁸

Signs and symptoms of liver issues

An acute liver problem may cause you to develop the following symptoms: 

• Fever

• Yellow skin and eyes

• Vomiting and nausea

• Abdominal pain

• Fatigue

• Dark urine

Sometimes, a mild acute liver injury can heal itself without treatment, while in other circumstances, the issue could progress fast to become severe.

If you suspect having any type of liver problem this warrants immediate medical attention to ensure the condition doesn’t progress and avoid complications that may lead to liver failure where the need for a liver transplant might become necessary. 

Although abruptly stopping this medication is strongly advised against as it can lead to serious withdrawal symptoms, in the case of experiencing symptoms of liver injury, you should not proceed with taking your next dose, and you must seek immediate medical attention to prevent further liver damage.

Stopping Xanax requires medical supervision

If Xanax becomes unsuitable for you for any reason while taking it, it is vital that a doctor guides you on what to do next, which may include tapering your medication (slowly reducing the dose under medical supervision).

Do not stop taking Xanax abruptly or change your dosage. Doing so can cause acute withdrawal symptoms, which may include increased anxiety, seizures, suicidal thoughts, and other potentially life-threatening reactions.⁹

Your doctor can recommend ways to ease potential withdrawal symptoms, which may include prescribing you other medications.

Is it possible to reverse damage to the liver from Xanax use?

The liver is one of the few organs in your body that can regenerate and repair itself completely after damage. It can restore up to 70% of its structures in just 14 days after an injury.

In some cases, drug-induced liver injury can resolve within days or weeks of stopping the problematic drug.¹⁰ More often, it can take several weeks or months to heal completely.

While an overdose of a pain reliever like acetaminophen (paracetamol) can cause severe damage should you take more than 4 grams in 24 hours, in the case of no serious damage, your liver may be able to repair itself within 30 days if there are no complications.¹¹

Even though the liver is very good at regeneration, health outcomes and recovery times vary. 

As mentioned earlier, there is a report of someone using alprazolam who experienced a mild, acute liver injury, but they rapidly recovered after stopping Xanax therapy.¹²

Since no permanent liver damage cases are associated with taking Xanax, it seems that potential damage may be reversible.¹³

However, while it's possible to reverse liver damage, if the liver is continually subjected to drugs, alcohol, prescription medications, or viruses, they can hinder liver regeneration.

For instance, if scar tissue (cirrhosis) develops, that is an advanced type of damage that may be difficult or impossible to reverse. Nonalcoholic fatty liver disease (NAFLD), which is often linked to an unhealthy diet and obesity, can also affect your liver’s innate ability to heal and may progress to cause cirrhosis. 

When the liver itself can’t regenerate, and no medication can revert the damage, a liver transplant may be the only viable option. The damaged liver is surgically removed and replaced with a healthy one. 

Early diagnosis can help prevent severe complications and make reversing liver damage more likely.

Other possible side effects of Xanax

Apart from some liver-related issues, other general side effects of Xanax use range from mild to serious and life-threatening. Commonly reported side effects include:¹⁴

• Drowsiness

• Memory impairment

• Irritability

• Impaired speech and coordination

• Light-headedness

• Dry mouth

• Fatigue

• Constipation

• Menstrual disorders

• Skin rash

• Change in appetite

• Weight fluctuation

• Low blood pressure

• Altered sex drive

Potential for addiction

You can become addicted to Xanax, even if you follow your doctor’s instructions for taking it. Additionally, it can cause respiratory failure and death if used with certain other medications or drugs, including central nervous system depressants such as opioids or alcohol.

Xanax also interacts with how other drugs work, which may increase the risk of overdose or severe side effects.

Therefore, before starting Xanax, it is crucial to inform your prescribing physician of any and all medications, supplements, or herbs you are currently taking, as well as any history of substance misuse or abuse.

Not everyone can use Xanax. Check with your physician to confirm whether the medication is safe for you based on your allergies, current medications, and pre-existing medical conditions. 

Additionally, don’t use Xanax with alcohol. Doing so can cause respiratory depression, coma, or death. 

Xanax can also make you sleepy or dizzy so it should not be taken when driving or operating machinery.

How to protect your liver while taking Xanax

Follow your doctor’s exact instructions regarding the dose, frequency, and duration you take Xanax. Using higher doses than prescribed, or taking Xanax with multiple other drugs can damage the liver.

Before using the medication, inform your doctor of all the other drugs and substances you use, whether they are herbal supplements, over-the-counter, or by prescription. 

Using Xanax with certain other drugs can cause severe side effects or change the effectiveness of either medication, so it’s important to disclose everything you take to your doctor.

Also, be sure to mention any previous liver problems to your doctor before taking Xanax. 

When to see a doctor

If you start to experience any of the symptoms associated with liver problems (jaundice, fatigue, pain under right-side ribs, fever, or darkened urine), or other persistent or severe side effects after starting Xanax, contact your doctor immediately. 

The lowdown

Xanax is generally safe when taken as directed. However, it still carries the risk of serious side effects, so it is important to discuss with your doctor all your medical history and any medications you take, so you and your doctor can weigh the benefits against any risks. In the rare event that liver problems occur during treatment, the damage is likely to be reversible as long as it is addressed promptly and there are no complications. Always follow your doctor’s instructions, and seek urgent medical care if you suspect having any symptoms that may indicate a liver problem.