*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Ativan (lorazepam) and Xanax (alprazolam) are medications used for anxiety and panic disorders. These medications are in the benzodiazepine class. Ativan is used to treat anxiety and tension while Xanax is used to treat anxiety and panic attacks. Ativan has a longer-lasting effect on the body compared to Xanax, making it more convenient as a once-daily dose. However, Xanax acts quickly and can have soothing effects in as few as 30 minutes for many people.
If you’re considering a prescription Ativan or Xanax, you may have some difficulty finding a doctor to provide an assessment and prescription online. Talkiatry is one of the few online psychiatry platforms that can and will prescribe benzodiazepines, like Ativan and Xanax, which are controlled substances. They can connect you with a provider quickly and offer assessments and prescription consultation.
Boxed Warning: Lorazepam (Ativan) – Risk of medication misuse or abuse
Lorazepam, the active ingredient in Ativan, has black box warnings. These are the most serious types of warnings from the Food and Drug Administration (FDA).
– Taking lorazepam, a benzodiazepine, with other opioid medications increases your risk for serious side effects that include severe sedation, slower breathing, coma, and death. Lorazepam should not be taken with an opioid unless there are no other options.
– Taking lorazepam can lead to misuse (abuse) and addiction of the medication, which can increase your risk of overdose and death.
– Using lorazepam can lead to physical dependence and this risk increases the longer you take lorazepam. If you suddenly stop taking lorazepam, you can expereince withdrawal. Withdrawal can be life threatening. Lorazepam should only be discontinued by gradual tapering of the dose.
Ativan is a controlled substance, which means that it’s more likely to be misused or cause dependence. There are federal and state laws that limit the amount of medication that can be prescribed or dispensed within a certain period of time.
Boxed Warning: Risks of Alprazolam (Xanax) include misuse, addiction, withdrawal and even death
Alprazolam, the active ingredient in Xanax, has a black box warning. These are the most serious types of warnings from the Food and Drug Administration (FDA).
- Taking Xanax, a benzodiazepine, with other opioid medications increases your risk for serious side effects that include severe sedation, slower breathing, coma, and death. Xanax should not be taken with an opioid unless there are no other options.
- Taking Xanax can lead to misuse (abuse) and addiction of the medication, which can increase your risk of overdose and death.
- Using Xanax can lead to physical dependence and this risk increases the longer you take Xanax. If you suddenly stop taking Xanax, you can experience withdrawal. Withdrawal can be life threatening. Xanax should only be discontinued by gradual tapering of the dose.
Xanax is a controlled substance, which means that it’s more likely to be misused or cause dependence. There are federal and state laws that limit the amount of medication that can be prescribed or dispensed within a certain period of time.
How Are Ativan & Xanax Similar?
Ativan tablets are FDA-approved for the treatment of anxiety and tension while Xanax tablets are FDA-approved to treat generalized anxiety disorder (GAD) and panic disorder with or without a fear of places and situations that might cause panic, helplessness, or embarrassment (agoraphobia). Ativan also comes as an injectable form that will not be covered in this article and Xanax also comes in an extended-release formulation called Xanax XR.
Ativan and Xanax belong to a group of psychoactive drugs called benzodiazepines. They are regarded as depressants as they produce a relaxing and calming effect by slowing down brain activity and promoting sleep if taken at bedtime. Both are treatments for anxiety and have similar effects on the brain. However, due to the dangers of physical dependence, misuse, and related adverse effects, both are addictive and not recommended for long-term therapy. Primary care physicians, nurse practitioners, or psychiatrists can prescribe these drugs in their practice.1
Similarities between Ativan & Xanax include that they:
- Belong to the benzodiazepine drug class.
- Have FDA-approved and off-label uses.
- Work the same way and enhance the effects of gamma-aminobutyric acid (GABA), a chemical messenger in the brain.
- Have the same potential for misuse, dependence, and negative consequences.
- Typically take one to two hours to fully take action.
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Key Differences Between Ativan & Xanax
The key differences between Ativan and Xanax are their onset of action and total duration of effect after individuals consumed them. Ativan stays for a longer period in the body for a soothing effect. However, it takes more time for the effect to kick in, compared to Xanax. When ingested orally, Xanax reaches its peak concentration in 1 to 2 hours, whereas Ativan takes at least 2 hours. Therefore, people may require more frequent doses of Xanax than Ativan. They are medications for anxiety but are not substitutes for each other.
Conditions Treated
Ativan and Xanax are FDA-approved medications to treat anxiety disorders. Xanax is also FDA-approved to treat panic disorders with or without agoraphobia (extreme fear of open or crowded places).2
When a drug is approved by the FDA, it means that it has met federal quality standards and is both safe and effective for its intended use, with its benefits outweighing any potential risks. An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Ativan is used as an off-label treatment for numerous conditions, ranging from vertigo and panic disorders to alcohol withdrawal and cocaine-associated heart conditions, In contrast, off-label uses of Xanax are more limited and include sleep deprivation, premenstrual syndrome, and depression.3
Standard Dosages & Forms
Ativan is available as a tablet in the following strengths: 0.5 mg, 1 mg, and 2 mg. The maximum daily Ativan dose should not exceed 10 mg.3
Xanax is available in regular and extended-release tablets known as Xanax XR. Xanax dosage is available in the following strengths: 0.25 mg, 0.5 mg, 1 mg, and 2 mg while Xanax XR is available in the following strengths: 0.5 mg, 1 mg, 2 mg, and 3 mg. The dose may be adjusted every 3 to 4 days, and the maximum daily recommended dosage is 4 mg.
Xanax and Ativan are equally effective, but Xanax works faster. Take with food if you have an upset stomach. Keep tablets in their original container. Don’t chew, crush, or divide any of the tablets, as this can alter the drug effect.
Side Effects
The side effects of Ativan and Xanax are mostly the same and can be more severe with higher doses. Ativan can cause sedation, dizziness, weakness, and unsteadiness, while Xanax may cause drowsiness, low blood pressure, tiredness, insomnia, memory problems, poor balance or coordination, slurred speech, and changes in libido.
This is not a comprehensive list of possible mild or serious side effects. Consult your prescriber and pharmacist to discuss possible side effects of Ativan or Xanax. Additionally, avoid operating heavy machinery or driving while taking these medications due to potential alert impairment.
The table below summarizes the key differences between Ativan versus Xanax tablets:
Key Components | Ativan | Xanax |
---|---|---|
What is the generic name? | Lorazepam | Alprazolam |
What forms does it come in? | Tablet | Tablet and Extended-release tablet |
What are the available strengths? | Tablets: 0.5 mg, 1 mg, 2 mg | Tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg Extended-release Tablets: 0.5 mg, 1 mg, 2 mg, 3 mg |
Who is approved to take it? | Children 12 years of age and older and Adults | Adults |
Drug uses | Anxiety, Tension | Anxiety, Panic disorders |
Dose adjustment | Yes, for certain people | Yes, for certain people |
What Is Ativan?
Ativan is a medication used to manage anxiety and tension in both adults and children aged 12 years and older. It comes as an immediate-release tablet and doctors may prescribe it off-label for other conditions such as restlessness, alcohol withdrawal, cancer-related nausea and vomiting, and vertigo, even though it is not specifically approved for these uses.
Ativan works by enhancing the effects of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter. It helps to decrease brain activity by blocking the transmission of messages between nerve cells, producing a depressive effect on the central nervous system (CNS).
What Is Xanax?
Xanax (alprazolam) is used to treat anxiety and panic disorders.5 It comes as a tablet or as an extended-release tablet. Prescribers may also recommend it for some off-label conditions, including sleep difficulty, premenstrual symptoms, and depression. It has the potential to be misused for recreational purposes due to its disinhibition, excitement, and anxiolytic effects.
When taken by mouth, Xanax is rapidly absorbed into the bloodstream, creating a calming and relaxing effect. It also enhances the effect of the neurotransmitter GABA, which calms and decreases brain activity.
Online Psychiatry
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What Are Ativan & Xanax Used to Treat?
Ativan and Xanax are minor sedatives to treat anxiety They may also treat symptoms of some similar physical and mental health conditions off-label like alcohol withdrawal and premenstrual syndrome, nausea, and vomiting associated with treatment for cancer. Both drugs are intended for short-term use. Unlike Xanax, Ativan can be prescribed to certain children ages 12 and older.
When a drug is FDA-approved, it indicates that the drug has been considered safe and effective by federal quality standards. Its benefits outweigh any potential risks for its intended use. However, healthcare providers may use their professional judgment to determine if a drug could be beneficial for someone outside of its intended use, which is known as off-label or non-FDA-approved use.
The table below compares the medical and mental health conditions Ativan and Xanax tablets are used to treat:
Condition | Ativan | Xanax |
---|---|---|
Anxiety | FDA-approved | FDA-approved |
Panic disorder with or without agoraphobia | Off-label | FDA-approved |
Anxiety associated sleep problems | Off-label | Off-label |
Anesthesia premedication | Off-label for tablets, FDA-approved for Ativan injection | No |
Seizures | Off-label for tablets, FDA-approved for Ativan injection | No |
Tranquilization for agitation | Off-label | No |
Alcohol withdrawal syndrome | Off-label | No |
Insomnia | Off-label | Off-label |
Delirium | Off-label | No |
Chemotherapy-associated nausea and vomiting | Off-label | No |
Psychogenic catatonia | Off-label | No |
Vertigo | Off-label | No |
Premenstrual syndrome | No | Off-label |
Depression | No | Off-label |
Side Effects of Ativan & Xanax
Ativan and Xanax share the majority of the same side effects due to their similar action on the brain. These side effects are dose-dependent, the higher the dose the more serious the side effects. Common side effects of Ativan and Xanax are dizziness, drowsiness, weakness, and unsteadiness.
There are several similar side effects between Ativan and Xanax, including sedation, dizziness, weakness, and unsteadiness. These side effects are not very frequent and are typically mild. However, some may require medical attention.
The table below compares the possible side effects of Ativan and Xanax:6
Side Effects | Ativan | Xanax |
---|---|---|
Nausea | Yes | Yes |
Constipation | Yes | Yes |
Increased salivation | No | Yes |
Appetite changes | Yes | Yes |
Appetite Changes | Yes | Yes |
Weight gain | No | Yes |
Weight loss | No | Yes |
Drowsiness | Yes | Yes |
Dizziness | Yes | Yes |
Weakness, Fatigue and Tiredness | Yes | Yes |
Unsteadiness (Impaired Coordination) | Yes | Yes |
Hypotension | Yes | Yes |
Respiratory failure | Yes | Yes |
Headache | Yes | Yes |
Hypothermia | Yes | No |
Light-headedness | Yes | Yes |
Restlessness (Irritability) | Yes | Yes |
Dermatitis/allergy | Yes | Yes |
Dry mouth | No | Yes |
Memory Impairment | Yes | Yes |
Cognitive Disorder | Yes | Yes |
Libido Changes | Yes | Yes |
Confusional state | Yes | Yes |
Menstrual disorders | No | Yes |
Disinhibition | No | Yes |
Talkativeness and Derealization | No | Yes |
Incontinence | No | Yes |
Severe Side Effects & Allergic Reactions With Ativan & Xanax
Ativan and Xanax may cause serious side effects such as trouble speaking, vision changes, and memory problems. Allergic reactions may include skin rash, itching, and swelling of the face, lips, tongue, or throat. Seek medical attention immediately if you experience shallow breathing, severe drowsiness, or difficulty waking up. Report any side effects to the FDA at 1-800-FDA-1088.
Severe side effects that may occur from taking Atvian or Xanax are similar and include:
- Excessive drowsiness
- Respiratory failure
- Suicidality or increased depression
- Syncope or a missed heartbeat
- Jaundice
- Seizures
- Excessive restlessness
- Confusion
- Trouble staying awake
- Severe skin rash
Warnings & Precautions for Ativan & Xanax
Using anti-anxiety medications at the same time as opioids may result in profound sedation, slowed breathing, coma, and in some cases, death. Risks of dependence and withdrawal increase with extended treatment and higher daily doses. An injection may be used for as-needed treatment. But if used more frequently than recommended, suddenly stopping or reducing the dosage may lead to withdrawal symptoms which may include life-threatening seizures.
Risks to consider when taking Ativan and Xanax include:
- Interactions with alcohol: Alcohol may interfere with the effects of these medications as this combination may lead to respiratory depression, extreme sedation, coma, or even death.
- Use while pregnant or breastfeeding: Safety of using either Ativan or Xanax while pregnant or breastfeeding is not established. Both drugs have the potential to cross the placenta and potentially contribute to low birth weight and premature birth. Due to these risks, they are not advised for use during pregnancy.
- Benzodiazepine withdrawal: Risks of benzodiazepine withdrawal increase with extended treatment, higher daily dose, or use more frequently than recommended. Suddenly reducing how much you take or stopping abruptly may lead to symptoms such as seizures, depression, hallucinations, and suicidality, which can be life-threatening. Gradual tapering is safe when discontinuing therapy to reduce withdrawal reaction risk.
- Use in older adults: These drugs may reduce cognition, mobility, and driving skills in older people; and also increases the risk of falls and automobile accidents. Dose reduction is recommended in the geriatric population due to increased sensitivity, and decreased metabolism and elimination.
- Hepatic disease: Lorazepam may worsen hepatic encephalopathy; therefore, lower doses may be sufficient in such patients.
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Potential Drug Interactions With Ativan & Xanax
Ativan and Xanax may potentially interact with other sedatives, hypnotics, opioids, cough and cold medicines, antiepileptics, muscle relaxers, and alcohol resulting in increased respiratory depression via a synergistic effect.
Therefore, concomitant use of benzodiazepines with people under the influence of the preceding drugs should be carefully performed, with respiratory monitoring in place.
Disclaimer: Taking certain medications, herbs, or supplements alongside Ativan and Xanax can change how these medications work in your body or increase the risk for serious side effects. This article does not consider all the possible interactions. Please let your doctor, psychiatrists, and pharmacists know about all the products you currently use, such as prescription medication, nonprescription drugs, and herbal supplements. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.
Medications and substances that have harmful interactions with Ativan and Xanax include:
Complicating Interactions | Ativan | Xanax |
---|---|---|
Opioids | X | X |
Other benzodiazepines | X | X |
CNS Depressants | X | X |
Strong Inhibitors of CYP3A | X | X |
Moderate or Weak Inhibitors of CYP3A | X | X |
CYP3A Inducers | X | X |
Ritonavir | X | |
Digoxin | X | X |
Ativan & Xanax: Key Pros & Cons
Ativan and Xanax are fast-acting antianxiety meds. Xanax works quicker, but Ativan lasts longer. They require a prescription, and the cost varies by pharmacy and insurance coverage. Generic versions (lorazepam and alprazolam) have almost the same price, and usually, insurance covers them.
Pros & Cons of Ativan
Ativan can only be prescribed for short-term treatment of anxiety due to the risk of overdose and addiction. Additionally, it is not advisable for everyday tension and stress due to the risk of serious side effects. It may cause memory problems, drowsiness, dizziness, and confusion. It carries the potential for the risk of misuse, addiction, or dependency.
Pros & Cons of Xanax
Xanax is the most commonly prescribed benzodiazepine due to its quick onset and ability to relieve anxiety symptoms and agitation. Within one to two hours, you will experience a sense of peace and relaxation. Panic symptoms like a racing heart, perspiration, or hyperventilation may disappear momentarily.
Once people experience its calming effects, it is difficult to stop Xanax, thereby doctors prescribe it only for a short-term duration due to its habit-forming nature and serious withdrawal reactions upon sudden discontinuation. Xanax is not appropriate for children, breastfeeding mothers, and pregnant woman as it can cross the placenta and harm babies. Overuse of Xanax might affect your emotions and harm your memory over the long run.
Which Is Right for You: Ativan or Xanax?
Ativan and Xanax certainly have some advantages over one another. Xanax is more fast-acting and Ativan stays for a longer duration in the body, and at least a third of people experience withdrawal symptoms after 4 to 6 weeks of continuous use on dose reduction of both drugs. Xanax is only advised for anyone above the age of 18, unlike Ativan, which can be prescribed to treat anxiety in children aged 12 years and older.
There are various factors that determine which medication will work best for an individual’s needs, including current health conditions, medical history, and occupation. A doctor will prescribe the appropriate medication based on these factors. In cases where an in-person visit to a doctor is not feasible, online psychiatry services can be considered. They can provide assistance in weighing the benefits and risks of each medication.
How to Get a Prescription for Ativan & Xanax
Ativan and Xanax can only be prescribed by licensed medical professionals, such as psychiatrists, psychiatric nurse practitioners, or other clinicians, after confirming that your anxiety is related to your physical health. Understanding how to get anxiety medication can help you as you consider treatments.
They may inquire about your mood swings, physical health, family history, and how long you have had symptoms. The type of anxiety medication recommended will depend on your specific anxiety disorder and any other mental or physical health conditions.
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Questions to Ask Your Health Team About Ativan & Xanax
When speaking with your healthcare provider, it is important to inquire about the reasons why they believe the medication they’ve prescribed will benefit you. Additionally, it’s important to discuss any potential side effects or risks that come with taking the medication. Don’t hesitate to ask further questions during your appointment.
Questions to ask your prescriber about Ativan and Xanax include:
- Is it safe to take Ativan or Xanax with my other medications?
- What are some Xanax alternatives to consider?
- Will Ativan or Xanax be covered by my insurance?
- Which one has the best results as a treatment for anxiety?
- Does my medical history increase my risk of side effects for either?
- How long can I expect side effects to last?
- How often should I see you for checkups while taking Ativan or Xanax?
- What should I do if I am unsure whether anti-anxiety medications are right for me?
- Can I drive or keep working while taking my medication?
- How long will my medication need to be taken?
- What if I have any allergy to the medication you prescribed?
- Can I continue smoking and drinking alcohol during the treatment period?
- Is there any specific diet restriction?
- Can I use over-the-counter cold and cough medication?
- What precautions do I consider at home to lower my anxiety symptoms?
- Any online help or educational resources you can recommend?
In My Experience
In my experience, Ativan and Xanax have a range of beneficial and harmful effects. However, they may be prescribed safely in the short term and can be effective treatments in many individuals whose quality of life is significantly affected by anxiety or insomnia. It is important to discuss all your mental and physical health issues with a health professional, who can assess the likely benefits and risks of each course of therapy early on. This will allow doctors, patients, and their caregivers to be prepared should complications arise.
Additionally, people should be aware of the risks of dependence if they continue these drugs over a longer period. A clinical judgment has to be made by a doctor for appropriate alternatives for each individual and for each proposed medication. Joining a self-help group can be helpful because you can talk and share with others who have dealt with the same issues. Stress relief techniques like breathing exercises and meditation can also relieve anxiety. Many resources are available for anxiety and insomnia. Ask your doctor, nurse, case manager, or pharmacist for more advice.
Additional Resources
To help our readers take the next step in their mental health journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy is compensated for marketing by the companies included below.
Online Psychiatry
Circle Medical Anxiety and Depression Treatment. Meet with an online doctor today! All prescriptions are based on necessity determined by a medical professional. Diagnosis and prescription over video. Insurance accepted. No membership or hidden fees. Same day appointments. Visit Circle Medical
Plushcare There are many effective medications for anxiety and depression, including Zoloft and Lexapro, which a Plushcare doctor can prescribe. In as little as 15 minutes, you can speak with a board-certified doctor from PlushCare to receive anxiety or depression treatment. Plushcare DOES NOT prescribe controlled substances. Visit Plushcare
Online Therapy
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For Further Reading
- How Long Does it Take for Anxiety Medication to Work?
- How to Get a Prescribed Xanax: Everything You Need to Know
- Benzodiazepines: Risks and Benefits. A Reconsideration
- Is Xanax Or Ativan Better For Treatment Of Anxiety?
- Ativan (Lorazepam) Side Effects: Common, Severe, Long-Term, & What to Do About Them
- How to Get Ativan Prescribed: Everything You Need to Know
Online Anxiety Test
A few questions from Talkiatry can help you understand your symptoms and give you a recommendation for what to do next.
Best Online Psychiatry Services
Online psychiatry, sometimes called telepsychiatry, platforms offer medication management by phone, video, or secure messaging for a variety of mental health conditions. In some cases, online psychiatry may be more affordable than seeing an in-person provider. Mental health treatment has expanded to include many online psychiatry and therapy services. With so many choices, it can feel overwhelming to find the one that is right for you.