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Ativan vs Xanax - What is the difference?

Answers (1)

Official Answer by Drugs.com 29 Mar 2016

The differences: Short answer...

Ativan and Xanax are both benzodiazepines used for the treatment of anxiety, and both are equally effective for this use. Xanax has a quicker onset of effect, but a shorter duration of action (4 to 6 hours) compared with Ativan’s 8 hours. Sedative and performance-impairing effects may occur sooner with Xanax, but dissipate quicker than with Ativan. Activity of Xanax is more likely to be affected by race (people of Asian descent achieve higher concentrations and activity of Xanax lasts longer), concurrent liver or kidney disease, alcoholism and obesity, whereas Ativan is less likely to be influenced by race or age. Ativan and Xanax are usually not prescribed together.

Long answer

What are Ativan and Xanax?

Ativan is the brand name for lorazepam and Xanax is the brand name for alprazolam.1,2 Although both drugs belong to the class of drugs known as benzodiazepines, so have a similar mechanism of action, there are structural differences between them that affect their activity in the body.

Which one works quicker?

Xanax is usually more quickly absorbed than Ativan with peak concentrations occurring within 1-2 hours following administration, compared to 2 hours for Ativan.1,2 Effects of Xanax last on average 4 to 6 hours although there are wide variations between individuals (see below). Effects of Ativan last approximately 8 hours, although may persist for longer in some people.1,2

How much Xanax equals 1mg of Ativan?

Benzodiazepine equivalency tables state that 0.5mg of alprazolam (Xanax) is approximately equivalent to 1mg lorazepam (Ativan).3 However, people of Asian descent metabolize Xanax differently to people of other races, and certain disease states such as alcoholism, liver and kidney disease, obesity and even old age can affect how Xanax behaves in the body; so benzodiazepine equivalency tables should be used as a guide only as they do not reflect individual variation.1,2,3 Both Ativan and Xanax should only be used short-term.1,2,3

How do Ativan and Xanax work?

Both Ativan and Xanax, like all benzodiazepines, enhance the actions of a neurotransmitter in the brain called GABA (gamma-aminobutyric acid).1,2 This neurotransmitter can reduce the activity of nerve cells, so enhancing it has a calming effect which can improve symptoms of anxiety, reduce muscle tension, stop seizures, and induce sleep. Benzodiazepines are also known for their amnesic effect – or ability to disrupt short-term memory – and this makes them useful before surgery. Because of structural differences, some benzodiazepines are more likely than others to make you sleepy, relieve anxiety, stop seizures, relax muscles, or make you forget.1,2,3 Ativan and Xanax are both FDA approved for anxiety-relief, and are less likely than some other benzodiazepines (such as diazepam or temazepam) to induce sleep. Sedative effects of lorazepam that did occur were of slower onset but lasted longer than alprazolam in one trial.4 Lorazepam may also be used in the treatment of seizures.1

Which drug is more effective for anxiety?

Trials that directly compared Ativan and Xanax for the treatment of anxiety have reported no significant differences in their effect, and few differences in their side effects, although mental confusion may be less with Xanax.5,6

Which drug is more addictive?

Both Ativan and Xanax should only be used short-term due to risk of addiction and dependence. Generally speaking, benzodiazepines with a shorter half life (such as Ativan and Xanax) are harder to stop than those with a longer half life (such as diazepam). Both Ativan and Xanax readily enter brain tissue which reinforces drug taking and is generally associated with more severe withdrawal symptoms. Therefore, Ativan and Xanax are both at high risk of abuse. Research directly comparing Ativan with Xanax is not available; however, many experts have particularly advised that Xanax be used with caution as it has been associated with particularly severe withdrawal symptoms.

References

  1. Ativan (lorazepam injection) [Package Insert] Revised 11/2011 West-ward Pharmaceutical Corp. https://www.drugs.com/pro/ativan.html Accessed 03/2016
  2. Xanax (alprazolam) [Package Insert] Revised 03/2015 Pharmacia and Upjohn Company https://www.drugs.com/pro/xanax.html Accessed 03/2016
  3. Benzodiazepine equivalency table Revised April 2007 http://www.benzo.org.uk/bzequiv.htm Accessed 03/2016
  4. Bernardi F, Fossi L, Faravelli C, et al. Alprazolam versus lorazepam in the treatment of anxiety: controlled clinical study. Riv Patol Nerv Ment. 1984 Jan-Feb;105(1):1-13.
  5. Botte L, Bienfait J, Dethier J et al. Clinical comparison between alprazolam and lorazepam. A polycentric study in double blind. Acta Psychiatr Belg. 1981 Nov-Dec;81(6):595-608.
  6. Greenblatt DJ, Harmatz JS, Dorsey C, Shader RI. Comparative single-dose kinetics and dynamics of lorazepam, alprazolam, prazepam, and placebo. Clin Pharmacol Ther. 1988 Sep;44(3):326-34.
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