Klonopin vs. Xanax - Differences and Similarities

Klonopin and Xanax are two prescription medications approved by the FDA for the short-term relief of anxiety and panic disorders. They are also the two most prescribed benzodiazepines on the market today. Although both prescription drugs share a few similarities, they have structural differences that set them apart. This article aims to provide a head-to-head comparison of Klonopin and Xanax to help you determine which one is the best for you.

Klonopin and Xanax are benzodiazepine medications that enhance the effects of gamma-aminobutyric acid (GABA), an important chemical messenger in your brain. These types of medications slow down nerve impulses throughout your body, resulting in a calming effect.

According to the U.S. Food and Drug Administration (FDA), Klonopin, the brand name for clonazepam, is an anxiolytic and anticonvulsant used for the acute management of panic disorder (with or without agoraphobia), epilepsy, and non-convulsive status epilepticus. Healthcare providers also use it off-label to treat acute mania, restless leg syndrome, insomnia, and tardive dyskinesia.

Xanax, the brand name for alprazolam, is approved by the Food and Drug Administration to treat generalized anxiety disorder (GAD) and panic disorder with or without agoraphobia. Healthcare providers also use it off-label to treat insomnia and alcohol withdrawal symptoms. Xanax is a short-acting benzodiazepine with antianxiety and anxiolytic properties.

Klonopin and Xanax are Schedule IV controlled substances with the potential to cause addiction and dependence, hence should only be used as a short-term treatment option. Although both medications work similarly, the structural differences between the two medications can affect your body differently.

The effects of Klonopin and Xanax also manifest at different times in the body. Klonopin is a long-acting benzodiazepine with a half-life of around 30 to 40 hours. It reaches peak concentrations within one to four hours of ingestion, while its effects last up to 12 hours. Hence, it doesn’t have to be dosed as frequently as other short-acting benzodiazepines.

Xanax is a short-acting benzodiazepine with a half-life of about 11.2 hours. It reaches peak levels in the blood within one to two hours of administration, while its effects last up to four to six hours. Hence, Xanax needs frequent administration to keep blood levels constant.

Klonopin is available as both generic and orally disintegrating tablets (wafers) in various strengths:

• Oral tablets – 0.5 mg, 1 mg, and 2 mg
• Orally disintegrating tablets – 1.125 mg, 0.25 mg, 0.5 mg, 1 mg, and 2 mg

A typical starting dose of Klonopin for panic disorder is 0.25 mg, taken twice daily. If the dose is insufficient to treat your symptoms, your healthcare provider may increase your dose every few days up until the maximum recommended daily dose of 4 mg.

In contrast, Xanax is available in many forms and strengths:

• Disintegrating tablets – 0.25 mg, 0.5 mg, 1 mg, and 2 mg
• Immediate-release tablets – 0.25 mg, 0.5 mg, 1 mg, and 2 mg
• Extended-release tablets – 0.5 mg, 1 mg, 2 mg, and 3 mg
• Oral liquid – 1 mg/ml

For generalized anxiety disorder, a typical starting dose of Xanax is 0.25 to 0.5 mg, taken three times per day, while the maximum recommended daily dose is 4 mg (in divided doses). On the other hand, the typical starting dose for panic disorder is 0.5 mg, taken three times per day, while the maximum recommended daily dose is 10 mg.

According to the benzodiazepine equivalency tables, 0.5 mg of clonazepam is equivalent to 0.5 mg of alprazolam. However, people of Asian descent metabolize Xanax differently than other races. And certain diseases such as alcoholism, liver and kidney disease, obesity, and even old age can also affect how Xanax behaves in the body. As such, benzodiazepine equivalency tables should only be used as a guide, as they do not reflect individual variations.

As Klonopin and Xanax fall into the same class of drugs, they cause many of the same adverse side effects. Some of the common side effects include:

• Dizziness
• Drowsiness
• Fatigue
• Loss of coordination
• Inability to concentrate

Severe side effects include:

• Shortness of breath
• Trouble speaking
• Extreme fatigue or dizziness
• Increased heart rate
• Headache
• Memory impairment
• Irritability
• Restlessness
• Severe allergic reaction and facial swelling (this can develop even with the first dose)
• Fainting
• Depression
• Suicidal thoughts and ideation
• Dependence and withdrawal

Sometimes, people taking benzodiazepines for sleep issues may engage in activities, such as eating, making phone calls, or driving, while they are asleep or partially awake. They may also have no memory of the events upon awakening. If you encounter this or any other severe adverse effects of benzodiazepines, seek immediate medical attention.

Klonopin and Xanax both have a potential for abuse and physical dependence and, thus, are only recommended for short-term use. Susceptibility to dependence varies depending on the dosage taken, regularity of consumption, and genetic factors. However, people can form a physical or psychological dependence on benzodiazepines after as few as 14 days of regular use. The risk is even higher in patients with a preexisting substance use disorder.
Individuals dependent on benzodiazepines should seek medical advice to taper off the medications gradually, as quitting them abruptly can trigger dangerous withdrawal symptoms.

Some of the withdrawal symptoms include:

• Anxiety
• Panic attacks
• Blurred vision
• Irritability
• Restlessness
• Depression
• Mood swings
• Hallucinations
• Elevated heart rate
• Headache
• Muscle pain
• Impaired memory
• Insomnia
• Nausea
• Vomiting
• Tremors or shaking

Patients taking large doses of these medications over a prolonged period are likely to experience more severe withdrawal symptoms due to physical and psychological dependence. The severity of withdrawal symptoms depends on the duration of treatment, daily dose, underlying medical conditions, and polysubstance use. However, since Klonopin lasts longer in the body, it is known to cause less severe withdrawal symptoms and rebound effects than Xanax.

Klonopin and Xanax addiction treatment usually entails medical detox, behavioral therapies, and counseling in an inpatient or outpatient setting to stabilize the patient and equip them with the tools and strategies needed to maintain life-long recovery.

As with all benzodiazepines, consuming large quantities of Klonopin or Xanax within a short period or combining it with other central nervous system depressants, such as alcohol or opioids, can increase the risk of a fatal overdose. Seek immediate medical attention if you or someone you know is experiencing the following symptoms of an overdose.

• Drowsiness
• Confusion
• Diminished reflexes
• Impaired coordination
• Loss of consciousness
• Slowed or labored breathing
• Respiratory arrest
• Coma

In cases of overdose, medical professionals will prescribe Flumazenil to counteract the effects of Klonopin or Xanax.

Klonopin and Xanax are primarily metabolized in the liver by the CYP3A4 enzyme. However, certain drugs can inhibit this enzyme and increase blood levels of these benzodiazepines, resulting in increased adverse effects. These CYP3A4 inhibitors include antifungals like ketoconazole and antibiotics like erythromycin.

On the other hand, some drugs can induce this enzyme and speed up the metabolism of Klonopin or Xanax, making them ineffective. These CYP3A4 inducers include anticonvulsant drugs like carbamazepine and phenytoin, among others.

Since Klonopin and Xanax have depressant effects, they can interact with drugs with similar effects, such as opioids and tricyclic antidepressants. Taking Klonopin or Xanax with these medications, especially in large doses, can increase the risk of severe drowsiness, respiratory depression, and death.

Although Klonopin and Xanax effectively treat panic disorders and other mental health disorders, their long-term implications have only been examined in a few studies. Clinical experts recommend periodic assessments of Klonopin’s and Xanax’s’ efficacy, with progressive tapering off if the treatment no longer seems to be helping.

Despite their differences and similarities, both Klonopin and Xanax are equally effective and can improve the quality of life for patients. After a comprehensive evaluation of your condition and medical history, your physician will choose the two medications best for you.