Ativan vs. Xanax - The Battle of the Two Benzodiazepines

Ativan (lorazepam) and Xanax (alprazolam) are two popular benzodiazepines used for the short-term relief of anxiety and other psychiatric disorders. Benzodiazepine medications like Ativan and Xanax work by increasing the effects of the gamma-aminobutyric acid (GABA) neurotransmitter in the brain. Improving levels of this neurotransmitter has a calming effect, helping with anxiety, reducing muscle tension, preventing seizures, and inducing sleep since it slows down the activity of nerve cells.

Although they share a similar mechanism of action, there are many differences between Ativan and Xanax. This article will compare and contrast the two most prescribed benzodiazepine medications by discussing their respective benefits, potential side effects, withdrawals, and potential for addiction.

According to the National Alliance on Mental Illness (NAMI), Ativan is approved for treating anxiety, insomnia, or sleep difficulty due to anxiety or stress, status epilepticus (continuous seizures), and as a medication given right before anesthesia. And Xanax is approved for treating generalized anxiety disorder (GAD) and panic disorder with or without agoraphobia. However, both benzodiazepines are also used to treat alcohol withdrawal symptoms.

The Anxiety and Depression Association of America (ADAA) recommends using these medications as second-line treatments; when first-line pharmaceuticals such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are not appropriate or effective, qualified healthcare providers may employ one of these benzodiazepine medications.

The peak concentrations of Xanax in the blood are reached within one to two hours after ingestion, while those of Ativan take around two hours. The duration of Xanax’s effects is quite variable; however, it typically lasts between four and six hours. Xanax is also available in extended-release tablet form (Xanax XR). The extended-release pill takes approximately nine hours to reach its full effect and lasts longer in the body.

Ativan’s effects typically wear off within eight hours; however, this time frame might vary from person to person. Xanax’s sedative effects may occur sooner than Ativan’s, but they wear off more quickly. The half-life of each medication, or the time necessary for a drug’s concentration in the body to be lowered by half, also varies greatly. Ativan has an average half-life of 10-20 hours, whereas Xanax has an average half-life of 11-15 hours.

Xanax’s effectiveness is more likely to be affected by race (Asians had higher peak concentrations and longer durations of Xanax’s effects), concurrent liver or kidney disease, alcoholism, and obesity, whereas Ativan’s effectiveness is less likely to be affected by race or age.

Ativan is available as both a brand and generic medication but is usually dispensed by pharmacies as a generic medication (lorazepam). You can get Ativan in pill form, injectable form, or oral concentrate.

• Immediate-release tablets – 0.5 mg, 1 mg, 2 mg
• Oral liquid – 2 mg/ml
• Injections – 2 mg/ml, 4 mg/ml
• Xanax comes in several forms and dosages, including:
• Immediate-release tablets – 0.25 mg, 0.5 mg, 1 mg, 2 mg
• Extended-release 24-hour tablets – 0.5 mg, 1 mg, 2 mg, 3 mg
• Disintegrating tablets – 0.25 mg, 0.5 mg, 1 mg, 2mg
• Oral liquid – 1 mg/ml

One of the key differences between the two medications is that Xanax is only available for adults, but Ativan can be prescribed to children over 12.
The daily dose of Ativan and Xanax may vary from one person to another, depending on their specific condition and other individual factors. But in most cases, people take larger doses of Ativan, usually 2-6 mg daily, compared to Xanax, which does not exceed 4 mg daily. However, higher doses of Xanax may be necessary for patients with panic disorder.

Both medications have the potential to induce tolerance and dependency. Depending on how long a person has been using Ativan or Xanax, abruptly ceasing use can cause potentially dangerous withdrawal symptoms.

Since Ativan and Xanax are both members of the same family of drugs with similar effects on the body, they also have some of the same potential side effects. The majority of adverse effects of benzodiazepines, including CNS effects and respiratory depression, are dose-dependent, with higher dosages producing more severe side effects.
Some of the most common side effects include:

• Drowsiness
• Dizziness
• Blurred vision
• Memory issues
• Fatigue
• Slurred speech
• Confusion
• Decreased libido
• Constipation
• Increased appetite
• Insomnia
• Headache
• Dry mouth
• Low blood pressure
• Muscle weakness
• Impaired balance and coordination
• Impaired driving skills

Although both prescription medications can cause drowsiness, this is less likely with Ativan than with Xanax. According to the U.S National Library of Medicine, Ativan may cause drowsiness in 15.9% of people taking it for anxiety. In comparison, Xanax may cause drowsiness in 41% of people taking it for anxiety and 76.8% of those taking it for panic attacks. However, Ativan can impair learning and coordination and cause amnesia for longer periods of time than Xanax.

Infants born to mothers on benzodiazepines have also been documented to have difficulty breathing, be delivered at low birth weight, have low sugar levels, and experience severe withdrawal symptoms. Therefore, before taking benzodiazepines, expectant or currently pregnant patients should consult their healthcare providers. Benzodiazepines are also not recommended for use by nursing mothers.

Both Ativan and Xanax carry a significant potential for abuse and physical dependence and, thus, are only recommended for short-term use. In comparison, Ativan has a lower risk for abuse and addiction than Xanax. This is because Ativan has a more prolonged effect and slower elimination rate than Xanax. Nevertheless, both prescription drugs should be used cautiously under the guidance of a healthcare professional.

People with a dependence on benzodiazepines may experience various symptoms of withdrawal when quitting them abruptly, including:

• Anxiety
• Panic attacks
• Nausea
• Vomiting
• Diarrhea
• Hallucinations
• Insomnia
• Muscle twitches
• Tingling in the arms and legs
• Cognitive deficits
• Mood swings
• Drug cravings

The intensity of withdrawal symptoms depends on the kind of benzodiazepine, the duration of treatment, the daily dose, underlying medical conditions, and the use of other substances, including alcohol. However, a person taking Ativan or Xanax for a month or longer should never abruptly stop taking medicine. Instead, patients should collaborate with their healthcare provider to gradually taper off the medicine. Seizures, psychosis, and confusion are some of the more severe benzodiazepine withdrawal symptoms.

To recover from an Ativan or Xanax addiction, you must first learn to deal with anxiety and challenging situations without using the medication. Long-term recovery from benzodiazepine addiction generally involves detoxification and continued treatment at an inpatient rehabilitation facility. Patients with milder Xanax or Ativan addiction may receive treatment at an outpatient rehabilitation facility. Recovery is possible with the right treatment and support.

It is possible to overdose on lorazepam; however, it is unlikely to be fatal. Patients are at greater risk of overdosing on Ativan when they combine their medication with alcohol or opioids. Generally speaking, toxic doses of lorazepam are not the cause of a lethal overdose. Life-threatening symptoms can develop from a non-fatal overdose if the person doesn’t get help fast enough. Respiratory depression is one of the most common and potentially fatal symptoms.

If you take too much Xanax or combine it with another central nervous system (CNS) depressants, such as opioids or alcohol, an overdose may arise. A Xanax overdose can be lethal, so seek immediate medical attention if you suspect someone is experiencing one.

Common signs of an overdose may include:

• Drowsiness
• Impaired coordination
• Cognitive impairment
• Slowed reflexes
• Agitation and irritability
• Slurred speech
• Mental confusion
• Muscle weakness
• Low blood pressure
• Slowed breathing
• Slow heart rate

The signs of an overdose should never be disregarded. Seek immediate medical attention if you or someone you know exhibits any of these symptoms.

Ativan and Xanax can negatively interact with other central nervous system depressants such as alcohol, barbiturates, opioids, and tricyclic antidepressants. Taking them together can increase the risk of dangerous side effects, overdose, or even death. Ativan and Xanax can also interact with several other drugs. Hence, it is best to have a medical professional review all current medications before starting the anti-anxiety medications.

Both medicines have the same amount of active ingredient, but the timing of their effects and duration of action necessitates different dosages. According to Benzodiazepine equivalency tables, half a milligram of Xanax is comparable to one milligram of Ativan. But one is not considered to be stronger than the other. Ativan acts slower and takes longer to leave the body than Xanax. Ativan’s peak concentration after an oral dose occurs around two hours after administration, while Xanax’s peak concentration occurs between one and two hours after dosing.

Trials that directly compared Ativan and Xanax to treat anxiety disorders showed no significant differences in their effect. Both medications work equally well to treat the emotional and physical symptoms of anxiety and panic disorders. However, their risk of dependence and addiction means they are not a first-line treatment for either condition.

Despite the difference between Ativan and Xanax, both medications are equally utilized to treat anxiety and panic disorders and improve a patient’s quality of life. Your healthcare practitioner will determine the right medication out of the two after thoroughly evaluating your condition and medical history.