Their inclusion does not guarantee they will be prescribed to any individual, as treatment decisions are ultimately at the discretion of healthcare providers. Healthcare providers may prescribe other medications or recommend non-pharmacological treatment based on the patient’s unique health circumstances and needs. Read more
Highlights
- Although both Xanax (alprazolam) and Ativan (lorazepam) are benzodiazepines, they are unique medications and last for different amounts of time in the body.
- Both medications are intended for short-term use. Using either medication long-term has a risk of physical dependence and an increased risk of withdrawal symptoms.
- There are many considerations to choose between Xanax and Ativan, including your specific symptoms, age, and other existing medical conditions.
Xanax and Ativan are often considered for short-term treatment of anxiety. They both cause you to feel relaxed by working on certain neurotransmitters in the brain. This guide comparing Xanax and Ativan will help you understand the similarities and differences between the two medications.
What Are Ativan and Xanax?
Ativan (lorazepam) and Xanax (alprazolam) are prescription medications known as
When to Use Ativan or Xanax
Ativan is FDA-approved for generalized anxiety disorder (GAD) and short-term treatment of anxiety-induced insomnia. It is also used in hospitals to reduce pre-surgery anxiety and to induce sedation.
Xanax is FDA-approved to treat panic disorder and other anxiety disorders and may be prescribed off-label for insomnia. It is often chosen for its relatively rapid onset of action, which allows it to work quickly to treat anxiety symptoms.
When comparing Ativan vs Xanax, or lorazepam vs alprazolam as generics, healthcare providers often will consider the type of anxiety you have. Ativan is often preferred for treating generalized anxiety disorder (GAD) as it lasts a little longer in the body.
Since Xanax tends to work more quickly than Ativan, it’s often used when the treatment of acute symptoms is needed, such as in panic disorder. However, the specific choice of using either medication depends on a number of factors and should be determined by working with your healthcare provider.
Ativan | Xanax | |
Generic name | Lorazepam | Alprazolam |
Drug class | Benzodiazepine | Benzodiazepine |
Potential Uses | Generalized anxiety disorder (GAD), anxiety-induced insomnia | Panic disorder and other anxiety disorders |
Common Side effects | Drowsiness and fatigue, dizziness, loss of coordination, nausea and constipation, changes in appetite | Drowsiness and fatigue, dizziness, lack of coordination, gastrointestinal issues |
Ativan vs Xanax Dosage
The dosage of Ativan or Xanax may differ based on the particular condition being treated, the severity of symptoms, health history, and individual response to treatment. The starting dose for Ativan is often 0.5 mg, and 0.25 mg for Xanax. However, note that dosages may vary based on the individual. It’s important to follow your healthcare provider’s instructions on how to take Ativan or Xanax.
Both Ativan and Xanax should only be used short-term. Taking them long-term can increase your risk of dependency or withdrawal symptoms. Additionally, they might interact with other medications, so it’s important to tell your healthcare provider about all medicines and supplements you are taking.
Xanax vs Ativan: Key Differences
Though both Ativan and Xanax are benzodiazepines, they have significant differences in their onset of action, duration of effect, and potential uses.
Onset and Duration of Action
One of the main differences between Ativan and Xanax is how fast they start to work in the body and their duration of action, or how long they continue working.
Xanax starts working faster than Ativan. It typically starts to work within minutes of taking the dose, which makes it a suitable choice for acute anxiety and panic attacks. The effects of Xanax usually wear off within 1-2 hours. The timeline is approximate; never increase the prescribed dosage if you don’t see the effects right away.
Ativan usually starts to work between 15 and 30 minutes after taking the dose, and the effects can last a little longer, for up to 4 to 6 hours. The extended effects of Ativan may make it a suitable choice for addressing some long-lasting symptoms of anxiety.
Uses
Both Xanax and Ativan work as treatments for anxiety. Xanax may be chosen for symptoms that need a quicker solution, while Ativan may be used when there are symptoms that need a treatment that lasts longer.
Half-life of Xanax vs Ativan
The half-life measures how long it takes for half of a medication to be excreted from your body. This directly relates to how long any medication lasts in your body (the duration of action). The half-life of Xanax is from 11 to 16 hours. In contrast, Ativan has a somewhat longer half-life of 12 to 20 hours. This means that Ativan will last longer in the body.
Xanax vs Ativan: Similarities
Xanax and Ativan are very similar medications and are both used for anxiety and panic disorders. Keep reading to learn about the similarities of these medications in further detail.
Drug Class
Both Xanax and Ativan are benzodiazepines and work by enhancing the effects of gamma-aminobutyric acid (GABA) in the brain.
Uses
Xanax and Ativan are both used to treat anxiety and panic disorders. Xanax is also sometimes used off-label to treat insomnia. Both medications are only intended to be used short-term since using them long-term can increase the risk of dependence and withdrawal effects.
Common Side Effects
All medications, including Xanax and Ativan, can cause side effects. It’s important to tell your healthcare provider about any side effects you experience. Common side effects of both Xanax and Ativan include:
- Drowsiness or fatigue
- Dizziness
- Impaired or loss of coordination
- Nausea or vomiting
- Changes in appetite
Serious side effects can also include confusion, changes in mood, difficulty speaking, or disorientation.
These are not comprehensive lists of side effects. Be sure to chat with your prescriber about what side effects to expect or to watch for with any new medication.
Sedative Effect
Ativan and Xanax can both cause sedation or drowsiness. They can also both impact coordination. It’s important not to drive or operate heavy machinery until you know how either medication impacts you.
Drug Interactions
Xanax and Ativan have overlapping drug reactions since they are both benzodiazepines. It’s important to tell your provider about every over-the-counter or prescription medication, herbs, or supplements you take. Many interactions with benzodiazepines can be dangerous and possibly even life-threatening. Examples of these dangerous interactions include:
Opioids[5] (pain medications)- Alcohol and other
CNS depressants[6] Sedating[7] medicationsAntipsychotics[8] - Antifungal medications
- Antidepressants
Precautions and Warnings
Xanax and Ativan may not be safe for certain people to take. This is not a comprehensive list but certain precautions and warnings include:
- Dependency and Addiction. Long-term use of Ativan or Xanax can result in physical and psychological dependence or addiction. Abrupt discontinuation of these medications may also cause withdrawal symptoms like agitation, sleep disturbances, and, in extreme situations, seizures.
- Respiratory or Breathing Problems. Xanax and Ativan can both cause respiratory depression and should be administered cautiously to patients with respiratory disorders, such as chronic obstructive pulmonary disease (COPD), asthma, or those who take medications with similar risk of respiratory depression.
- Liver Problems: Ativan is usually preferred over Xanax when someone has liver problems.
- Pregnancy and Breastfeeding: It is recommended to avoid using any benzodiazepines, including Ativan and Xanax, during pregnancy or breastfeeding. This is because the medications can be passed along to an infant and cause dangerous side effects like sedation, respiratory depression, or withdrawal in the infant.
- Older Adults: Lower doses are usually used in older adults since there is a much higher risk of confusion, memory loss, and dangerous falls in this population.*
*Ativan is usually preferred for older adults, since they commonly have decreased liver function. Ativan is metabolized differently from Xanax and is not metabolized as heavily in the liver, which may make it a better choice.
Ativan vs Xanax: Which Medication Is More Effective for the Treatment of Anxiety?
Both medications can be highly effective treatments for anxiety. Choosing a specific medication is a very individual decision and depends on a number of factors. These can include the type of anxiety, the severity of symptoms, medical history, and how someone responds to the medication.
Xanax tends to act faster and has a shorter duration of action, which may make it a better choice for acute or sudden episodes of anxiety and panic attacks. However, since it has a shorter duration of action, it may require more frequent dosing.
Ativan has a slightly longer onset but a longer duration of action. This means that it might be a better choice for managing persistent anxiety. Its longer half-life also means it may require less frequent dosing, which can be more convenient for some individuals. It is also often more effective in older adults since it can be used in people with certain liver issues.
Both Ativan and Xanax should only be used short-term. Taking them long-term can increase your risk of dependency or withdrawal symptoms. Additionally, they might interact with other medications, so it’s important to tell your healthcare provider about all medicines and supplements you are taking.
You should also discuss your long-term treatment approach with your healthcare provider. Benzodiazepines are usually only intended to be used for short-term treatment of anxiety. For long-term treatment, healthcare providers often recommend non-benzodiazepine options. These can include:
- Selective serotonin reuptake inhibitors (SSRIs), such as Zoloft (sertraline)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Effexor XR (venlafaxine)
These types of medications can be helpful in the long term and do not have a risk of physical dependence and withdrawal. Cognitive-behavioral therapy (CBT) is also usually recommended to help identify the cause of anxiety symptoms and build a self-support system.
In Conclusion
When considering the choice of Xanax versus Ativan, multiple factors may be considered to make the choice. These can include the available strengths of the medications, differences in how quickly they take to act or how long they last, and health history.
Your healthcare provider will help to determine the right treatment for you. Book your video visit with a licensed healthcare professional to get your symptoms assessed and receive a personalized treatment plan for anxiety online.
FAQ
What is 1 mg of Ativan equivalent to Xanax?
Converting an Ativan dosage to Xanax is not very clear. Roughly, 1 mg of Ativan would be converted to a 0.5 mg dose of Xanax, but this can vary for different individuals. Note that it’s important to stick to the medical provider’s instructions and take the prescribed medication. The change is possible only after a consultation with a healthcare professional.
Is Ativan stronger than Xanax?
Both medications are effective for treating anxiety. Generally, Xanax needs smaller dosages than Ativan to achieve effects, but this can vary from person to person, and neither medication is considered stronger than the other.
Does Xanax or Ativan make you more sleepy?
Both Xanax (alprazolam) and Ativan (lorazepam) are benzodiazepines and can make you feel sleepy. Ativan is used more commonly for inducing sleep or reducing anxiety since it’s FDA-approved for insomnia treatment. However, Xanax can be prescribed for insomnia off-label, too.
Can I use Ativan or Xanax while pregnant?
Neither medication is recommended for use while pregnant. All benzodiazepines should be avoided while a patient is pregnant or breastfeeding. This is because they can cause dangerous side effects for the infant. If you’re pregnant or planning to become pregnant, you should discuss your anxiety treatment options with your healthcare provider.
If you’re currently using Ativan or Xanax and become pregnant, contact your healthcare provider immediately. Don’t stop taking your medication until you consult with them so they can ensure you stop taking the medication safely to avoid withdrawal symptoms.
Can I use Ativan or Xanax with alcohol?
No, you should not combine Ativan or Xanax with alcohol. Both are benzodiazepines, which can be dangerous to take with alcohol. Both benzodiazepines and alcohol can cause respiratory depression and combining Ativan or Xanax with alcohol can intensify these effects and potentially result in severe and even life-threatening side effects, including:
- Increased drowsiness, dizziness, and risk of falling or accidents
- Severe confusion
- Slowed or difficulty breathing
Can I go from Xanax to Ativan?
It’s possible to transition from Xanax to Ativan, but you should work with your healthcare provider to ensure this transition is safe and effective.
Which is longer-acting: lorazepam or alprazolam?
Lorazepam has a longer half-life and is usually longer-acting compared to alprazolam.
Can You Take Xanax and Ativan Together?
No, you cannot take Xanax and Ativan together. The medications work on the same receptors (GABA) in the brain, and taking them together can increase the risk of dangerous and even life-threatening side effects.
