Ativan vs. Xanax

Alprozaolam tablets

Ativan (lorazepam) and Xanax (alprazolam) are prescription medications that belong to the benzodiazepine drug class. Both of these medications are used to treat anxiety, but there are some key differences between each drug.

Ativan vs. Xanax: Comparison Guide

While Ativan and Xanax are similar medications, there are a few differences between them. For example, they are FDA-approved for slightly different uses, though both are used off-label to treat similar conditions. They are also available in different formulations and have different common side effects and durations of action.

Ativan

Xanax

Generic Name Lorazepam Alprazolam
Drug Class Benzodiazepine Benzodiazepine
Drug Schedule Schedule IV Schedule IV
Dosage Examples 0.5mg, 1mg, 2mg tablets 0.25mg, 0.5mg, 1mg, 2mg tablets
Formulations  Injectable solution, oral tablet, oral solution Oral tablet (extended- or immediate-release)
Usage FDA-approved for: anxiety disorders (various) and anxiety associated with depression FDA-approved for: generalized anxiety disorder (GAD) and panic disorder (PD)
Side Effects Most commonly:  sedation, dizziness, weakness and unsteadiness Most commonly: impaired coordination, hypotension, dysarthria and increased libido
Potential for Abuse Abuse may lead to limited physical dependence or psychological dependence Abuse may lead to limited physical dependence or psychological dependence
Onset of Action Around two hours 30 minutes to two hours
Duration of Action Eight hours Four to six hours
Half-Life 11.2 hours 12 hours

Which Benzo Is Stronger?

Ativan and Xanax differ somewhat in how long their effects last. Xanax typically takes effect more quickly and also has a shorter duration of action than Ativan. Unlike Ativan, Xanax is available in both immediate-release (IR) and extended-release (ER) tablets. Because of this, the likelihood for misuse and addiction is slightly higher for Xanax than it is for Ativan.

Ativan is only available in immediate-release tablets, liquid or intravenous (IV) solutions (which would be administered by a health care provider). Ativan takes effect more slowly than Xanax does and each dose lasts longer. This results in a slightly lower risk of misuse or addiction than Xanax.

Because tolerance can develop with either of these medications, higher doses may be needed to get the same effect over time.

Fastest-Acting Benzo

Xanax is the fastest-acting benzodiazepine, meaning its effects are felt more quickly than any other medications like it. This can be particularly useful if the medication is being taken for an urgent situation that can come on suddenly, such as a panic attack.

Best Benzo for Anxiety

Both Xanax and Ativan are FDA-approved to treat anxiety disorders, but each one can be more helpful in certain situations.

Xanax may be better in situations where quick effects are needed. This includes during a panic attack, which is usually sudden, or during a procedure that involves anesthesia. Xanax would also be used for infrequent or unpredictable times of anxiety.

On the other hand, Ativan may be helpful when a longer effect is needed or where side effects like drowsiness or memory impairment can be detrimental. For example, a musician with performance anxiety would not want to forget their notes during a recital. Ativan can also be helpful if anxiety is more frequent or more predictable because each dose will last longer than Xanax.

Best Benzo for Panic Disorder

Due to its fast onset, Xanax is approved for panic disorder. Ativan may also be used at the discretion of a healthcare provider, but this would be an off-label use. Either medication could be effective for panic disorder, so always consult your physician to determine which would be best for your situation.

Best Benzo for Sleep

Xanax and Ativan can both cause drowsiness, so some people take these medications to help them sleep. However, these medications typically are not used as first-line treatments for insomnia due to the potential for misuse and abuse. Taking benzodiazepines consistently may result in the development of tolerance (needing more medication to create the same effect) and dependence on the medication.

Best Benzo for Alcohol Withdrawal

Like benzodiazepines, alcohol acts as a depressant. For this reason, benzodiazepines can help people to stop drinking alcohol safely. This is because the depressant effects of benzodiazepines can help prevent seizures that can occur during alcohol withdrawal.

Benzos with lower risks for abuse are often safer for treating alcohol withdrawal symptoms. Longer-lasting benzodiazepines like Ativan (lorazepam), Librium (chlordiazepoxide) and Valium (diazepam) have a slightly lower potential for abuse than alcohol or other benzos.

Additionally, each dose lasts longer in the body. This allows you to take fewer doses per day than if you were taking a shorter-acting medication like Xanax. Shorter-acting benzos with multiple doses per day are more likely to create an immediate, positive experience that reinforces use, giving them a higher potential for abuse.

Which Benzo Is More Addictive?

While Xanax and Ativan are both classified as Schedule IV medications, medications with a faster onset of action are generally more addictive. This is generally because you can directly associate the feeling of the drug’s effects with the act of taking the drug. While there are no readily available statistics on the different rates of addiction to Xanax or Ativan, this may mean that Ativan is slightly less addictive than Xanax.

Insurance Coverage and Cost Comparison for Ativan vs. Xanax

Both Ativan and Xanax are readily available in generic form and are typically covered by insurance. Without insurance, Xanax typically costs $4.93 per 0.25 mg tablet and Ativan costs $43.40 per 1 mg tablet.

Choosing the Right Benzo

Always talk to your doctor to determine which medication would work best for you. There are many factors to consider, such as how quickly the medication should work, how long it should last and whether it will interact with other medications you are taking.

Switching from Ativan to Xanax

If you have been taking Ativan without your symptoms improving, your doctor might consider prescribing a different medication, like Xanax. Additionally, if you are experiencing side effects like drowsiness or memory problems, your doctor may also consider prescribing a different medication. It is important not to abruptly stop taking Ativan if you have been taking them consistently, as doing so can cause Ativan withdrawal symptoms to occur.

In general, 1 mg of Ativan is equivalent to 0.5 mg of Xanax. This conversion is simply used as a guide, as many other factors are considered when prescribing these medications. These factors include genetics, age, liver function, kidney function and use of other medications.

Switching from Xanax to Ativan

Likewise, if you are needing multiple doses of Xanax to treat your panic disorder, for example, Ativan may be a more appropriate choice. Each dose of Ativan lasts longer in the body and would “cover” you for a longer amount of time.

As with Ativan, stopping Xanax without speaking to your doctor can cause Xanax withdrawal symptoms to occur. Always seek medical advice if you are considering switching or stopping your medication.

Withdrawal Risks

Ativan withdrawal symptoms include:

  • Difficulty sleeping
  • Hallucinations
  • Headaches
  • Seizures
  • Stomach or muscle cramps
  • Tremors
  • Unusual behaviors

Xanax withdrawal symptoms include:

  • Difficulty concentrating
  • Difficulty sleeping
  • Feeling discouraged, sad or empty
  • Feeling irritable
  • Hallucinations
  • Lack of interest or pleasure
  • Loss of appetite
  • Nausea or vomiting
  • Seizures or tremors
  • Stomach or muscle cramps
  • Suicidal thoughts
  • Sweating
  • Unusual behaviors

Getting Help for Benzodiazepine Addiction

Located a short distance from Portland, Seattle and surrounding cities, The Recovery Village Ridgefield aims to treat addiction throughout Washington and Oregon. Our 80-bed facility sits on five acres of land and provides people with a safe environment that promotes lifelong recovery from addiction. We offer inpatient treatment, medical detox, outpatient care, partial hospitalization programs (PHPs) and aftercare planning. In addition, we now offer online counseling services to help make addiction treatment more accessible.

If you or someone you care about is struggling with benzodiazepine abuse or addiction, The Recovery Village Ridgefield can help. Contact us today to learn more about benzodiazepine addiction treatment services that can work well for your situation.

Sources

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.