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    Ativan vs. Xanax

    When comparing medications, it’s sometimes hard to make a decision when there are so many factors to consider. We’ve put two of the most common anti-anxiety meds side by side and done the comparison for you.

    With this easy-to-understand guide, you’ll have all the information you need to make the right choice for you or your loved one.

    Quick Overview

    The Anxiety and Depression Association of America estimates that 40 million adults have some type of anxiety disorder. Unfortunately, that number is going up rather than going down.

    A recent survey from the American Psychiatric Association (APA) found that 39% of respondents reported they were more anxious than the year before and just 19% reported feeling less anxious.

    Ativan and Xanax are two leading prescription medications used primarily for the treatment of anxiety disorders. Both are part of the benzodiazepine drug class, more commonly known by the nickname “benzos.”

    Benzodiazepines are psychoactive drugs meaning they are a chemical substance acting within the central nervous system (CNS) to alter brain function. These drugs work by altering the function of a neurotransmitter called GABA (gamma-aminobutyric acid).

    They have strong anxiolytic and amnesic properties. The chemical changes produced by benzodiazepines can have a variety of effects on a person’s mood, behavior, perception and consciousness.

    Both medications are controlled substances, which means you’ll need a prescription to take Ativan and Xanax. In fact, benzodiazepines are among the most commonly prescribed drugs in the United States.

    Differences Between Ativan vs Xanax

    At first glance, Ativan and Xanax may seem very similar, but there are a few key differences that are important to note.

    While they are both benzodiazepines, they are different forms. Ativan is the brand name for lorazepam intensol whereas Xanax is the brand name for alprazolam intensol.

    Medical studies have shown that alprazolam benzodiazepines bind more to GABA receptors than lorazepam benzodiazepines.

    Because the mechanisms of the drugs are slightly different there are a few important differences:

    • Xanax works faster than Ativan
    • The effects of Xanax only last 4-6 hours whereas Ativan’s effects last around 8 hours
    • The effects of Ativan aren’t as affected by a person’s race and age compared to Xanax
    • The onset of sedative effects are slower with Ativan but last longer
    • Mental confusion may be less likely with Xanax
    • Ativan has a lower chance of toxicity and side effects because it’s expelled from a person’s system more quickly

    Ativan Uses

    Ativan is a sedative or depressant that’s used to treat a variety of ailments. It’s prescribed most often to treat anxiety symptoms and panic disorders.

    Because it is an anticonvulsant, Ativan can also be used to treat seizure disorders. Lorazepam is the drug therapy of choice for status epilepticus, a dangerous form of seizure that can last more than five minutes.

    The anticonvulsant effects of lorazepam medications like Ativan last typically anywhere from 6-12 hours.

    Other conditions treated with Ativan include:

    • Epilepsy
    • Sedation for surgery
    • Muscle spasms
    • Premenstrual syndrome

    Ativan works by enhancing the actions of GABA. Since GABA reduces nerve cell activity, Ativan use results in a calming effect.

    Xanax Uses

    The primary use of Xanax is the treatment of panic and anxiety disorders. It’s an extremely popular medication because it is highly effective at reducing anxiety.

    Xanax is also used to treat insomnia and seizures.

    The way Xanax works is similar to Ativan. Like other benzodiazepines, the chemical substances of Xanax affect GABA receptors.

    It attaches to GABA receptors in the brain, depressing the central nervous system. The result – calmer mood and less anxiety.

    Possible Side Effects

    All medications have intended and unintended effects. The latter is the known a side effect of using a drug.

    When taken as prescribed, most people tolerate Ativan and Xanax just fine and experience no serious side effects. However, it’s never clear how a person will react when they begin taking a prescription medication.

    Your physician should carefully weigh the benefits and risks before prescribing either Ativan or Xanax.

    Possible Side Effects of Ativan

    Even if you use Ativan as directed the following side effects can occur:

    • Amnesia
    • Weakness
    • Sedation
    • Dizziness
    • Memory problems
    • Drowsiness
    • Blurred vision
    • Nausea
    • Constipation
    • Vomiting
    • Muscle weakness
    • Headaches
    • Difficulty concentrating
    • Skin rashes

    Ironically, paranoia is a side effect of Ativan. However, it is a rare side effect.

    Long-term use of Ativan is not recommended. The longer a person uses Ativan the more likely they are to experience side effects.

    Possible Side Effects of Xanax

    There are also possible side effects that come with using Xanax. The potential side effects include:

    • Drowsiness
    • Fatigue
    • Difficulty concentrating
    • Confusion
    • Delirium
    • Dizziness
    • Increased saliva production
    • Changes in sex drive
    • Hallucinations
    • Slurred speech
    • Difficulty walking
    • Loss of coordination
    • Insomnia
    • Constipation
    • Diarrhea
    • Headaches
    • Nausea
    • Blurred vision
    • Appetite changes
    • Dry mouth
    • Muscle weakness
    • Irritability
    • Swelling in hands and feet
    • Congestion

    More rare but serious side effects include seizures and the yellowing of skin and eyes.

    Long-term use is often a concern in regards to the side effects of Xanax. Older adults are also more likely to experience them.

    Because everyone reacts differently, there are also concerns when a person first starts taking Xanax. For example, it’s recommended that patients not drive a car during the first week due to possible drowsiness.

    Drug Interactions

    Currently, 60% of Americans take prescription drugs. But they aren’t taking just one medication.

    On average, four prescription medications are taken at any given time. Whenever a person is taking two or more medications simultaneously there’s potential for drug interactions.

    Drug interaction can also refer to mixing a medication with alcohol.

    When drug interaction occurs it can affect the way a medication works and/or increase the risk of side effects. That’s why it’s extremely important for a physician to know what medications are being taken before writing a prescription.

    Ativan Drug Interactions

    The potential adverse effects of Ativan means drug-drug interactions must be carefully considered. When directly compared to Xanax, Ativan has less drug interaction. However, negative drug interactions can occur with:

    • Anxiety medications
    • Depressants
    • Alcohol

    Drinking alcohol while taking Ativan can be very dangerous. Doing so can significantly slow breathing or even cause death.

    The list above notes substances that most commonly cause Ativan drug interaction. Check the prescription bottle label and talk with your doctor about potential drug interaction while taking Ativan.

    Xanax Drug Interactions

    As with other benzodiazepines, there are known drug interactions with Xanax. Alcohol should be avoided entirely while taking Xanax since it has the same risks that are associated with Ativan.

    Taking Xanax at the same time as opioids also poses a serious risk.

    Other substances and medications that are known to affect Xanax use include:

    • Some anti-depressants
    • HIV therapies
    • Azole antifungals
    • St. John’s Wort
    • Seizure treatments
    • Rifamycins
    • Macrolide antibiotics
    • Kava
    • Sodium oxybate

    The list above notes some but not all substances that can cause Xanax drug interactions. Be sure to check the label of the prescription bottle and discuss potential drug interaction with your physician.

    Medication Dosage

    Dosage is an important factor when taking a medication. It can affect everything from effectiveness to side effects to cost.

    Patients are urged to always follow the dosage directions exactly. If you miss a dose or take more than recommended, contact your healthcare provider.

    Most physicians start a patient on a very low dose and gradually increase it until the desired effect is achieved. Because of concerns over withdrawal, the dosage is gradually decreased rather than stopping use suddenly as well.

    Ativan Dosage

    Ativan dosage depends on what the drug is being used to treat. It’s generally offered as a 0.5 mg, 1 mg or 2 mg tablet. Ativan is also available as an oral solution. The dosages for the solution are usually slightly higher.

    Epilepsy and Seizures

    The anticonvulsant effect is strong in Ativan. Usually, just 2-4 doses are needed in a 24-hour period. The dosage is typically between 4 mg and 8 mg per day.

    Anxiety

    Adults and children over 12 years old are typically prescribed to take 2-3 mg in tablet form per day to treat anxiety. Older adults are often advised to only take 1-2 mg per day.

    Insomnia

    Adults and children over 12 years old can take 2-4 mg in one dose shortly before bed.

    Xanax Dosage

    Since Xanax is stronger than Ativan the doses are smaller. Approximately 0.5 mg of Xanax is the equivalent of 1 mg of Ativan. Doses as small as 0.25 mg may be prescribed, but single tablets go up to 2 mg.

    Xanax dosage is based on numerous factors including age, race, health conditions, response to the drug and the medical condition. People of Asian descent are more susceptible to the effects of Xanax, which usually influences the prescribed dosage.

    Costs: Ativan vs. Xanax

    For many people the choice between Ativan and Xanax comes down to cost. The cost varies depending on the strength, with stronger doses costing more.

    When directly compared to one another Ativan is much more expensive than Xanax.

    According to Drugs.com, as of April, 2019, the average retail cost for Ativan is $2,588.85 for a 100 count of 0.5 mg tablets, $3,455.48 for 1 mg tablets and $5,501.89 for 2 mg tablets. The cost for Xanax is approximately $447 for a 100 count of 0.25 mg tablets, $554.87 for 0.5 mg tablets, $737.54 for 1 mg tablets and $1,248.06 for 2 mg tablets.

    These are pre-insurance prices, however, insurance coverage varies by provider and plan. There are also generic versions of both medications that are significantly cheaper.

    Risks: Ativan vs. Xanax

    The truth is all medications carry a certain level of risk. Ativan and Xanax are not exceptions to the rule. As noted above, there are a few side effects and drug interactions that can pose significant risks when taking Ativan or Xanax.

    Risks Associated With Taking Ativan:

    -Suicidal ideation

    Suicidal ideation can occur with Ativan.

    -Death Due to Drug Interactions

    Drug interaction with alcohol and other narcotics is also a serious risk. Fortunately, this risk is mitigated by simply abstaining from drinking alcohol while taking Ativan.

    If you have a dependence on alcohol or are going through alcohol withdrawal you’ll need to avoid taking all benzodiazepines.

    Risks Associated With Taking Xanax:

    -Death Due to Drug Interactions

    Deadly drug interaction is also possible with Xanax. Consuming alcohol and opioids are known to slow down breathing to the point that breathing stops and becomes fatal.

    Aspiration is also possible. The key problem is that the sedative properties of the drug are enhanced by opioids and alcohol.

    -Birth Defects

    If taken during pregnancy Xanax could cause birth defects. Cleft palate is possible, particularly if Xanax is taken in the first three months of pregnancy. Chemical substances can also pass through to breast milk, therefore breastfeeding mothers shouldn’t take Xanax.

    -Suicidal Thoughts

    Xanax can have a depressant effect so severe that it leads to suicidal thoughts. It’s primarily a concern for those who have developed a dependency on Xanax and are trying to stop taking the drug.

    People who are taking Xanax are urged to call their physician or the National Suicide Prevention Hotline at 1-800-273-8255 if they experience suicidal thoughts.

    Addiction – Serious Risk With All Benzodiazepines

    Addiction is the most significant concern with Ativan and Xanax. Benzodiazepines are known to be highly addictive and lead to psychological dependence when they aren’t used properly or taken in the proper dosage.

    Research has found that addiction can occur quickly within the first week of use.

    On top of the addictive pharmacology, benzodiazepines can also create a euphoric high which increases the likelihood of abuse.

    Addiction is more likely if:

    • You’ve been addicted to other substances in the past
    • You take doses higher than 4 mg
    • You’ve been taking the medication more than 12 weeks

    If you stop taking the medications after becoming addicted or after long-term use you will likely experience withdrawal. Withdrawal symptoms can include blurred vision, seizures, impaired concentration and muscle cramps.

    Anyone who is taking Ativan or Xanax recreationally, using it as a self-treatment without the oversight of a doctor or believe they’ve developed a dependence should consider addiction treatment.

    Making a Choice Between Ativan and Xanax

    Which medication is best is a personal choice that can hinge on one or all of the factors above.

    The prescribing physician should take a patient’s symptoms, general health, medical history and current medications into account before recommending either medication.

    Need more information before making the decision? YourDrug.org has additional resources that can help you make the choice between Ativan and Xanax.