Valium vs. Xanax - Difference Between the Two Benzodiazepines

October 28 , 2022

Many of us experience anxiety and symptoms of nervousness from time to time. For people with anxiety disorders, however, this can be a daily occurrence that can severely impact their ability to function at home, work, or school. According to the Anxiety and Depression Association of America (ADAA), anxiety disorders are the most common mental health issue in the United States, affecting almost 40 million adults aged 18 and over annually.

Medical professionals have been developing many ways to address this mental health disorder, and there are several pharmacological treatments for anxiety. These include benzodiazepines such as Valium and Xanax. Many people think that Xanax and Valium are essentially the same. However, although they share some similarities, many differences set them apart. This article hopes to shed some light on these key differences so people considering these two medications can make sound decisions.

Valium vs. Xanax - What Are They?

Valium (diazepam) is a prescription medication used to treat symptoms of anxiety, muscle spasms, and seizure disorders. It’s also commonly used in hospitals to reduce alcohol withdrawal symptoms, such as sweating and insomnia, and as a sedative before surgery. Valium is a long-acting benzodiazepine with a half-life of around 48 hours. As a result, the medicine will stay in the body for about ten days. Its metabolites, however, may linger for a considerably longer period. It starts working quickly and reaches peak effects within one to two hours of ingestion. Valium is available as tablets, an oral solution, a rectal gel, and an intravenous injection.

Xanax (alprazolam), on the other hand, is a prescription medication approved for treating generalized anxiety disorder (GAD) and panic disorder. It’s also frequently used off-label to treat alcohol withdrawal and insomnia. Like Valium, Xanax starts working quickly and reaches peak concentrations within one to two hours of consumption. However, it has a half-life of roughly 11 hours in healthy adults and, thus, leaves the body within a few days, compared to Valium. Xanax is available as immediate-release tablets, extended-release tablets, orally disintegrating tablets, and oral solutions.

Valium vs. Xanax - How Do They Work?

Benzodiazepines work by amplifying the effects of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter that reduces the activity of nerve cells in the central nervous system (CNS). When amplified, GABA has a calming effect that can help relieve anxiety symptoms, reduce muscle tension, prevent seizures and induce sleep. Benzodiazepines are also known to cause an amnesic effect, making them useful before medical procedures.

Although Valium and Xanax are from the same drug class, they have a few structural differences that affect their ability to induce sleep, alleviate anxiety, prevent seizure disorders, relax muscles, and affect short-term memory. While both are FDA-approved for anxiety relief, Xanax is less likely than Valium to make you sleepy.

How Much Xanax Equals 5mg of Valium?

According to benzodiazepine equivalency tables, 5mg of diazepam is equivalent to 0.25mg of alprazolam. However, people of Asian descent process Xanax differently than other races. And certain diseases such as liver and kidney disease, alcoholism, obesity, and even old age can affect how Xanax acts in the body. Hence, benzodiazepine equivalency tables should only be used as a guide, as they do not show individual variations.

Unfortunately, only a few studies have been conducted to examine the metabolism of diazepam in different ethnic groups. According to the National Center for Biotechnology Information (NCBI), CYP3A4 and CYP2C19 are responsible for most of Diazepam’s metabolism to the primary active metabolite (desmethyldiazepam). And studies indicate that around 15.7% of Asians and 18.5% of African Americans show a slow metabolism rate for the CYP2C19 enzyme.

Side Effects of Valium and Xanax

Valium and Xanax share a similar side effects profile due to their effects on the CNS. Some of the common side effects include:

  • Drowsiness
  • Dizziness
  • Fatigue
  • Impaired coordination
  • Difficulty concentrating

Rare but serious side effects include:

  • Shortness of breath
  • Trouble speaking
  • Extreme dizziness
  • Headache
  • Increased heart rate
  • Extreme fatigue
  • Memory impairment
  • Irritability
  • Changes in sex drive
  • Restlessness
  • Depression
  • Suicidal thoughts and behaviors

This is only a partial list of side effects, and effects may vary from one person to another. Talk to your healthcare provider if the side effects do not improve in a few days or get problematic. Valium and Xanax should only be used short-term due to their high risk of adverse effects and potential for abuse and addiction.

Xanax vs. Valium - Potential for Misuse and Addiction

Despite being developed for medical purposes, benzodiazepines such as Valium and Xanax are widely misused for recreational purposes. According to the National Institute on Drug Abuse (NIDA), around 17.1% of benzodiazepine users misused them, while fewer than 2% had benzodiazepine use disorder.

Most individuals who abuse benzodiazepines do so to experience the euphoric effects that appear when taken in large dosages. However, this may swiftly result in the build-up of tolerance, wherein higher doses of the drug are required to obtain the intended effects, eventually leading to physical dependence. People who use benzodiazepines such as Valium and Xanax exactly as prescribed can also develop a physical dependence on the prescription drug and experience withdrawal symptoms.

Benzodiazepine withdrawal symptoms include:

  • Anxiety
  • Panic attacks
  • Blurred vision
  • Insomnia
  • Irritability
  • Restlessness
  • Headache
  • Nausea and vomiting
  • Muscle aches and pains
  • Changes in blood pressure
  • Hallucinations
  • Impaired memory
  • Rapid heart rate
  • Tremors
  • Depression
  • Seizures

Generally speaking, benzodiazepines with a shorter half-life (such as Xanax) are much more difficult to quit than benzodiazepines with a longer half-life (like Valium). This is mainly because withdrawal symptoms may begin within a few hours of stopping the prescription drug use.

Xanax is also known to cause more severe withdrawal symptoms than Valium. Individuals with a Valium or Xanax addiction typically require medical detox, counseling, and behavioral therapy to recover from their addiction and return to a healthier lifestyle.

Xanax vs. Diazepam - Risk of Overdose

All benzodiazepines have a significant risk of overdose and, thus, should be used with caution. Consuming large doses of either Xanax or Valium within a short period or combining them with other substances such as opioids or alcohol can have serious consequences, including death. In case of an emergency, rush to the nearest emergency room if you or someone you know is showing the following symptoms of an overdose:

  • Extreme drowsiness
  • Confusion
  • Impaired coordination
  • Slow reflexes
  • Loss of consciousness
  • Difficulty breathing or labored breathing
  • Coma

A benzodiazepine overdose is a medical emergency that requires prompt treatment to prevent it from ending fatally.

Drug Interactions of Valium and Xanax

The concomitant use of Valium and Xanax, with opioid drugs, such as hydrocodone and morphine, can cause severe respiratory depression and sedation, leading to coma or even death. Hence, patients should be monitored closely if this combination becomes medically necessary. The CNS depression caused by Valium and Xanax can also be enhanced by other CNS depressants such as alcohol, anticonvulsants, and other psychotropic medications.

Valium and Xanax are both primarily metabolized by the liver. However, some medications can slow down or speed up their metabolism when taken simultaneously. For example, enzyme inhibitors such as fluoxetine, ketoconazole, and omeprazole may increase benzodiazepine levels by slowing their metabolism. At the same time, enzyme inducers such as carbamazepine may reduce benzodiazepine levels by speeding up their metabolism.

Which Medication Is More Effective for Anxiety?

According to clinical trials, alprazolam is equivalent to diazepam in providing relief of anxiety symptoms. In contrast to diazepam, alprazolam’s adverse effects were much less common. Patients who took alprazolam reported drowsiness less often than those who took diazepam.