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Updated on December 23, 2021

Ativan vs Xanax

Key Takeaways

  • Ativan (lorazepam) and Xanax (alprazolam) are benzodiazepines used to treat anxiety. 
  • Both drugs are similarly effective in treating anxiety. 
  • Both Ativan and Xanax have an intermediate speed of onset for oral medications.
  • 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’s the Difference Between Ativan and Xanax?

Ativan and Xanax are both benzodiazepines

The two drugs have many similarities, so they are not usually prescribed together. Doctors recognize their differences and select which one to prescribe based on their properties.

Both drugs are used to treat anxiety:

  • Ativan is FDA approved for generalized anxiety disorder and panic disorder
  • Xanax is FDA approved for anxiety disorders and anxiety associated with depression

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

Ativan and Xanax work in the same way. They increase the impact of a chemical messenger called GABA in the brain. The result is a calming effect which lessens anxiety. Both drugs carry the same risk of dependence and misuse and cause similar adverse effects.

The Anxiety and Depression Association of America (ADAA) recommends Ativan or Xanax as a second-line treatment for generalized anxiety disorders.7 This means that 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 both considered first line treatments for generalized anxiety disorder.

Doctors often prefer to prescribe SSRIs and SNRIs as they are effective and have little potential for addiction. On the other hand, people can become dependent on benzodiazepines. They are considered an unsafe treatment for long-term use due to an increased risk of physical dependence. 

Ativan and Xanax have a high potential for misuse. As such, people with a history of drug or alcohol dependency should be careful when taking these drugs.

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 drug 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 2 to 4 weeks of prescription treatment. 

Ativan is very habit-forming. The body can quickly develop tolerance to it. 

Common Side Effects

Common side effects of Ativan include:

  • Drowsiness
  • Confusion
  • Dizziness
  • Headache
  • Nausea or stomach problems
  • Dry mouth
  • Changes in appetite
  • Low blood pressure
  • Blurred vision

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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.

Common Side Effects

Side effects of Xanax can include:

  • Drowsiness
  • Dizziness
  • Dry mouth
  • Memory impairment
  • Low blood pressure
  • Rebound insomnia 
  • Increased risk of mania in those with bipolar disorder

Ativan vs. Xanax: The Main Differences 

Here are the main differences between the two drugs:

Which Works Better for Anxiety? 

Ativan and Xanax are similar in their effectiveness for treating anxiety. However, due to their increased risk for dependence, benzodiazepines are not considered first line treatment for this condition.

Which Has More Side Effects/Risks?

Ativan and Xanax have many of the same side effects due to their similar action on the central nervous system. It is important to remember that they cause drowsiness. 

Both alcohol and driving should be avoided when taking either medication.  

Which is More Addictive? 

Both Ativan and Xanax should be used short-term. Otherwise, there’s risk of addiction and dependence.

The half-life is the amount of time needed for a drug’s concentration to be reduced by half in the body. Generally, benzodiazepines like Ativan and Xanax with a shorter half-life are harder to stop using than those with a longer half-life, such as diazepam. 

Both Xanax and Ativan readily enter brain tissue and psychological dependence is a risk with both medications. More severe withdrawal symptoms can be seen with higher doses and longer duration of treatment.

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Ativan vs. Xanax: Costs & Insurance Coverage 

Generic Ativan 1 mg doses cost $5.66 for 30 tablets. Generic Xanax 0.5 mg doses cost around $4.05 for 30 tablets.

Alternatively, generic Xanax 1 mg extended-release costs approximately $16.81 for 30 tablets.

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

Treatment for Ativan or Xanax Dependence

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

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

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

The following are 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 
  • In extreme cases, coma, seizures, or a fatal overdose

There are no medications 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

The above therapies can help people with addictions recognize and change the thought processes and beliefs that lead to substance use disorder. 

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

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Resources

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  1. Ativan, Drugs, April 2021
  2. Xanax, Drugs, September 2021
  3. Ativan vs Xanax - What is the difference?, Drugs, April 2021
  4. Botte, L et al. “Comparaison clinique entre alprazolam et lorazepam. Une étude polycentrique en double insu” [Clinical comparison between alprazolam and lorazepam. A polycentric study in double blind]. Acta psychiatrica Belgica vol. 81,6 : 595-608.
  5. Cohn, J B, and C S Wilcox. “Long-term comparison of alprazolam, lorazepam and placebo in patients with an anxiety disorder.” Pharmacotherapy vol. 4,2 : 93-8
  6. Ghiasi N, Bhansali RK, Marwaha R. Lorazepam. [Updated 2021 Feb 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. 
  7. SSRIs and Benzodiazepines for General Anxiety Disorders (GAD), Anxiety & Depression Association of America (ADAA), May 2020

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