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

Key Differences Between Valium & Ativan

While Valium and Ativan are both medications used for tedications for anxiety, they have some notable differences. Valium has a longer duration of action than Ativan, making it more suitable for long-term use or as a muscle relaxant.² On the other hand, Ativan has a faster onset of action and is generally considered more potent than Valium.¹ Additionally, they may have differences in terms of side effects and individual responses.

These medications are similar but not interchangeable. The choice between Valium and Ativan should be based on individual patient characteristics, the specific anxiety disorder being treated, and the prescribing healthcare professional’s judgment.

The key differences between Valium and Ativan are:

• Valium has a longer half-life and duration of action than Ativan.
• Ativan is generally considered to be more potent than Valium.
• While both are commonly used for anxiety disorders, Valium is also approved for the treatment of alcohol withdrawal symptoms, muscle spasms, and seizures.³
• Side effects, while similar, may have different severity and frequency.
• Valium is processed through the liver differently than Ativan, which may impact how the drug is cleared from the body.

Conditions Treated

Valium and Ativan have some differences in the conditions they are approved to treat by the U.S. Food and Drug Administration (FDA) as well as conditions for which they may be prescribed off-label. The use of medications for off-label indications is a common practice in medicine, where a healthcare professional prescribes a medication for a condition that is not specifically listed in the FDA-approved indications. Although a medication may be useful for an off-label condition, more research is still needed to determine its safety and efficacy for those purposes.

Valium is FDA-approved to treat:²

• Anxiety disorders
• Short-term relief for the symptoms of anxiety
• Treatment of alcohol withdrawal symptoms
• Muscle spasms
• Seizures

Valium also has off-label (non-FDA-approved) uses treating:⁵

• Insomnia
• Agitation
• Pre-medication before certain medical procedures

Ativan is FDA-approved to treat:¹

• Anxiety disorders including generalized anxiety disorder (GAD) and anxiety associated with depression

Ativan also has off-label (non-FDA-approved) uses treating:⁴

• Rapid tranquilization of agitated patients
• Alcohol withdrawal delirium
• Insomnia
• Panic disorder
• Chemotherapy-associated anticipatory nausea and vomiting

Standard Dosages & Forms

Ativan and Valium differ in dosages and available forms. Ativan is available as a tablet and an injection. This article focuses on tablets. Ativan tablets have three standard strengths, 0.5 mg, 1 mg, and 2 mg.⁶

Valium is only available as a tablet. Valium tablets come in 2 mg, 5 mg, and 10 mg.⁷

The dosages of both medications are determined by a healthcare professional based on a thorough evaluation of the patient’s needs and response to treatment. Dosages may be adjusted over time to achieve the desired therapeutic effect while minimizing the risk of side effects or adverse reactions.

Side Effects

There are some differences between the side effect profiles of Valium and Ativan. However, many side effects overlap because they are both benzodiazepines. Common side effects associated with both medications include drowsiness, sedation, dizziness, and impaired coordination. These effects can impact an individual’s ability to perform tasks requiring mental alertness or physical coordination. Other common side effects may include confusion, memory problems, and changes in appetite.^{6, 7}

Valium, due to its longer duration of action, may be more likely to cause daytime drowsiness and residual sedation than Ativan. It can also have a greater potential to cause muscle weakness or fatigue. In some cases, Valium may cause reactions that are opposite of what’s expected, such as increased anxiety, restlessness, irritability, or aggression.⁷

Ativan, on the other hand, is generally considered to have a more potent and rapid onset of action than Valium. This can result in a higher incidence of certain side effects, including increased immediate sedation, dizziness, and cognitive impairment. Ativan may also have a higher likelihood of causing rebound anxiety or withdrawal symptoms when discontinued abruptly.⁶ This is not a comprehensive list of possible mild or serious side effects. It is essential to discuss any concerns or side effects with a healthcare professional.

The table below summarizes the key differences between Valium versus Ativan:^{6, 7}

What Is Valium?

Valium contains the active medication diazepam and is a medication that belongs to the class of drugs called benzodiazepines. It is primarily used for its anti-anxiety, sedative, muscle-relaxing, and anticonvulsant properties. Valium acts on the central nervous system by enhancing the effects of a chemical messenger called GABA. GABA is inhibitory and helps regulate brain activity, and plays a crucial role in reducing anxiety and promoting relaxation.²

What Is Ativan?

Ativan contains the active medication lorazepam and is a medication that also belongs to the benzodiazepine class of drugs. It is primarily used for the treatment of anxiety disorders and related conditions. Ativan is known for its anti-anxiety, sedative, muscle-relaxing, and anticonvulsant properties.

Ativan works by enhancing the effects of GABA, a chemical messenger in the brain that helps to regulate brain activity. Ativan binds to specific receptors in the brain that are associated with GABA, which enhances GABA’s inhibitory effects on the nervous system. This results in reduced anxiety, increased sedation, muscle relaxation, and potential anticonvulsant effects.¹

What Are Valium & Ativan Used to Treat?

Ativan tablets are FDA-approved to treat anxiety symptoms and anxiety-related conditions. Valium is FDA-approved to treat alcohol withdrawal syndrome, anxiety symptoms, anxiety disorders, muscle spasms, and active seizures.^{6, 7}

FDA-approved uses refer to specific indications for which the medication has been thoroughly evaluated and approved by the U.S. Food and Drug Administration (FDA) based on clinical trials and evidence. Non-FDA-approved or off-label uses refer to the practice of prescribing a medication for a condition or use that is not specifically listed on the FDA-approved label.

The table below compares the medical and mental health conditions Valium and Ativan are used to treat:^{1, 2}

*These indications are FDA-approved in other forms of the medication.

Side Effects of Valium & Ativan

Both Valium and Ativan can cause side effects, although not everyone will experience them. It’s important to note that most commonly experienced side effects are usually mild and transient, requiring no medical intervention. However, some side effects may be more severe and require medical attention.

Common side effects of both include drowsiness, dizziness, sedation, and impaired coordination. These effects are more likely to occur when initiating treatment or increasing the dosage.

Severe side effects of both include allergic reactions, difficulty breathing, severe drowsiness, mood changes, and unusual behavior. Contact a healthcare professional if any severe or concerning side effects arise.

The table below compares the possible side effects of Valium and Ativan:^{1, 2}

Severe Side Effects & Allergic Reactions With Valium & Ativan

Severe side effects or allergic reactions to Valium or Ativan can occur. If someone experiences severe side effects such as difficulty breathing, extreme drowsiness, or signs of an allergic reaction, call emergency services (911) or go to the nearest emergency room.

Severe side effects that may occur from taking Valium or Ativan include:^{1, 2}

• Excessive drowsiness
• Suicidal thoughts or behaviors
• Trouble breathing
• Allergic reactions
• Increased agitation
• Restlessness
• Irritability
• Aggressiveness
• Hallucinations

Warnings & Precautions for Valium & Ativan

Benzodiazepines like Valium and Ativan carry important warnings and precautions to be aware of before starting treatment. Both medications are associated with the risk of dependence, tolerance and withdrawal symptoms. These medications should also not be taken with alcohol or other sedating substances. Prolonged use of these medications can lead to physical and psychological dependence with sudden discontinuation or rapid dose reductions resulting in rebound side effects.

Do not stop taking either of these medications abruptly. If you need to stop taking the medication or reduce your dose, your prescriber will provide instructions and guidance for tapering safely. Additionally, these medications affect mental alertness and coordination and should not be taken before driving or operating machinery.

Risks to consider when taking Valium and Ativan include:^{1, 2}

• Interactions with alcohol: Alcohol and anti-anxiety medications can increase the sedative effects of these medications and should never be taken together.
• Use while pregnant or breastfeeding: Use of these medications in pregnancy can result in sedation, respiratory depression, lethargy, lack of muscle, and/or withdrawal symptoms in newborns.
• Dependency and withdrawal: Continued use of benzodiazepines may lead to clinically significant physical dependence. Abrupt discontinuation or rapid dosage reduction of them may precipitate acute withdrawal reactions, which can be life-threatening.
• Sedation and impairment: Benzodiazepines can cause drowsiness, dizziness, and can affect cognitive functioning. These effects may impair daily activities and require caution during tasks requiring mental alertness.
• Respiratory depression: Benzodiazepine use can lead to slowed or reduced breathing, particularly when used in high doses or combined with other central nervous system depressants.
• Increased risk for older adults: Elderly individuals are more susceptible to the sedative effects of Ativan, which may increase the risk of falls and cognitive impairment.

Potential Drug Interactions With Valium & Ativan

Valium and Ativan have the potential to interact with many different medications and substances. Individuals taking either medication should avoid opioids and other anti-anxiety medications or sedatives, as these can all increase the risk of respiratory depression. Alcohol is also not recommended due to the enhancement of the sedative effect of benzodiazepines.

Additionally, interactions may occur with medications that affect the liver, which is responsible for processing Valium and Ativan through the body. Drugs that inhibit liver enzymes include certain antidepressants and antifungal medications. On the other hand, inducers of these enzymes, such as some anticonvulsants or St. John’s Wort, may decrease the effectiveness of Valium or Ativan.^{1, 2}

Disclaimer: Taking certain medications, herbs, or supplements alongside Valium 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 Valium and Ativan include:

Valium Vs. Ativan: Insurance Coverage and Cost Effectiveness

Most insurance plans will cover both Valium and Ativan. But will likely prefer their generic counterparts, diazepam and lorazepam, due to lower cost. The average retail price for 30 tablets of Valium 2 mg is $156.57 and the average retail price for 30 tablets of Ativan 0.5 mg is $1,054. Under most plans, these medications would be reduced to a zero-dollar copay after meeting a yearly deductible. There are also discount cards individuals may be eligible for to make these medications more affordable in some cases.^{8, 9}

Valium & Ativan: Key Pros & Cons

Valium is a long-acting benzodiazepine that takes longer to be removed from the body. Ativan is a shorter-acting benzodiazepine and may need to be dosed multiple times a day in certain situations. Both medications are very similar cost-wise and have similar side effects and treatment profiles. Barring any specific indications, either medication could be a suitable choice. Prescribers consider an individual’s personal needs and other factors when looking into either medication.

Pros & Cons of Valium

Valium is a longer-acting benzodiazepine, which means it has a prolonged duration of action and can provide sustained relief from anxiety symptoms. It also has muscle relaxant properties, making it effective for conditions such as muscle spasms. However, the longer duration of action of Valium can also increase the risk of daytime sedation and impair cognitive function. In terms of cost and insurance coverage, both medications are roughly the same and available as generics.²

Pros & Cons of Ativan

On the other hand, Ativan is a shorter-acting benzodiazepine, which allows for quicker onset of action and shorter duration of effects. This can be helpful for individuals who require immediate relief from acute anxiety. However, its shorter duration of action may require more frequent dosing throughout the day. In terms of cost and insurance coverage, both medications are roughly the same and available as generics.¹

Which Is Right for You: Valium or Ativan?

Choosing the most suitable medication for anxiety depends on various factors, including individual needs, response to treatment, potential side effects, and overall treatment goals. It is essential to work closely with a healthcare professional to assess these factors and make an informed decision.

If seeing a doctor in person is not be feasible, online psychiatry services can be a valuable alternative. You can get access to qualified professionals who can help evaluate your specific needs and consider the benefits and risks of medications like Valium and Ativan.

How to Get a Prescription for Valium & Ativan

Anxiety medications such as Valium and Ativan are prescription medications that can only be obtained through a healthcare professional. To get anti-anxiety medications, individuals should start by scheduling an appointment with healthcare provider authorized to prescribe medications. These include primary care physicians, psychiatrists, or psychiatric nurse practitioners.

During the appointment, the healthcare provider will evaluate the individual’s symptoms, medical history, and overall mental health condition. They will discuss the severity and duration of anxiety symptoms, any previous treatment attempts, and any underlying medical conditions that may impact the choice of medication. Based on the assessment, the healthcare provider will discuss the treatment options, including the potential use of anti-anxiety medications such as Valium or Ativan.

Questions to Ask Your Health Team About Valium & Ativan

Open communication with your healthcare provider is crucial when seeking treatment for anxiety or any other condition. Come to your appointment prepared with any questions or concerns you may have. By working together, you and your provider can create a treatment plan to suit your needs.

Questions to ask your prescriber about Valium and Ativan include:

• Is it safe to take Valium or Ativan with my other medications?
• Will Valium 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 Valium or Ativan?
• What should I do if I am unsure whether anti-anxiety medications are right for me?
• What should I initially keep an eye out for when starting this medication?
• Are there any restrictions on what I can do while taking this medication (driving, operating machinery, etc.)?
• How should I handle missed doses or if I accidentally take more than the prescribed amount?
• Are there any lifestyle changes or precautions I should be aware of while taking these medications?
• What kind of medical care do I need if I develop symptoms of Valium or Ativan withdrawal?

In My Experience

In my experience, Ativan and Valium can both be excellent and affordable options for patients with anxiety. I have seen many patients personally do very well on both medications and specifically their generic counterparts. Ultimately I believe it is most important to have a personal dialogue with your provider. Doing so helps them understand all of your concerns and what you personally want out of your medication and treatment for these conditions.