*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.
Klonopin and Xanax are both used to treat panic disorders.1 Klonopin also treats seizures, while Xanax also treats generalized anxiety disorder (GAD).2, 3 The advantage of Klonopin is that it does not need to be taken as often and is less likely to cause withdrawal symptoms. Xanax’s advantage is that it has a quicker onset.
If you’re considering a prescription for Klonopin or Xanax, you may have some difficulty finding a doctor to provide an assessment or discuss your current prescription. Talkiatry is one of the few online psychiatry platforms that can and will prescribe benzodiazepines, like Klonopin and Xanax, which are controlled substances. They can provide an assessment and may offer you a Klonopin or Xanax prescription if they determine the medication may help your symptoms.
Boxed Warning: Clonazepam (Klonopin) - Risk of medication misuse or abuse
Clonazepam, the active ingredient in Klonopin, has black box warnings. These are the most severe warnings from the Food and Drug Administration (FDA).
- Taking clonazepam, a benzodiazepine, with other opioid medications increases your risk for serious side effects, including severe sedation, slower breathing, coma, and death. Clonazepam should not be taken with an opioid unless there are no other options.
- Taking clonazepam can lead to misuse (abuse) and addiction of the medication, which can increase your risk of overdose and death.
- Using clonazepam can lead to physical dependence and this risk increases the longer you take clonazepam. If you suddenly stop taking clonazepam, you can experience withdrawal. Withdrawal can be life-threatening. Clonazepam should only be discontinued by gradual tapering of the dose.
Klonopin 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.
Key Differences Between Klonopin & Xanax
Klonopin (clonazepam) and Xanax (alprazolam) are benzodiazepine medications for anxiety. They do not contain the same active ingredients and are not interchangeable. They both can be used for panic disorder but Klonopin can also be used for certain types of seizures, while Xanax can also be used for generalized anxiety disorder (GAD). The main differences include their uses, doses, side effects, duration, frequencies, time to onset, and addiction potential.
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The key differences between Klonopin and Xanax are:
Conditions Treated
Klonopin is approved by the Food and Drug Administration (FDA)-approved to treat panic disorder and certain types of seizures. FDA-approved means a drug has shown in multiple clinical trials to be safe and effective for a certain use. Xanax is FDA-approved for GAD and panic disorder in adults.
Both medications may be used off-label for some conditions. Off-label means it is not approved by the FDA to treat a condition but based on the judgment of your prescriber, they may use it if they believe it can be useful. Klonopin’s potential off-label uses include anxiety4, insomnia 5, restless leg syndrome6, tic disorder7, Bipolar disorder8, and Parkinson’s disease.9 Xanax may be used off-label to treat depression10, insomnia11, premenstrual disorder12, and seizures.13
Standard Dosages & Forms
Klonopin is a brand-name medication that is only available as tablets. Klonopin tablets are available in different strengths of 0.5 mg, 1 mg, and 2 mg.2, 14
Xanax is a brand-name medication that is an immediate-release tablet. It is also available as Xanax XR which is an extended-release tablet. Xanax tablets are available in strengths of 0.25 mg, 0.5 mg, 1 mg, and 2 mg. Xanax XR tablets are available in strengths of 0.5 mg, 1 mg, 2 mg, and 3 mg.
Side Effects
Klonopin and Xanax have many of the same common side effects including changes in libido and drowsiness.2
Side effects that are specific to Klonopin include delirium, paranoia, nightmares, urinary tract infections, and muscle pain. Side effects specific to Xanax include difficulty or inability to urinate and abnormal muscle movements.
This is not a complete list of side effects for either medication.You should talk with your prescriber about all possible side effects before starting any medication.
How Long It Takes to Work
Both Klonopin and Xanax will start working as soon as you take them, but it may take some time for you to feel their effects. Xanax will work quickly with the maximum amount of the medication in your body after 1 to 2 hours of taking your dose. Klonopin will often take longer to work with the maximum amount of the medication released after 1 to 4 hours of taking your dose.
Addiction Potential
Both medications can cause physical dependence, which means that your body gets used to having the medication. Both medications carry a risk for addiction, meaning that you continue to take the medication even if it is causing you harm. With physical dependence, if you stop taking your medication suddenly, you may have withdrawal symptoms. It’s important to take your medication as it is prescribed and to talk with your prescriber before changing your dose or stopping your medication.
The table below summarizes the key differences between Klonopin versus Xanax:2, 3, 14, 15
| Key Components | Klonopin | Xanax |
| What is the generic name? | Clonazepam | Alprazolam |
| What forms does it come in? | Oral tablets XR tablets ODT | Oral tablets XR tablets |
| What are the typical dosages? | Panic Disorder: Initially, 0.25 mg by mouth twice daily. After 3 days, dose may be increased to the recommended dose of 1 mg per day. | Panic Disorder: Xanax is prescribed as 0.5 mg three times daily. The dose can be adjusted every 3 to 4 days with a maximum dose of 10 mg per day. Xanax XR is prescribed as 0.5 mg to 1 mg once a day. The dose can be adjusted every 3 to 4 days with a maximum dosage of 6 mg per day. Generalized Anxiety Disorder: 0.25 mg to 0.5 mg three times daily. The dose can be adjusted every 3 to 4 days with a maximum dose of 4 mg per day. Xanax XR is not approved for this condition. . |
| Who is approved to take it? | Adults 18 years or older and children with seizure disorder, up to 10 years of age or 66 pounds | Adults 18 years or older |
| What are its approved uses? | Panic disorder and seizures | Panic disorder and GAD |
What Is Klonopin?
Klonopin (clonazepam) is a benzodiazepine that acts on gamma-aminobutyric acid (GABA) receptors to increase GABA, an inhibitory molecule, in the brain and cause thought relaxation.2 Though not approved as a muscle relaxer, it also works in the body and can help ease muscle tension caused by anxiety. Klonopin may be used off-label for anxiety over other benzodiazepines when you need a longer-acting medication.
What Is Xanax?
Xanax (alprazolam) is also a benzodiazepine that acts on GABA receptors to increase GABA in the brain and cause thought relaxation.3 Like Klonopin, it can also help ease muscle tension. Xanax is often prescribed by doctors for anxiety over other benzodiazepines when you only need an anti-anxiety medication with quicker onset.
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How Are Klonopin & Xanax Similar?
Klonopin and Xanax are both benzodiazepines and they are both prescribed for panic disorder. They are used alone or as an add-on treatment for anxiety and are intended after selective-serotonin reuptake inhibitors (SSRIs) have been tried. Klonopin is not FDA-approved for the treatment of anxiety. General practitioners can provide these, but it is best to see a psychiatrist for them since they can be very dangerous.
In general, Klonopin and Xanax are in the same drug class and have similar uses, drug interactions, side effects, warnings and precautions, and prices. They interact with opioids, other benzodiazepines, central nervous system (CNS) depressants, and antidepressants. They can cause drowsiness, confusion, depression, addiction, and withdrawal. The price for each will depend on your insurance provider and the pharmacy you use.
Similarities between Klonopin and Xanax include:
- Being part of the benzodiazepine drug class
- Having multiple uses as FDA-approved and non-FDA-approved treatments
- Having similar drug interactions
- Having similar side effects
- Having similar warnings and precautions
- Having similar prices
What Are Klonopin & Xanax Used to Treat?
Klonopin and Xanax are both FDA-approved for anxiety and panic disorders. FDA-approved means a drug has shown in multiple clinical trials to be safe and effective for a certain use. They are both non-FDA-approved for insomnia. Non-FDA-approved means the drug has not been approved by the FDA for a particular use, but smaller trials have shown safety and clinical benefit.
The table below compares the medical and mental health conditions Klonopin and Xanax are used to treat:2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13
| Condition | Klonopin | Xanax |
| Panic Disorder | FDA-approved | FDA-approved |
| Seizures | FDA-approved | Off-label |
| Anxiety | Off-label | FDA-approved |
| Insomnia | Off-label | Off-label |
| Restless Leg Syndrome | Off-label | No |
| Tic Disorder | Off-label | No |
| Bipolar Disorder | Off-label | No |
| Parkinson's Disease | Off-label | No |
| Depression | No | Off-label |
| Premenstrual Disorder | No | Off-label |
| Alcohol Withdrawal Syndrome | No | Off-label |
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Side Effects of Klonopin & Xanax
Common side effects of Klonopin and Xanax include drowsiness, dizziness, depression, and impaired cognitive and motor function.2, 3 Serious side effects, such as difficulty breathing, abuse, misuse, addiction, mania, coma, and death, are rare but possible. Commonly experienced side effects are often mild, though some may require medical attention. This is not a comprehensive list of possible mild or serious 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 Xanax:2, 3
| Side Effects | Klonopin | Xanax |
| Nausea | Yes | Yes |
| Abuse, Misuse, Addiction, or Physical Dependence | Yes | Yes |
| Withdrawal Reactions | Yes | Yes |
| Excessive Drowsiness | Yes | Yes |
| Difficulty Breathing | Yes | Yes |
| Delirium | Yes | No |
| Paranoia | Yes | No |
| Hallucinations | Yes | Yes |
| Suicidal Ideation and Behavior | Yes | No |
| Rage, Aggression, or Hostile Behavior | Yes | Yes |
| Mania | No | Yes |
| Vertigo | Yes | No |
| Nightmares | Yes | No |
| Increased Salivation | Yes | Yes |
| Porphyria | Yes | No |
| Drowsiness | Yes | Yes |
| Depression | Yes | Yes |
| Dizziness | Yes | Yes |
| Nervousness | Yes | No |
| Abnormal or Impaired Cognitive and Motor Performance | Yes | Yes |
| Difficulty Speaking | Yes | Yes |
| Decreased Libido | Yes | Yes |
| Increased Libido | Yes | Yes |
| Confusion | Yes | Yes |
Severe Side Effects & Allergic Reactions of Klonopin & Xanax
Drowsiness, difficulty breathing, abuse, misuse, addiction,, coma, and death are severe side effects of Klonopin and Xanax that may occur.2, 3 Drowsiness is common, but the likelihood of experiencing other severe side effects or allergic reactions with either drug is rare but may occur when combined with other medical conditions or substances. If you experience severe side effects from Klonopin or Xanax, talk to your doctor or pharmacist immediately.
Severe side effects that may occur from taking Klonopin or Xanax include:2
- Excessive drowsiness
- Breathing difficulty
- Delirium
- Paranoia
- Hallucinations
- Rage, aggression, or hostile behavior
- Mania
- Suicidal ideation and behavior
- Abuse, misuse, or addiction
- Seizures
- Coma
- Death
- Allergic reaction
Warnings & Precautions for Klonopin & Xanax
Klonopin and Xanax should not be suddenly stopped.2, 3 Discontinuing abruptly can lead to withdrawal syndrome. Symptoms can include impaired concentration, diarrhea, blurred vision, anxiety, and seizures. In addition, serious interactions with alcohol, opioids, and medical conditions exist, and these medications should not be taken during pregnancy or lactation.
Risks to consider when taking Klonopin and Xanax include:2, 3
- Interactions with alcohol: Anti-anxiety medications and alcohol can affect your cognitive and motor function. The combination of these two should be avoided.
- Use while pregnant or breastfeeding: When pregnant or breastfeeding, it’s not known if taking anti-anxiety medications while pregnant or breastfeeding is safe. Both Klonopin and Xanax can cause neonatal withdrawal syndrome in babies who are exposed to benzodiazepines during pregnancy.
- Use in children: Children 18 years or young should not take benzodiazepines for panic disorder, as paradoxical effects, such as aggression, anxiety, nightmares, hallucinations, and psychosis can occur.
- Benzodiazepine withdrawal: Abruptly stopping and drastically reducing your dose of Klonopin or Xanax can result in benzodiazepine withdrawal. Symptoms may include heightened sensory perception, impaired concentration, a change in sense of smell, clouded senses, burning or prickling sensations, muscle cramps or twitches, diarrhea, blurred vision, decreased appetite, weight loss, anxiety, insomnia, and seizures.
- Interactions with opioids: Klonopin and Xanax have a warning for severe interaction with opioids. The combination should be avoided, as breathing may be impaired, leading to coma or death.
- Interference with cognitive and motor performance: Klonopin and Xanax can impair decision-making and motor skills. Heavy machinery, such as cars and forklifts, should not be operated while taking these medications.
- Worsening depression, suicidal thinking, and behavior: Klonopin and Xanax may cause suicidal thoughts and behaviors. Appropriate precautions should be taken to prevent overdosing.
- Mania: Klonopin and Xanax may cause mania or hypomania in patients with depression.
- Increased salivation: Klonopin can increase salivation, so precautions should be taken for patients with difficulty swallowing or handling secretions.
- Phenylketonurics: Klonopin’s orally-disintegrating form contains phenylalanine and should not be taken if you have trouble metabolizing phenylketonuria.
- Impaired renal, hepatic, or pulmonary function: Since Klonopin and Xanax can have serious effects, caution should be taken if you have impaired kidney, liver, or lung function.
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Potential Drug Interactions With Klonopin & Xanax
Klonopin and Xanax can interact with certain foods, substances, and medications2, 3, so it’s important to speak with your doctor about your lifestyle to make sure that these medications are safe for you.
Anti-anxiety medications can interact with substances like alcohol and other medications, increasing the risk of side effects. Klonopin and Xanax can also affect your cognitive function, and if interactions enhance this, it can be dangerous.
Disclaimer: Taking certain medications, herbs, or supplements alongside Klonopin and Xanax can change how these medications work in your body or increase the risk of 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 Xanax include:2, 3
| Complicating Interactions | Klonopin | Xanax |
| Opioids | X | X |
| Other benzodiazepines | X | X |
| Alcohol | X | X |
| Grapefruit juice | X | X |
| Fluoxetine | X | X |
| Fluvoxetine and nefazodone | X | X |
| Tricyclic Antidepressants | X | X |
| Monoamine Oxidase Inhibitors | X | X |
| Anticonvulsants, e.g., phenytoin, phenobarbital, and carbamazepine | X | X |
| CNS depressants, e.g., muscle relaxers, trazodone, and sleep-aids | X | X |
| Nicardipine, nifedipine, diltiazem, and verapamil | X | X |
| Digoxin and Amiodarone | X | X |
| Clarithromycin and erythromycin | X | X |
| Itraconazole and ketoconazole | X | X |
| If taking orally-disintegrating form: proton pump inhibitors and H2 blockers, e.g., omeprazole and ranitidine | X | X |
| Cyclosporine | X | X |
Klonopin & Xanax: Key Pros & Cons
The advantage of Klonopin is that it does not need to be taken as often and is less likely to cause withdrawal symptoms. Xanax’s advantage is that it has a quicker onset, but its effects will not last as long. Xanax has the advantage of being approved for GAD.
Pros & Cons of Klonopin
Klonopin’s advantages are that it is only taken twice a day and is less likely to cause addiction and withdrawal symptoms. It also has approval for seizures and non-approved uses for restless leg syndrome, tic disorder, Bipolar disorder, and Parkinson’s disease. Disadvantages include that it takes a longer time to start working.
Pros & Cons of Xanax
The advantages of Xanax include that it has a faster onset and can be taken as needed.. It also has approval for GAD and non-approved uses for depression, insomnia, premenstrual disorder, and seizures. Disadvantages include that it has a higher risk of addiction and withdrawal.
Which Is Right for You: Klonopin or Xanax?
The medication best for your needs can depend on many factors. Factors include uses, formulations, your medical history, other medications you are on, and side effects. So, you may need to consider online psychiatry services if seeing a doctor in person isn’t feasible. They can help you consider the benefits and risks of each medication.
How to Get a Prescription for Klonopin & Xanax
Klonopin and Xanax are typically anxiety medications used after SSRIs have been tried. They can be used alone or as add-on medications. You can get them from your primary care doctor or nurse practitioner. However, they may want you to see a psychiatrist to be sure that a benzodiazepine is right for you based on your medical history and other medications since they are dangerous.
Questions to Ask Your Health Team About Klonopin & Xanax
It is important to have open communication with your doctor so they can accurately decide which medication is best for you. Also, you should go to your appointment prepared with any questions or concerns you have. It is also important to be open about your habits because these medications can be very dangerous.
Questions to ask your prescriber about Klonopin and Xanax include:
- Is it safe to take Klonopin or Xanax with my other medications?
- Will Klonopin 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 Klonopin or Xanax?
- What should I do if I am unsure whether anti-anxiety medications are right for me?
- How long will it take for me to adjust to taking Klonopin or Xanax?
- Am I at risk for more severe symptoms if I am already taking other anxiety/depression medications?
- Will a previous history of addiction make me more susceptible to dependency?
- How long can I take Klonopin or Xanax?
- How do I prevent addiction to Klonopin or Xanax?
- What should I do if I feel like I am becoming addicted to Klonopin or Xanax?
- What are some Xanax alternatives to consider?
- Is it safe to take Klonopin or Xanax with Adderall or other stimulants?
In My Experience
In my experience, patients tend to tolerate benzodiazepines moderately well. You may have some initial side effects like drowsiness, which should go away after a couple of weeks. Severe side effects are rare and have a greater chance of occurring if you have certain medical conditions or use certain substances. Also, make sure you fully understand your doctor’s instructions when changing doses to prevent side effects.
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
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For Further Reading
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.
