The short answer: Long-term use is not proven safe. The Xanax Medication Guide says safety and effectiveness beyond 4 months for anxiety disorder are not known. The FDA's 2020 boxed warning covers addiction, dependence, and withdrawal. Some people still take benzodiazepines long term under close review, and stopping suddenly can be life-threatening.
What do the FDA warning and the Xanax label say about long-term use?
On September 23, 2020, the FDA required an updated Boxed Warning for all benzodiazepines, including alprazolam (Xanax), clonazepam, and lorazepam. It is the agency's most prominent warning. The update covers abuse, misuse, addiction, physical dependence, and withdrawal reactions.
Long courses are common. The FDA reported that in 2018, about half of patients who received oral benzodiazepines got them for two months or longer.
The current Xanax label lists two uses in adults: acute treatment of generalized anxiety disorder and treatment of panic disorder. Its anxiety studies lasted 4 weeks, and its main panic studies lasted up to 10 weeks. The Medication Guide says it is not known if Xanax is safe and effective past 4 months for anxiety disorder or past 10 weeks for panic disorder.
Those limits describe the evidence. They do not mark a date when harm begins.
Guidance in the UK is stricter. NICE says not to offer a benzodiazepine for generalized anxiety disorder except as a short-term measure during crises. It also says these drugs should not be prescribed for panic disorder, because of poorer long-term outcomes. For how the options compare, see our guide to the best medication for anxiety. For how fast each class works, see how long anxiety medication takes to work.
Is physical dependence the same as addiction?
No. Physical dependence means your body has adapted to the drug, so withdrawal symptoms appear if it stops or drops quickly. The 2025 joint tapering guideline, led by the American Society of Addiction Medicine, calls this an expected result of ongoing use. The FDA says it can occur after several days to weeks of steady use, even as prescribed.
Addiction, or substance use disorder, is a chronic disease. It involves impaired control and continued use despite harm. The guideline cites an estimate that only 1.5% of people who use benzodiazepines meet the criteria for benzodiazepine use disorder. It tells clinicians not to presume that a physically dependent patient has an addiction.
The two can still overlap. The label warns that even taking benzodiazepines as prescribed may put people at risk for abuse and misuse. It also describes tolerance, which means a drug has less effect after repeated use.
Why is stopping a benzodiazepine suddenly dangerous?
The brain adapts to the drug, so a sudden stop or fast dose cut can trigger acute withdrawal. The label says these reactions can be life-threatening, and it names seizures as the most important. The Medication Guide also lists hallucinations, losing touch with reality, and suicidal thoughts or actions.
Risk rises with higher doses and longer use. The joint guideline's consensus table flags withdrawal risk at any dose for people who take a benzodiazepine 4 or more days a week for 3 months or longer. Shorter courses can carry risk too.
Some symptoms can last. The label describes a protracted withdrawal syndrome, with symptoms lasting weeks to more than 12 months. They include anxiety, insomnia, memory trouble, tremor, tingling, and ringing in the ears. Withdrawal can be hard to tell apart from anxiety returning.
Any dose change is planned with a prescriber. The FDA says no standard tapering schedule suits all patients, so the plan is individual. The joint guideline says the goal may be stopping or reaching a dose where risks no longer outweigh benefits. Most people can taper as outpatients, but some need inpatient care.
Get emergency care for a seizure, severe confusion, or seeing or hearing things that are not there. If you have thoughts of harming yourself, call or text 988.
What is known about falls, memory, and dementia?
Falls: this evidence is the most consistent. A 2018 meta-analysis of older adults found benzodiazepine use tied to 42% higher odds of falling (pooled odds ratio 1.42). The authors could not account for prescription bias. The 2023 AGS Beers Criteria say all benzodiazepines raise the risk of falls, fractures, delirium, cognitive impairment, and vehicle crashes in older adults.
Memory: the label lists memory impairment among adverse reactions, and it says little tolerance develops to these cognitive effects. The joint guideline ties long-term use to ongoing risk of cognitive impairment.
Dementia: the evidence is mixed, and no study has proven cause. Three findings show the range:
- A 2025 meta-analysis found a small link (relative risk 1.11), but results varied widely between studies.
- A 2026 meta-analysis on Alzheimer's disease found higher odds (1.21), yet the time-to-event estimate for sedative-hypnotics overall was not statistically significant. It rated certainty as very low to moderate.
- A 2016 BMJ cohort of 3,434 adults aged 65 and older found slightly higher dementia risk with low use, but not with the highest use, and no faster cognitive decline.
One problem is reverse causation: early dementia symptoms may themselves prompt a prescription. A causal link is unproven, and it is not ruled out.
Why are opioids and alcohol so dangerous with benzodiazepines?
Both slow the central nervous system. The boxed warning on the Xanax label says use with opioids may cause profound sedation, respiratory depression, coma, and death. Prescribers are told to reserve the combination for patients with no adequate alternative.
The joint guideline reports that in 2021, nearly 88% of U.S. overdose deaths involving benzodiazepines also involved opioids. In a BMJ study of U.S. veterans on opioid pain medicine, about half of the 2,400 overdose deaths happened while veterans had both prescriptions. Current benzodiazepine prescriptions carried nearly four times the overdose death risk (hazard ratio 3.86). The group was mostly male, and the study shows association, not cause.
The Medication Guide says not to drink alcohol or take other drugs that cause sleepiness while on Xanax without first talking to your prescriber. The guideline says clinicians should offer naloxone, an opioid overdose reversal medicine, to everyone prescribed both drugs.
Who is at higher risk, and what should a safe review cover?
These groups need extra care:
- Adults 65 and older. The Beers Criteria say to avoid benzodiazepines, with limited exceptions that include severe generalized anxiety disorder. The joint guideline generally favors tapering unless there are compelling reasons to continue.
- People taking opioids or living with a substance use disorder. The guideline calls for more frequent reviews.
- People with depression or suicidal thoughts. The label warns benzodiazepines may worsen depression. If low mood is part of the picture, depression.md has more.
- People who are pregnant. Use late in pregnancy can cause sedation or withdrawal in the newborn.
- People with liver disease or certain drug interactions. The label cites slower clearance in alcoholic liver disease. Xanax is contraindicated with ketoconazole and itraconazole.
The joint guideline says clinicians should ideally weigh risks and benefits at least every 3 months, and at minimum at each new prescription or renewal. Built from that guideline and the label, a safe review covers these points:
- Why it was first prescribed, and whether it still helps your daily function.
- How many days a week you take it, and for how long.
- Every other medicine, plus alcohol, non-prescribed drugs, and grapefruit juice.
- Falls, memory problems, drowsiness, and driving safety.
- Your mood, and any thoughts of self-harm.
- A check of your state's prescription monitoring records.
- Whether naloxone makes sense for you.
- Other options, including anxiety treatments such as cognitive behavioral therapy.
- If a change makes sense, a personal plan, including who to call about withdrawal symptoms.
The bottom line
The studies behind the Xanax label do not show long-term safety, and the FDA warns about dependence, addiction, and withdrawal across the class. Some people do take these medicines for years, so the useful question is whether benefits still outweigh risks for you. Raise it with your prescriber, and plan any change together.
Last updated: October 2026. This article is for informational purposes only and does not constitute medical advice. Do not start, change, or stop a medicine based on this page. If you may be in withdrawal, get emergency care. If you are thinking of harming yourself, call or text 988.