July 25, 2022
6 min. read

Xanax Vs. Ativan: What’s the Difference?

Medly

Good to Know:

  • Xanax (alprazolam) and Ativan (Lorazepam) are both anti-anxiety medications called benzodiazepines. Benzodiazepines affect the central nervous system to help ease symptoms of anxiety and produce a feeling of calm.
  • Ativan and Xanax work very similarly, but there are some key differences, such as the ways in which the medications are administered and how long each medication lasts.
  • Both medications can cause serious side effects, including physical dependence. It’s essential to follow your provider’s medical advice when taking benzodiazepines such as Xanax and Ativan.
  • If your healthcare provider recommends Ativan or Xanax, take the medication exactly as it is prescribed. Higher doses, missing a dose, or stopping your medication can cause serious health concerns, including symptoms of withdrawal.

Ativan and Xanax, also respectively known as lorazepam and alprazolam, are medications used to treat anxiety disorders and panic disorders. There are critical differences between the two medications, but they function similarly; they also carry similar risks regarding physical dependence and serious side effects, including withdrawal symptoms. We’ll discuss the differences and similarities between the two medications. If you’re struggling with your mental health, this information can help you start a conversation about treatment options with your healthcare provider.

What are benzodiazepines?

Xanax and Ativan belong to a group of anxiety medications known as benzodiazepines (sometimes shortened to “benzos.”) Benzodiazepines work as anti-anxiety medication by working short-term to provide a calming effect. Benzodiazepines do this by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that blocks specific signals in the central nervous system to provide a calming effect. Your brain needs GABA to manage stress and improve your sleep.

Did You Know? Gamma-aminobutyric acid is the major neurotransmitter in your central nervous system.

By enhancing the effects of GABA in your brain, benzodiazepines help quickly reduce anxiety symptoms, offering an effective treatment for panic attacks, insomnia, generalized anxiety disorder, and other anxiety disorders. Benzodiazepines are considered safe and effective when used short-term, and several patients see success using either Xanax or Ativan as part of their treatment plan for anxiety.

Ativan vs. Xanax: 3 important differences

One of the most notable differences between Xanax and Ativan is how quickly they work and how long the effects last. Xanax tends to work more quickly, with an oral dose reaching full effect in 1-2 hours. The half-life of Xanax, or how long it takes for half the medication to leave the body, is approximately 11 hours. In comparison, an oral dose of Ativan takes about 2 hours to reach full effect, and the half-life is between 12 and 18 hours.

Fast Facts: In addition to its use as an anxiety medication, Ativan is approved for the treatment of seizures by the U.S. Food and Drug Administration (FDA). Ativan is also used to alleviate nausea and vomiting from cancer treatments, and to control agitation caused by alcohol withdrawal.

The second important distinction between the two medications is how they can be taken. Ativan is available in oral tablets, liquid concentrates, and injections. Xanax is available in liquid concentrates, immediate-release tablets, extended-release 24-hour tablets, and disintegrating tablets.

The third difference is the amount of medication commonly prescribed. It’s more common for patients to receive higher doses of Ativan compared to Xanax. The usual dosage of Ativan is approximately 2-6 milligrams each day, whereas Xanax doses are usually below 4mg, although it’s not uncommon for patients with panic disorders to take more. 

These numbers aren’t absolutes; your prescribing physician will choose the appropriate dose based on your health history, needs, and goals. 

Xanax vs. Ativan: Side effects

Despite their effectiveness as an anxiety treatment, benzodiazepines such as lorazepam (brand name: Ativan) and alprazolam (brand name: Xanax) are not without their risks. Benzodiazepines all have similar side effects. Common side effects of benzodiazepines include:

  • Confusion
  • Constipation
  • Drowsiness and/or fatigue
  • Dry mouth
  • Increased appetite
  • Lightheadedness
  • Memory problems
  • Slurred speech

Quick Tips: Benzodiazepines can also impact your balance and coordination, and they might also make it difficult to drive. If you’re concerned about the potential side effects of your anxiety medication, talk with your healthcare provider.

Side effects of Xanax

Xanax is far more likely to cause drowsiness than Ativan. Approximately 16% of patients with anxiety experienced drowsiness with Ativan; in comparison, 41% of patients with anxiety disorders and 77% with panic disorder experienced drowsiness on Xanax.

Side effects of Ativan

Ativan is more likely to impair learning and coordination than Xanax. It can also cause amnesia or memory issues for longer periods of time than Xanax.

Can benzodiazepines cause withdrawal?

Yes, benzodiazepines can cause withdrawal symptoms. Between Xanax and Ativan, Xanax is far more likely to cause withdrawal symptoms. This is due to Xanax’s quick-acting effects and shorter half-life compared to Ativan. Abruptly stopping Xanax—or even a missed dose—may lead to symptoms of withdrawal.

The most common withdrawal symptoms when taking benzodiazepines include:

  • Anxiety
  • Cognitive issues
  • Craving the medication
  • Diarrhea
  • Hallucinations
  • Insomnia
  • Mood swings
  • Muscle twitching
  • Nausea and vomiting
  • Panic attacks

Preventing withdrawal

Benzodiazepines can cause tolerance and/or physical dependence in as little as a few weeks of use; one professor at Yale Medicine estimates that 50% of patients who use medications such as Xanax or Ativan can develop a tolerance within 4 weeks. Tolerance means that the daily dose your provider first prescribed stops becoming effective, and you need higher doses to achieve the same effect.

This does not mean that the medications are unsafe to take; doctors have been safely prescribing benzodiazepines for years. Benzodiazepine medications are an effective short-term treatment for anxiety, panic attacks, or insomnia. However, it does mean you need to follow your healthcare provider’s medical advice on when and how often to take your medication. If you choose to reduce or stop your daily dosage, tapering off is essential to prevent symptoms of withdrawal. Do not abruptly stop your medication without discussing your concerns with your doctor first.

It is possible that, even while following the medical advice of your provider, you may still experience withdrawal symptoms when stopping benzodiazepines, especially if you are taking Xanax. These symptoms may last for a week or longer. If you’re interested in changing or stopping your medication, discuss it with your provider so you can both develop a plan to ensure you stop treatment safely.

Medication interactions and safety

Lorazepam and alprazolam, like all benzodiazepines, have some potentially unsafe drug interactions. One of the most dangerous is combining benzodiazepines with opioids. As both medications affect the central nervous system, combining both medications can lead to serious and potentially life-threatening side effects. These include profound sedation, respiratory depression, coma, and possibly death.

Quick Statistics: The National Institute of Drug Abuse estimates that over 30% of opioid overdose deaths included the use of a benzodiazepine.

Drinking alcohol while taking Xanax or Ativan is not recommended for the same reason it’s not recommended to mix benzodiazepines with opioids. Benzodiazepines also do not mix well with other antidepressants, as well as other medications. This is why benzodiazepines should only be used under the close supervision of a healthcare provider.

Ativan vs. Xanax: The takeaway

Both lorazepam (brand name: Ativan) and alprazolam (brand name: Xanax) are types of anti-anxiety medications called benzodiazepines. These medications affect the central nervous system to produce a calming effect. They’re a safe choice for short-term anxiety treatment, but long-term use may lead to physical dependence and withdrawal. Only take benzodiazepines as they are prescribed; do not exceed your daily dose. 

Sources

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