Ativan vs. Xanax – What Are The Key Differences, Uses, and Side Effects?
Ativan and Xanax belong to the Benzodiazepine family and are both listed as Schedule IV controlled substances, meaning they are prescription medications and can not be accessed “over the counter.”
Ativan is the brand name for the drug Lorazepam, and Xanax is the brand name for Alprazolam. Both are commonly used to treat anxiety and occasionally used to treat insomnia, panic disorders, muscle spasms, and seizures [2].
Benzodiazepines work by altering the activity in the GABA-A receptors. This impacts the central nervous system (CNS) by calming it down. It also prevents the reuptake of dopamine and serotonin, allowing the user to experience a surplus of these naturally occurring chemicals. The calming down of the CNS and the boosting of dopamine and serotonin have a very desirable euphoric and sedated effect. If either drug is abused or overused, it could lead to serious dependence and addiction disorders.
Ativan vs Xanax, they have many commonalities but, a patient’s experience can vary based on factors such as how quickly each drug takes effect, how long the effects last, their safety, and the method of ingestion [2]. If you are considering Ativan vs Xanax for anxiety, understanding their key differences, uses, and side effects can help you make an informed decision with your doctor.”
Short periods of anxiety are a normal part of life as fear can be a primal response to danger, helping us take action. However, for people with anxiety disorders, this sense of anxiety and worry never goes away. This may manifest in a number of disorders, including generalized anxiety, panic disorder, social anxiety, OCD, and other phobia-related disorders [1]. An estimated 31.1% of U.S. adults experience an anxiety disorder at some point in their lives [3].
Living with any of these conditions without proper treatment and care can be extremely challenging. Even managing everyday tasks may become a source of overwhelming worry, dread, or fear.
Most anxiety disorders are treated with psychotherapy, such as talk therapy, cognitive behavioral therapy, acceptance & commitment therapy. In many cases, medication is used, not to cure but, to manage ongoing anxiety disorders. Of these medications, the most commonly used for anxiety disorder is Benzodiazepines, which include Xanax and Ativan.
Both drugs can be used to treat anxiety disorders, but Ativan for panic attacks is particularly effective due to its calming properties. Understanding the difference between Ativan and Xanax can help you determine which medication aligns better with your needs.
You may be wondering, which is better, Ativan or Xanax for anxiety? We’ll dig into all the similarities and notable differences to help you make an informed decision with your healthcare provider.
Many people wonder, is Ativan like Xanax? Xanax and Ativan work primarily the same way—by increasing activity in the brain’s GABA-A receptors. This reaction typically allows the person to experience a sense of calmness, relaxation, and the ability to worry less.
As benzodiazepines, these two drugs provide short-term relief of anxiety symptoms, but prolonged use is not recommended due to the risk of dependence, abuse, and harmful side effects. Because of these risks, neither drug is typically advised for long-term anxiety management. Healthcare providers may prescribe these for a period but often prefer safer, non-habit-forming alternatives for anxiety disorders.
A common topic of interest for those considering Ativan vs Xanax is which is stronger Ativan or Xanax?
The most notable difference between Xanax and Ativan is that Xanax is more commonly prescribed for short-term use due to its faster onset, making it effective for immediate relief during anxiety or panic attacks. In contrast, Ativan (lorazepam) has a slower onset but may be more effective for long-term use or for those who require less frequent doses. However, both medications are used for panic attacks and panic disorders.
Typically, both drugs come in pill form. Xanax takes effect within about 30 minutes, while Ativan may take up to 2 hours. Some patients, however, report no noticeable difference in the onset of the two drugs. Additionally, Ativan can be administered via injection, which significantly increases its speed of action.
Although Ativan may be slower to take effect, it generally has a longer half-life than Xanax. Ativan’s half-life is between 12-18 hours, while Xanax’s half-life is about 11 hours. As a result, Xanax users may need more frequent doses throughout the day, while Ativan may provide longer-lasting relief.
Xanax is more widely known and often considered more prone to abuse. Some studies suggest that long-term use of Ativan can have adverse effects on cognitive function and learning. These studies also indicate that chronic use of both Ativan (lorazepam) and Xanax (alprazolam) reduces GABAA receptor function. Ativan decreases receptor binding in both the cortex and hippocampus, while alprazolam primarily affects the cortex.
Moreover, Ativan, unlike Xanax, was found to increase the presence of Type 2 benzodiazepine receptor sites, which are responsible for mood and cognition regulation. This may suggest that Ativan could have a more significant impact on brain function with prolonged use compared to Xanax. The differences in how each drug affects the brain may explain why long-term Ativan use has been linked to cognitive and emotional regulation issues.
Opinions vary on whether Ativan or Xanax is better for the treatment of anxiety disorders. The following will break down the individual characteristics of each drug to highlight the difference between Ativan and Xanax.
As with any drug, some candidates may respond better to one perscription over the other. Consulting your doctor and attending frequent check-ins to evaluate your condition and alter medications as needed are strongly encouraged.
Xanax has a rapid absorption rate when taken orally, with a peak plasma concentration occurring within 1-2 hours. Additionally, its bioavailability—meaning the amount of a drug that is absorbed for use by the body—averages between 80-100% [6]. The lower the bioavailability, the less effect the drug can have. Xanax absorbs at a high bioavailability rate because it binds to serum protein. Once the liver metabolizes the drug, any remaining substance will be filtered by the kidneys and expelled through urine.
Xanax is prescribed at various strengths ranging from 0.25mg, 0.5 mg, 1 mg, and 2 mg tablets. However, extended-release Xanax is available in strengths of 0.5 mg, 1 mg, 2 mg, and 3 mg [6]
Your doctor will adjust your dosage depending on your age (geriatric dosage is typically reduced) and the intended treatment. Doses differ for the treatment of anxiety disorders, panic disorders, hepatic impairment, and debilitating diseases. Alprazolam (Xanax) has not been approved for pediatric patients [6]
Ativan (Lorazepam) also has a high absorption rate when taken orally, reaching peak plasma concentrations approximately 2 hours after ingestion. Its bioavailability is around 90%. Lorazepam easily crosses the blood-brain barrier, binding itself to plasma proteins, allowing it to quickly affect the CNS [7].
Once in the bloodstream, Ativan binds to plasma proteins and distributes throughout the body. The drug is metabolized in the liver, bypassing the enzyme system. This makes Ativan a safer option for patients with liver dysfunction since its metabolism is less dependent on liver enzymes. Any excess of the drug is eventually metabolized and eliminated from the body, primarily through urination [7].
Ativan is prescribed in various strengths, ranging from 0.5 mg to 1 mg and 2 mg tablets, and the extended-release version of Lorazepam is administered at 1 mg, 2 mg, and 3 mg [7].
Your dosage will be adjusted according to the reason for your Ativan prescription. Doses are adjusted based on age and type of condition. Lorazepam can be used to treat anxiety disorder, insomnia (due to stress), prolonged seizures, agitation in intensive care, alcohol withdrawal syndrome, chemotherapy-related nausea, and hepatic impairment. It is not generally administered to children [7].
Xanax and Ativan both have approved FDA status for the treatment of anxiety and panic disorders. Xanax is widely prescribed for managing generalized anxiety disorder and panic disorder, but Ativan is also approved for insomnia, epileptic symptoms (anticonvulsant use), and anesthesia premedication to relieve anxiety, induce sedation, and amnesia [6,7].
Both Xanax and Ativan have off-label uses. Off-label use occurs when doctors prescribe a drug for conditions not FDA-approved, relying on their clinical expertise to assess its potential benefits for similar conditions.
For example, Xanax is used off-label for insomnia, depression, or premenstrual syndrome based on a doctor’s clinical experience and judgment [6].
Ativan is also used off-label for the treatment of urgent inpatient cases, such as agitation in intensive care units or alcohol withdrawal delirium, due to its rapid calming effect and effectiveness when administered through an I.V. This makes it a valuable option for managing severe symptoms in critical care settings where immediate intervention is required [7].
Sometimes, the question of “Which is stronger, Ativan or Xanax?” arises when talking about the onset of the two drugs. Xanax takes 30 minutes to metabolize and affect the body, but Ativan can take up to 2 hours.
This does not mean that Xanax is stronger than Ativan, but rather, their chemical compounds are digested at differing rates [4]. Additionally, extended-release versions of these drugs may alter how fast the body absorbs the drug, but onset alone does not determine the strength or effectiveness of Ativan or Xanax.
Others may question how long after Ativan can I take Xanax? It’s vital to consult your doctor before switching medication to ensure your safety and effectiveness of your treatment.
Your dosage for anxiety disorders and other off-label uses of Ativan and Xanax will vary per person and per condition.
Xanax and Ativan share many similar effects. Unfortunately, there are many associated risks and health consequences to these drugs. You and your doctor should discuss these potential issues and weigh the benefits vs. rewards of your medication.
The following two lists provide common and severe effects for Xanax and Ativan:
Severe Side Effects
People who take Xanax or Ativan are cautioned against abruptly stopping their medication. Withdraw symptoms for both of these drugs can lead to severe side effects. Your physician should gradually reduce the dosage for these medications over time to avoid these effects. The suggested daily reduction does not exceed 0.5mg every three days [6]. In some cases, your doctor may suggest switching to a longer-acting benzodiazepine like Klonopin or diazepam to further assist with any potential withdrawal symptoms.
While there is no definitive evidence to suggest that Xanax is more addictive than Ativan (or vice versa), the risk of dependence does greatly increase with prolonged use of either drug. This highlights the importance of using these medications only as prescribed and under close medical supervision, as well as exploring alternative treatments to minimize the risk of long-term dependency.
Xanax and Ativan are CNS depressant prescription medications. As such, there are a few different prescription and over-the-counter drugs that should not be taken concurrently.
Lorazepam (Ativan) should not be taken with any other sedatives, muscle relaxers, opioids, or cold medications. You should also never drink alcohol with Ativan. Additionally, Metronidazole and Kratom should not be co-administered or used as they increase the risk of CNS depression and other harmful reactions [7].
Alprazolam (Xanax) should also not be taken with CNS depressants, opioids, or alcohol. Xanax is not suitable for those with a history of pulmonary disease as there is an increased risk of respiratory depression. Other medications that should be avoided while on Xanax including anti-depressants, certain antibiotics, specific seizure medications, antihistamines, and muscle relaxants [7].
Benzodiazepines, such as Xanax or Ativan, can cross the placenta and may impact the baby in utero. However, neither drug has been linked to an increased risk of miscarriage, major congenital disabilities, or significant fetal or maternal complications. Despite this, other risks, such as neonatal withdrawal syndrome, still exist. Your healthcare provider needs to monitor the baby’s health closely, as benzodiazepines can have effects during pregnancy.
As with any medication, the risks versus benefits must be carefully considered and discussed with your doctor before continuing treatment during pregnancy.
Xanax and Ativan are prescription medications classified as Schedule IV controlled substances by the FDA (Food and Drug Administration). It is illegal to take either of these drugs without a prescription. This includes borrowing from a friend or family member and purchasing off the black market.
As you work with your physician to choose between Ativan and Xanax, consider how the drug might impact your daily functioning and cognitive clarity. With any medication, the benefits should outweigh the potential side effects.
For many users, Ativan’s longer-lasting effects may be preferable for all-day use, though it could also result in an extended period of drowsiness. Xanax, on the other hand, has a faster onset of action and may be ideal for sudden panic attacks, but it is less likely to be a long-term solution for generalized anxiety. Discuss your condition, concerns, and goals with your doctor. Factors such as age, metabolism, reaction to the medication, liver function, and overall health may influence your experience and preference for one drug over the other.
It may take time and adjustments to find the right dosage and prescription. Be patient with yourself and promptly communicate any concerns with your doctor.
The effects of Ativan and Xanax on different mental health conditions must be taken into consideration before use. If you have a history of PTSD or depression, these drugs may or may not cause an uptick in your symptoms.
Most notably, Xanax has been associated with worsening depression in some users. It’s important to discuss the potential mental health side effects of these medications with your doctor before starting either drug to ensure they are the right choice for your treatment.
Ativan and Xanax both pose a threat of dependence, especially with long-term use. The longer the body depends on a drug to assist its CNS, the harder it may be for the body to withdraw from the medication. Additionally, prolonged use may lead to higher tolerance and less effective results.
Long-term use of both these benzodiazepines is linked to a reduction in GABAA-receptor function, which can negatively impact the cortex and hippocampus. These areas of the brain are important for memory, cognition, emotions, reasoning, and more.
While prescription drugs like Xanax and Ativan may provide some temporary relief, they do not cure anxiety disorders or panic disorders. It is recommended that people who suffer from chronic anxiety also pursue other therapies to manage anxiety long-term.
Ativan and Xanax are both benzodiazepines and schedule IV controlled substances by the FDA. Under a doctor’s supervision, they can effectively alleviate anxiety symptoms but are best used in short time periods as they are not a cure for anxiety. Both drugs pose a risk of addiction due to their desirable effects of relaxation and sedation.
If you or someone else is struggling with addiction to prescription drugs like Xanax or Ativan, California Detox offers personalized treatment administered by expert clinicians. Our treatment programs provide:
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