Klonopin Vs. Ativan: Differences, Similarities, & Which to Take

Key Differences Between Klonopin & Ativan

Klonopin (clonazepam) and Ativan (lorazepam) are medications commonly prescribed for anxiety disorders. Both medications are benzodiazepines that work by increasing the chemical GABA (gamma-aminobutyric acid) in the brain.^{1, 2} Increased GABA leads to a calming effect, decreasing anxiety and panic attacks. Although they are similar medications for anxiety, they are not interchangeable and are FDA-approved for different uses.

The key differences between Klonopin and Ativan are:

Standard Dosages & Forms

Klonopin and Ativan come in tablet form and are available in different strengths. Both medications are available in strengths of 0.5 mg, 1 mg, and 2 mg tablets. Klonopin is also available in disintegrating wafers, while Ativan is also available as a liquid. These forms are typically used in children or those with difficulty swallowing.

Side Effects

Because Klonopin and Ativan cause the same effect on the body, many side effects are the same. Both medications can cause symptoms of depression, dizziness, impaired coordination, and problems with memory.⁷ Klonopin and Ativan can also cause sedation, but this is more common with Ativan as it acts more quickly on the body. Ativan also wears off more quickly, which increases the chance of rebound anxiety.

Strength

Klonopin and Ativan are high-potency benzodiazepines, with Klonopin slightly more potent than Ativan. Potency refers to how strong or effective a medication is in producing the desired effect. The usual starting dose for adults with panic disorder is 0.25 mg twice per day and can be increased to 0.5 mg per day. Doses can exceed 1 mg/day, but this often does not improve the effect.³ The usual starting dose for Ativan when treating anxiety is 2-3 mg per day divided into 2-3 doses. The daily dose can range from 1-10 mg.⁴

How Long It Takes to Work

Both medications can lead to immediate relief after the first dosing. However, it can take several weeks with daily dosing to reach the maximum benefit. An individual may start to notice the effects of Ativan 30 minutes after being ingested, while Klonopin may take 1-2 hours for the effects to be noticeable.

The duration of action for benzodiazepines can vary and is based on the half-life of the medication. The half-lives of Ativan and Klonopin are considered short to intermediate compared to other benzodiazepines.⁸ The half-life of a medication refers to the time it takes for half of the drug to be eliminated from the body. Generally, after 4 to 5 half-lives, the amount left in the body is not considered significant. The half-life for Klonopin is 30-40 hours and the half-life for Ativan is about 12-18 hours.^{1, 2}

Addiction Potential

All benzodiazepines carry the risk of addiction and dependence. Prolonged use, particularly at higher doses, can lead to physical and psychological dependence. Abruptly stopping these medications can lead to withdrawal symptoms such as rebound anxiety, insomnia, tremors, and seizures.

The half-life of a benzodiazepine plays a major role in the addiction potential. A longer half-life can produce a more gradual decline in a drug concentration reducing the risk of withdrawal symptoms. Shorter half-lives can increase the risk of withdrawal symptoms leading users to seek more medication to alleviate symptoms.

The table below summarizes the key differences between Klonopin and Ativan:^{1, 2, 3, 4}

What Is Klonopin?

Klonopin (clonazepam) is a medication used for the treatment of panic disorders and seizure disorders. Klonopin is in the class of medication called benzodiazepines. These medications increase the amount of GABA (gamma-aminobutyric acid) in the brain.¹ Increasing GABA may lead to calming of the brain, reducing excessive brain activity and alleviating symptoms of anxiety. Klonopin is FDA-approved for the treatment of panic disorders in adults and certain seizure disorders in adults and children.³

What Is Ativan?

Ativan (lorazepam) is a medication used to treat anxiety disorders and active seizures. Similar to Klonopin, Ativan is a benzodiazepine that increases the amount of GABA in the brain, leading to the reduction of excessive brain activity and alleviation of anxiety symptoms. Ativan is FDA-approved for anxiety disorder, anxiety associated with depressive symptoms, and treatment for active seizures.^{4, 7}

How Are Klonopin & Ativan Similar?

Klonopin and Ativan share many similarities as they both belong to the benzodiazepine class of medications. Benzodiazepines are a group of drugs known for their anti-anxiety, sedative, and muscle-relaxing properties. As both medications can help with feelings of anxiety, such as excessive worry, restlessness, and tension, they are used for the treatment of anxiety disorders. However, their FDA-approved uses are for different anxiety disorders. These medications are prescribed by licensed medical professionals, including psychiatrists and primary care physicians.

Similarities between Klonopin & Ativan include that they are both:^{1, 2}

• Part of the benzodiazepine drug class
• Have multiple uses as FDA-approved and off-label treatments
• Act as central nervous system depressants, leading to relaxation and sedation
• Cause similar side effects
• Prescribed by licensed medical professionals
• Carry the risk of dependence and withdrawal symptoms

What Are Klonopin & Ativan Used to Treat?

Klonopin is FDA-approved for the treatment of panic disorder and certain seizure disorders.³ Ativan, on the other hand, is FDA-approved for treating anxiety disorder, anxiety associated with depressive symptoms, and treatment for active seizures.⁴ FDA-approved medications are medications that have undergone rigorous clinical trials that demonstrate the safety and efficacy to meet FDA criteria for approval.

There are off-label uses for Klonopin and Ativan, as well. Off-label means the medication is used for a non-FDA-approved reason. This can occur when a physician, in their professional judgment, believes the medication will still benefit an individual for a non-FDA-approved use.

Off-label uses of Klonopin and Ativan include:^{5, 6, 7}

• Acute mania
• Acute psychosis
• Insomnia
• Catatonia

Other off-label uses of Klonopin are:^{5, 7}

• Restless leg syndrome
• Tardive dyskinesia
• REM sleep behavior disorder

Other off-label uses of Ativan are:^{6, 7}

• Alcohol withdrawal syndrome and delirium
• Muscle spasms
• Headache
• Panic disorder

Side Effects of Klonopin & Ativan

The side effects of Klonopin and Ativan are similar as both are benzodiazepines. The most common side effects are due to central nervous system depression, which can cause drowsiness, depression, impaired movements, and memory problems. Some of these effects can occur more frequently when starting the medication and may resolve over time.

The severity of the effects can vary from person to person. While most side effects are mild and resolve with time, some may require medical attention. Uncommon but more severe side effects may include severe drowsiness, trouble talking, persistent tremor, and allergic reactions.^{9, 10}

This is not a comprehensive list of possible mild or severe side effects. You should talk with your prescriber and pharmacist about any potential side effects from either medication.

The table below compares the possible side effects of Klonopin and Ativan:^{1, 2, 7, 9, 10}

Warnings & Precautions for Klonopin & Ativan

When considering anti-anxiety medications like Klonopin and Ativan, it is essential to be aware of the associated warnings and precautions. These medications are benzodiazepines and can lead to the risk of physical and psychological dependence. The risk increases when using these medications for extended periods of time or at high doses. Individuals who should take precautions when considering these medications include those with a history of substance abuse, certain medical conditions, and pregnant or breastfeeding mothers.

Risks to consider when taking Klonopin and Ativan include:^{1, 2, 7, 11, 12}

• Interactions with alcohol: Consuming alcohol while taking benzodiazepines can intensify the sedative effects and increase the risk of drowsiness and impaired coordination.
• Use while pregnant: There are no adequate studies assessing the use of Klonopin and Ativan anti-anxiety medication while pregnant. The decision to continue taking Ativan or Klonopin during pregnancy should be made by the individual and prescribing health care provider.
• Use while breastfeeding: Ativan and Klonopin are excreted in low levels in breast milk. While it may safe to continue these medications when breastfeeding, infants should be monitored for drowsiness, poor weight gain, and poor feeding.
• Benzodiazepine withdrawal: Discontinuing Klonopin or Ativan abruptly, especially after prolonged use, can lead to benzodiazepine withdrawal. Symptoms include rebound anxiety, insomnia, tremors, and seizures.
• Allergic reactions: While allergic reactions to these medications are rare, they can occur. Symptoms may include difficulty breathing, hives, and swelling of the face or mouth. If an individual develops an allergic reaction, they should be seen immediately by a medical provider.
• Use for those with kidney/liver problems: Individuals with a history of kidney or liver problems may need to be treated with lower doses.
• Use for the elderly: Older individuals may be more sensitive to the effects caused by Ativan and Klonopin and may require lower doses.

Potential Drug Interactions With Klonopin & Ativan

Klonopin and Ativan can have harmful interactions with other drugs, herbal supplements, and substances. For example, combining these medications with alcohol or other central nervous system depressants can amplify the sedative effects. Some substances can increase the effect of these medications by reducing the elimination from the body. Other substances can lead to increased removal from the body leading to decreased effectiveness.

Disclaimer: Taking certain medications, herbs, or supplements alongside Klonopin and Ativan 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 Klonopin and Ativan include:^{1, 2, 3, 4, 7}

Klonopin & Ativan: Key Pros & Cons

Although Klonopin and Ativan are similar medications, each one offers different advantages. The medications are FDA-approved for different uses, and because of this, one may be preferred over the other when starting treatment. The time it takes for the medication to have an effect should also be considered. Lastly, the choice between these medications may be influenced by factors such as cost, insurance coverage, and individual response.

Pros & Cons of Klonopin

Klonopin is FDA-approved for adults with panic disorder, with or without agoraphobia. For this reason, it may be preferred in individuals with this disorder. Klonopin also has a longer half-life, and the effects are felt more slowly. This can provide a gradual impact on anxiety symptoms and decrease the potential for withdrawal symptoms.

Pros & Cons of Ativan

Ativan is FDA-approved for treating anxiety disorder and anxiety associated with depressive symptoms. Therefore, it may be preferred in individuals with these disorders. Ativan effects can be seen more quickly and would be more beneficial for those requiring a faster response. It also has a shorter half-life which can increase the risk of Ativan withdrawal symptoms.

Which Is Right for You: Klonopin or Ativan?

Choosing the most suitable anxiety medication, whether it’s Klonopin, Ativan, or others, depends on several factors. These factors can include the type and severity of your anxiety, coexisting medical conditions, lifestyle, personal preferences, and personal response to these medications.

Consulting a healthcare provider can help with these considerations. If seeing a psychiatrist in-person isn’t feasible, you can try online psychiatry services. These platforms allow you to connect with qualified professionals from your home, and they can help guide you when considering each medication.

How to Get a Prescription for Klonopin & Ativan

If you are wondering how to get anxiety medication such as Klonopin or Ativan, you need to meet with a healthcare provider, such as a psychiatrist or primary care physician. Ativan and Klonopin are not sold over the counter, and they require a prescription by a licensed medical professional.

When meeting with a healthcare provider, either in person or virtually, they will conduct a thorough assessment of your symptoms to determine the most appropriate treatment. There are many medications to consider when treating anxiety disorders, and your healthcare provider can discuss the available options with you.

Questions to Ask Your Health Team About Klonopin & Ativan

Open communication with your healthcare provider is vital when considering anxiety medications like Klonopin or Ativan. Going to your appointment with prepared questions and concerns can improve your experience. Your doctor will need a comprehensive understanding of your medical history, current symptoms, lifestyle, and preferences to provide the best guidance.

Questions to ask your prescriber about Klonopin and Ativan include:

• Is it safe to take Klonopin or Ativan with my other medications?
• Will Klonopin or Ativan 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 Klonopin or Ativan?
• What should I do if I am unsure whether anti-anxiety medications are right for me?
• Are there any potential interactions with over-the-counter medications or herbal supplements?
• What lifestyle factors might impact the effectiveness of these medications?
• How will these medications affect my daily activities, such as driving or working?
• Could I take estazolam instead of Ativan since both are intermediate-acting benzodiazepines?

In My Experience

In my experience, Ativan and Klonopin are good medications to consider for the treatment of anxiety disorders. Although I do not use these medications much in the pediatric setting, I have seen the benefits these medications can have in adults through my training and personal acquaintances. There are many medications to consider when treating anxiety. It is important to discuss all the possible treatment options with your healthcare provider.