*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.
Valium (diazepam) and Xanax (alprazolam) are benzodiazepine medications used mainly as short-term treatments for anxiety and panic disorders. While Valium is a long-acting benzodiazepine, it also takes effect slightly faster than Xanax – which is a short-acting benzodiazepine. For sudden episodes of anxiety or panic that are unable to be managed without medication, Xanax is sometimes recommended as it will leave your body faster than Valium does. Other than their timelines of action, Valium and Xanax work very similarly and have similar side effects.
If you are considering Valium 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 Valium and Xanax, which are controlled substances. They offer assessments and can provide a prescription if they determine Valium or Xanax may help your symptoms.
Boxed Warning: Diazepam (Valium) – Risk of medication misuse or abuse
Diazepam, the active ingredient in Valium, has black box warnings. These are the most serious types of warnings from the Food and Drug Administration (FDA).
– Taking diazepam, a benzodiazepine, with other opioid medications increases your risk for serious side effects that include severe sedation, slower breathing, coma, and death. Diazepam should not be taken with an opioid unless there are no other options.
– Taking diazepam can lead to misuse (abuse) and addiction of the medication, which can increase your risk of overdose and death.
– Using diazepam can lead to physical dependence and this risk increases the longer you take diazepam. If you suddenly stop taking diazepam, you can expereince withdrawal. Withdrawal can be life threatening. Diazepam should only be discontinued by gradual tapering of the dose.
Valium 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.
What Is Valium (Diazepam)?
Diazepam (Valium) is a medication that is used for its ability to sedate and relax, whether for anxiety symptoms, seizures, or drug withdrawal. It falls under the benzodiazepine family just like alprazolam (Xanax). Benzodiazepines, like Valium, are able to create a calming and sedating effect on individuals by targeting the receptors of gamma-aminobutyric acid (GABA), a neurotransmitter that acts on the central nervous system.
What Is Xanax?
Xanax is another medication that is under the benzodiazepine family. Just like Valium, Xanax is also used for its relaxation and sedation abilities to treat similar issues to what is treated by Valium. The mechanism of action of Xanax is similar to that of Valium.
How Are Valium & Xanax Similar?
Both Valium and Xanax are benzodiazepine medications that are used to treat symptoms of anxiety-related disorders.
Both Valium and Xanax can be addictive and care must be taken by the provider prescribing the benzodiazepine and by the patient taking the medication when it is used. In the United States, benzodiazepines are considered controlled substances. This means that medications like Valium and Xanax can only be prescribed by healthcare providers who have DEA (Drug Enforcement Administration) prescribing numbers. These include physicians, psychiatrists, physician assistants (PAs), and nurse practitioners (NPs).
Similarities between Valium & Xanax include that they are both:
- Medications under the benzodiazepine family
- FDA approved to treat anxiety-related disorders
- Used for their sedative and relaxing properties for both FDA-approved and non-FDA approved treatments
- Work by targeting the GABA neurotransmitter receptor
- Are controlled substances which can be prescribed only by prescribers with a DEA prescribing number
- Can be addictive and dangerous (can decrease abilities to breathe properly/fully)
- Has the potential to be abused
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Key Differences Between Valium & Xanax
Although Valium and Xanax are similar medications – both used to treat anxiety-related disorders and events (calming down the central nervous system), they are not interchangeable. Your physician might have certain reasons for prescribing you the medication they prescribed you, such as the dosage/strength of the medication you require, the length of the action the medication will have on you, your ability to tolerate the medication, etc. The main difference between Valium and Xanax is that Valium is a long-acting benzodiazepine, while Xanax is a short-acting one.
The key differences between Valium and Xanax are:
Conditions Treated
Both Valium and Xanax are FDA approved for the short-term treatments of anxiety disorders. However, unlike Xanax, Valium also has FDA approval for the treatment of recent alcohol withdrawal, muscle spasms, and emergency treatment for seizures.1
Overall, Valium impacts symptoms for longer as compared to Xanax. Xanax is used to treat acute and quick episodes of panic attacks. Because of the differences in how they affect anxiety symptoms, both are beneficial in different situations.
Standard Dosages & Forms
Valium can be used orally (as a tablet) or as an injectable liquid. The available dosages vary from 2 mg to 10 mg per dose.1 1. Xanax is available as regular-release and extended-release tablets. Xanax dosages available for the regular-release tablets are 0.25 mg, 0.5 mg, 1 mg, and 2 mg.2 The dosages available for the extended-release tablets are 0.5 mg, 1 mg, 2 mg, and 3 mg.3 There is also an oral liquid formulation, known as Alprazolam Intensol, 0.25 mg to 0.5 mg given three times daily.4
Whether you are prescribed Valium or Xanax, talk to your prescriber about the dosage and frequency you take the medication. It is important to understand that taking other medications or substances can affect how benzodiazepines since as Valium or Xanax can work in your body. This includes how long it takes for it to start working and how long it lasts in your body.
Side Effects
Although the side effects of both Valium and Xanax are similar, the side effects will last longer when taking Valium as it is a longer-acting benzodiazepine medication compared to Xanax.
Strength
It is difficult to compare which medication (Valium or Xanax) is stronger because the strength of the medication is dependent on the dosage and the frequency at which each medication is taken. Although Valium has a quicker onset of action, its effects can last in the body for a longer time compared to Xanax.
Although Xanax takes slightly longer to have an initial effect, it can also be quickly broken down by the body. This makes its intended effects and side effects last for a shorter time.
How Long It Takes to Work
As mentioned in the previous section (and seen in the table below), Valium works slightly faster in the body compared to Xanax. However, Xanax has a shorter half-life and thus is able to be processed by the body and then leave the body quicker than Valium. Xanax is considered a short-acting benzodiazepine.
Because it can take the body over 24 hours to process half of the Valium given during a single dosage, it is considered a long-acting benzodiazepine.
Addiction Potential
Both Valium and Xanax have significant potential for addiction if they are misused, in a manner other than how it is prescribed or if taken without a prescription. This is another reason why it is important to have careful discussions with your prescribing provider about how you should take the medication and if you have any concerns that arise while taking the medication. Rebound anxiety is a common problem described with sudden discontinuation of Xanax, especially if it was being taken for a long period of time.5
The table below summarizes the key differences between Valium versus Xanax1,2,3,5
Key Components | Valium | Xanax |
---|---|---|
What is the generic name? | Diazepam | Alprazolam |
What forms does it come in? | 1. Oral tablet 2. Injectable solution 3. Rectal Gel | 1, Regular (disintegrating) oral tablet 2. Extended-release oral tablet 3, Injectable solution (for IV [intravenous] or IM [intramuscular]) 4. Rectal Gel |
What are the typical dosages? | For anxiety • 2-10 mg tablets (by mouth 2x-4x per day) • 2-10 mg (via IV or IM every 3-4 hours) For additional seizure treatment and/or for muscle relaxation • 2-10 mg (by mouth up to 4x per day) | For anxiety: 0.25-0.5 mg tablets (by mouth 3x times per day) |
What is the maximum recommended daily dosage? | 40 mg | 1. For anxiety: 4 mg 2. For panic disorders: 6-10 mg |
What are the FDA-approved treatment uses? | 1. Anxiety disorders 2. Acute alcohol withdrawal symptoms 3.Skeletal muscle spasms (as additional therapy to other standard treatment options) 4. Seizure disorders (as additional therapy to other standard treatment options) | 1. Generalized anxiety disorder (GAD) 2. Panic disorder |
How long will it take for the medication to start having an effect? | 0-15 minutes | 15-30 minutes |
How much time does it take for the medication to reach its peak effect? | 0.5-1 hour | 1-2 hours |
How long will it take for half of the original medication to be metabolized in the body? (What is the medication’s half-life?) | 20-100 hours | 6-20 hours |
Are the initial metabolized parts of the medication also able to actively work as a benzodiazepine derivative? | Active metabolites (oxazepam, temazepam, & desmethyldiazepam) | In-active metabolites |
Online Psychiatry
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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
What Are Valium & Xanax Used to Treat?
The US Food and Drug Administration (FDA) approves the use of medications for appropriate treatments based on their research and evaluations of the medications. However, prescribing physicians might use a certain medication to treat conditions or symptoms that are not listed as approved by the FDA. This is called an “off-label” usage.
Valium is FDA approved for the short-term treatment of anxiety disorders, recent alcohol withdrawal, muscle spasms, and acute seizure treatment.1 Valium is sometimes used off-label by medical professionals to treat serotonin syndrome and drug withdrawals, such as benzodiazepines and opioids.
Xanax is FDA-approved for the immediate treatment of generalized anxiety disorders and panic disorders.2 Sometimes, a prescriber might prescribe Xanax or Valium as treatment for anxiety related to a medical procedure (examples: completing a CT/MRI scan, undergoing a sleep study, undergoing stitches, etc). It is important to remember that benzodiazepines are not meant to treat normal anxiety or tension that is related to everyday life.1
The table below compares the medical and mental health conditions Valium and Xanax are used to treat:
Condition | Valium | Xanax |
---|---|---|
Anxiety Disorders | Yes, FDA-approved | Yes, FDA-approved |
Panic disorders | No | Yes, FDA-approved |
Procedural anxiety | Intravenously: Yes, FDA-approved Orally: Yes, Off-label | Yes, Off-label |
Sudden Vertigo Episodes | Yes, Off-label | Yes, Off-label |
Muscle Spasms/Rigidity | Yes, FDA-approved | No |
Seizures | Yes, FDA-approved | No |
Cocaine, Methamphetamine Intoxication | Yes, Off-label | No |
Neuroleptic malignant syndrome | Yes, Off-label | No |
Serotonin syndrome | Yes, Off-label | No |
Alcohol withdrawal syndrome | Yes, FDA-approved | No |
Opioid withdrawal | Yes, Off-label | No |
Side Effects of Valium & Xanax
Common side effects of benzodiazepines such as Valium and Xanax are increased drowsiness/dizziness and trouble with coordination/walking. 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.
It is important to discuss the side effects you are experiencing while taking the medication with your prescribing provider. If you are experiencing severe side effects, it is important to access immediate medical attention.
Because of their side effects, it is important not to drive or operate heavy machinery while using benzodiazepines like Valium or Xanax.
Severe Side Effects & Allergic Reactions With Valium & Xanax
When taking benzodiazepine medications such as Valium and Xanax, it is possible to experience severe side effects. These can include changes in consciousness, loss of consciousness, hallucinations, slow or shallow breathing (to a dangerous point), agitation, and sluggishness. It is important to seek immediate medical attention if you think you or someone you know has overdosed on a benzodiazepine as it can be a fatal emergency. Almost 14% of the overdose-related deaths in 2021 involved benzodiazepines.6
Although not common, there have been reported cases of severe allergic reactions to benzodiazepines. Allergic reactions also require immediate medical attention. If you feel as if you are having trouble breathing, coughing, lightheaded, or other signs of anaphylaxis and have an Epipen, you should use your EpiPen and call 911 as soon as possible.
Severe side effects that may occur from taking benzodiazepines such as Valium and Xanax include:
- Excessive drowsiness/decreased consciousness
- Loss of consciousness
- Slow and shallow breathing
- Trouble walking or standing straight
- Hallucinations
- Increased agitation/irritability
Warnings & Precautions for Valium & Xanax
Benzodiazepines such as Valium and Xanax should not be taken haphazardly. Although they are used to treat anxiety disorders, they must only be used short-term. Both Valium and Xanax (like other benzodiazepines) have highly addictive properties and can cause physical dependence. This means that when they are stopped suddenly, people can start to experience severe withdrawal symptoms.
To prevent this, benzodiazepine dosages are decreased gradually by prescribers before it is stopped completely. Both Valium and Xanax can also decrease an individual’s breathing function to a critical point. This effect is worsened when benzodiazepine and opioid medications are taken in the same time period.
Risks to consider when taking Valium and Xanax include:
- Interactions with alcohol: As both alcohol and benzodiazepines are central nervous system depressants, they can worsen some of each other’s effects. Thus, it is important to never combine them.
- Use while pregnant or breastfeeding: The use of benzodiazepines as anti-anxiety medication during pregnancy or breastfeeding presents the risk of absorption of the medication by the fetus/newborn. This can lead to sedation and withdrawal symptoms in the neonates. Thus, if possible, should be avoided. However, you must discuss with your physicians including your primary care physician, your psychiatrist, and your obstetrician before making changes to your medications if you are pregnant, think you will be pregnant soon or are breastfeeding.
- Benzodiazepine withdrawal: Benzodiazepine withdrawal symptoms can be fatal. Thus, if you are using benzodiazepines, it is important to discuss with your physician how to decrease your dosages until you can stop the medication instead of abruptly stopping it.
- Decreased Respiratory Drive: When taken with other central nervous system depressants such as alcohol, opioids, and other sedatives, the risk of decreased breathing function increases. With a decreased drive to take full, proper breaths, the level of oxygenation in the body also decreases putting key organs at risk. This is a risk for people who have diseases that already decrease their ability to take full, proper breaths – such as those who have chronic obstructive pulmonary disease (COPD), sleep apnea, or neuromuscular diseases (like myasthenia gravis).
- Use in patients with depression: There is an increased risk of worsening depression when benzodiazepines are used in patients with depression.
- Use in patients with increased fall risk: As benzodiazepines can increase sedation and worsen coordination, the use of benzodiazepines should be avoided as much as possible in people who are already at an increased risk of falling.
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Potential Drug Interactions With Valium & Xanax
Benzodiazepines such as Valium and Xanax can interact with various other substances.
For example, when taken with other sedating medications, benzodiazepine enhances the sedating effect as it is also a sedative. When used to certain other medications or other substances that are processed by the liver, benzodiazepines’ toxicity and effectiveness can be either increased or decreased depending on the other substance.
Disclaimer: Taking certain medications, herbs, or supplements alongside Valium 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 Valium and Xanax include:
Complicating Interactions | Valium | Xanax |
---|---|---|
Opioids | X | X |
Other benzodiazepines | X | X |
Alcohol | X | X |
Anti-fungal medication | X | X |
Antidepressants | X | X |
Omeprazole | X | |
Anti-seizure medications | X | X |
St. John's Wort | X | X |
Kava | X | X |
Grapefruit juice | X | X |
Valium & Xanax: Key Pros & Cons
The specific pros and cons of using Valium or Xanax depends on the specific reason for which the medication is being prescribed. This is why it is important to have a conversation with your physician regarding the reasons why you are being prescribed the medication. The prices of medication can vary with and without insurance coverage. If you do not have insurance or if your insurance does not (fully) cover the medication you are prescribed, you can compare discounted prices at your local pharmacies or online.
Pros & Cons of Valium
Valium can be used as a short-term treatment for anxiety disorders and increased agitation. It is also FDA-approved for the treatment/management of seizures, treating muscle spasms, and to treat withdrawal disorder symptoms. However, like all benzodiazepines, Valium can cause many side effects such as drowsiness, memory problems, impaired reaction skills, etc.
Pros & Cons of Xanax
Xanax can be used as a short-term treatment for anxiety disorders and as immediate, acute treatment/management for panic disorders. The cons of Xanax are also the side effects caused by the medication, which are similar to most in the benzodiazepine class of medications.
Which Is Right for You: Valium or Xanax?
Whether Valium or Xanax is right for you is based on many factors. Some of the main factors considered are why you might need the medication and the duration for which you will need your symptoms or condition managed. Thus, it is important to discuss with your prescribing provider/physician – why you are being prescribed the medication, and any other concerns you might have. 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 Valium & Xanax
All benzodiazepines, including Valium and Xanax are considered controlled substances. Therefore, they are only available via prescription in the United States. Your prescribing provider will likely also require frequent follow up for close monitoring while you are on the medication.
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Questions to Ask Your Health Team About Valium & Xanax
It is important to take medications that work for you in the best manner with minimal adverse side effects. For this to happen, open communication must happen between you and your healthcare team. When you go to your doctor’s appointments, it can be helpful to come prepared with a written list of questions or concerns you might have when it comes to taking a benzodiazepine like Valium or Xanax.
Questions to ask your prescriber about Valium and Xanax include:
- Is it safe to take Valium or Xanax with my other medications?
- Will Valium 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 Valium or Xanax?
- What should I do if I am unsure whether anti-anxiety medications are right for me?
- How often should I be taking Valium or Xanax?
- Which long-term anti-anxiety medication works best when Valium or Xanax is taken for breakthrough anxiety?
- How can I identify markers that might indicate that I am being dependent or addicted to Valium or Xanax? What should I do if I reach that point?
- What are some Xanax alternatives to consider?
- What happens if I overdose on Xanax or Valium?
In My Experience
In my experience, benzodiazepines (such as Xanax and Valium) should never be the primary prescription to treat anxiety or panic disorders. SSRIs and SNRIs, combined with cognitive behavior therapy, are the treatments of choice to treat anxiety or panic disorders.
Benzodiazepines are prescribed additionally to be used only as a bridge until the SSRI or SNRI starts to take effect (which can take a few weeks initially) – or – for instances of breakthrough anxiety or panic events.
The medication combination that works best for you can be specific to you as an individual. This is why it is important to talk to your physician about which treatment and management options are the best for you. As these are medications that can have significant impacts on you if misuse them, it is important to follow the instructions of your prescribing provider when taking these medications. In addition to your physician, if you have any additional questions, you can also ask your pharmacist – from whom you are picking up these medications.
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
- Choosing Therapy: Medication for Anxiety: Types, Side Effects, and Management
- Valium Vs. Ativan: Differences, Similarities, & Which to Take
- Klonopin Vs Xanax: Differences, Similarities, & Which to Take
- How to Get Prescribed Valium (Diazepam): Everything You Need to Know
- Is Valium Addictive?
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.