Ativan vs Xanax

Key Takeaways

• Ativan (lorazepam) and Xanax (alprazolam) are benzodiazepines used to treat anxiety 
• Both drugs are similarly effective in treating anxiety 
• Xanax has a quicker onset (5 to 10 minutes) but a shorter duration of effects (4 to 6 hours) vs. Ativan (15 to 30-minute onset and 8-hour duration)
• Both drugs are equally habit-forming and should usually be taken short-term
• Treatment for Xanax and Ativan addiction is usually similar; options include talk therapies and support groups

What are the Similarities and Differences Between Ativan and Xanax?

Ativan and Xanax are more similar than they are different. However, it’s important to know what sets them apart before taking either medication.

Differences Between Ativan and Xanax

Ativan and Xanax are more similar than they are different. 

A few differences include:

Onset, Peak, and Duration

Once taken, Xanax usually kicks in between five and ten minutes.² Ativan’s onset, on the other hand, takes between 15 and 30 minutes.¹

Ativan’s effects usually peak within 2 and 6 hours after being swallowed.¹ Xanax’s peak is around one to two hours after consumption.²

On average, Ativan lasts longer than Xanax. Ativan can last up to 8 hours, whereas Xanax lasts an average of about four to six hours.²

Pricing

Costs vary depending on pharmacy and insurance coverage. The cost for generic Ativan is similar to generic Xanax.

Most Medicare and insurance plans cover generic Xanax and Ativan. The final cost depends on a person’s insurance coverage.

Side Effects

A few side effects of Xanax differ from the side effects of Ativan. Some report that Xanax increases the risk of mania in those with bipolar disorder.

Similarities Between Ativan and Xanax

Both drugs have many similarities and are not usually prescribed together. Doctors recognize their differences and select which one to prescribe based on their properties and your needs.

They’re Both Benzodiazepines

Ativan and Xanax are both benzodiazepines. Benzodiazepines are a class of psychoactive drugs that are considered depressants.

Depressants decrease brain activity. They are often prescribed for insomnia, anxiety, and seizures.

They Both Treat Anxiety 

Ativan is FDA approved and often prescribed for generalized anxiety disorder and panic disorder

Xanax is FDA-approved and often prescribed for anxiety disorders and anxiety associated with depression

Your prescriber may use these medications to treat other conditions not listed above.

They Affect the Brain Similarly

Ativan and Xanax work in the same way. They increase the impact of a chemical messenger called gamma-aminobutyric acid (GABA) in the brain. 

The result is a calming effect, which lessens anxiety, muscle tension, seizures, and can induce sleep. 

There are no significant differences in their effectiveness for anxiety relief.

They Are Both Used as Second-Line Treatments for Anxiety

The Anxiety and Depression Association of America (ADAA) recommends Ativan or Xanax as a second-line treatment for generalized anxiety disorders.³ Health professionals may use one of these medications when first-line treatments aren’t suitable or effective.

Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are considered first-line treatments for generalized anxiety disorder (GAD).

They Carry the Same Risk of Dependence

Unfortunately, benzodiazepines, like Ativan and Xanax, are highly addictive. As a result, healthcare providers often prefer to prescribe SSRIs and SNRIs as they are effective and have little potential for addiction. 

Benzodiazepines are considered an unsafe treatment for long-term use due to the risk of physical dependence. 

Ativan and Xanax carry the same risk of dependence and misuse and cause similar adverse effects. 

They Have Most of the Same Side Effects

Ativan and Xanax have many of the same side effects due to their similar action on the central nervous system (CNS). 

Side effects of both Ativan and Xanax include:

• Drowsiness
• Dizziness
• Dry Mouth
• Low blood pressure
• Headache
• Blurred Vision
• Changes in appetite
• Insomnia
• Muscle weakness
• Memory loss

It is important to remember that they cause drowsiness. Therefore, both alcohol and driving should be avoided when taking either medication.  

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What is Ativan?

Ativan is the brand name for the generic drug lorazepam. As an oral medication, it is typically used to manage generalized anxiety and anxiety associated with depression. 

The injectable version of Ativan may also be used for:

• Long-lasting seizures (status epilepticus) 
• Preanesthetic medication

Ativan is usually intended for short-term use. It’s not recommended that someone continues using Ativan after two to four weeks of prescription treatment. 

Ativan is very habit-forming. The body can quickly develop tolerance and dependence on it. 

What is Xanax? 

Xanax is the most well-known brand name for alprazolam. It is an oral medication and is used to manage anxiety disorders, including:

• Generalized anxiety disorder (GAD)
• Anxiety with depression
• Panic disorders

Xanax shouldn’t be used for more than two weeks. Like Ativan, it’s very habit-forming.

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Signs and Symptoms of Ativan or Xanax Dependence

Signs of Ativan and Xanax dependence usually begin after stopping the medication. 

The following are some common signs and symptoms of Ativan and Xanax misuse:

• Delirium 
• Slurred speech 
• Impaired coordination
• Weakness
• Missing school or work 
• Isolation
• No longer engaging in former activities 
• Suicide
• In extreme cases, coma, seizures, or a fatal overdose

The following are some common signs and symptoms of Ativan and Xanax withdrawal:

• Tremors
• Stomach cramps 
• Muscle cramps
• Insomnia
• Vomiting
• Sweating
• Seizures

Treatment for Ativan or Xanax Addiction

No medications are approved by the U.S. Food and Drug Administration (FDA) to treat addiction to drugs like Ativan or Xanax. However, other therapies can help.

Treatment for Xanax and Ativan addiction is usually the same and can include:

• Cognitive-behavioral therapy (CBT)
• Motivational enhancement therapy
• Contingency management 
• Twelve-step support groups

Therapy can help people with addictions recover from substance use disorders. 

Twelve-step programs can also reinforce those lessons and sustain recovery.

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