SAMHSA has found that benzodiazepines in the U.S. are the most abused pharmaceutical drug. Two of the drugs in the “benzo” family are Ativan and Xanax. They are two types of benzodiazepine medications that are available for nearly the same conditions. They come with many of the same risks and users will often abuse them with other substances.
In fact, a TEDS report stated that 95% of people admitted for benzodiazepine dependency abused other substances with it. The Treatment Episode Data Set (TEDS) found that alcohol was frequently abused along with benzodiazepines.
Xanax (alprazolam) and Ativan (lorazepam) are both a part of the benzodiazepine drug group. Benzos are considered a psychoactive drug. They can be administered as sedatives, muscles relaxants, and tranquilizers. They will both be prescribed to ease patients with the following disorders:
- Nervous tension.
- Psychological symptoms of all kinds.
- They can stop seizures and tremens.
- Insomnia due to anxiety.
When comparing Xanax and Ativan, there are quite a few similarities but also some differences. So which is the most effective with the least amount of risks?
Xanax vs. Ativan – How are They Similar?
Xanax and Ativan share many of the same qualities as well as risks. They have the same potency and both medications will begin working relatively quickly in the body. When it comes to Xanax dosage vs. Ativan dosage, they are both administered in low doses due to their high potency.
Ativan dosage: 0.5-1 mg
Xanax dosage: 0.25-1 mg
Ativan vs. Xanax Prescriptions
The uses of Ativan vs. Xanax differ. Doctors will give them to patients with different disorders. They have been FDA approved for patients of different ages as well. Ativan can be used for patients 12 and over while Xanax isn’t prescribed to patients that are under 18.
Ativan dosages are used for patients with anxiety. They can also be used as a preoperative sedative. Ativan is available in a pill or liquid form. The doses are available in 0.5 mg, 1 mg, and 2 mg.
Xanax is also given to patients with anxiety. They can additionally help patients who suffer from panic disorder. Xanax is prescribed to adults that are over 18. Xanax comes in Pill, Extended release, Dissolving tablet, and Liquid form. The doses are available in .25 mg, 0.5 mg, 1 mg, and 2 mg.
Ativan Off-Label Uses
Off-label Ativan use refers to the drug being prescribed for something differently than its FDA approved for. Doctors may choose to prescribe it for purposes that have been proven to work but isn’t an approved use. Here’s what Ativan might be prescribed for:
- For a patient who is irritable.
- For someone suffering from mania.
- Someone who experiences recurring seizures.
- Pre-surgery sedating.
- Vomiting due to chemotherapy.
- Subduing severe seizures.
- Assisting in alcohol withdrawal to prevent delirium tremens.
Xanax Off-Label Uses
Xanax also has some off-label uses. They include:
- Relief of irritable bowel syndrome.
- Someone who experiences premenstrual syndrome.
- Relief of ringing ears.
- Prevention of tremors.
Action Times Between Ativan vs. Xanax
The action times between Ativan and Xanax are different although they are both short acting benzodiazepines. One of the biggest difference between the two drugs is how long they’re active in your body. Ativan action times are longer.
This means that the medicinal effects will last longer in the body. Xanax action time is less so the person will gain benefits of the medication more quickly. It also takes less time for the drug to peak within the body. Ativan can be detected in urine for up to 6 weeks when it’s used in high doses. Even if a person is using the proper doses, it may be detected in drug screening for up to 7 days.
Ativan vs. Xanax-Peak hours
Ativan-Expected time to peak is between 1-6 hours
Xanax-Expected time to peak is between 1-2 hours
Ativan Half Life Times
Ativan average half life is 14-15 hours
Xanax Half Life Times
Xanax average half life is 11-12 hours.
Doctors will prescribe the smallest Xanax dosage possible. The daily dosage is between 0.5-6mg. The medical industry is cautious of Xanax because of the addiction and withdrawal risks. Usually, the Xanax half life is 9-16 hours, depending on how much the person took. Generally, the drug will be completely out of their system in about 4 days.
Addiction Between Ativan and Xanax Differ
When you chronically take any benzodiazepine, the risk of dependency and addiction are there. Both Ativan and Xanax are no exception. To avoid uncomfortable or painful withdrawal, you’ll want to taper off the drugs over a period of time. One of the Xanax side effects is that is has a greater potential to be abused in comparison to other benzos. This includes Ativan.
Ativan Benefits for the Short-Term
Ativan has its benefits for patients who suffer from anxiety and sleeplessness.
Ativan is a CNS depressant that slows down unusual activity in the brain. Through calming the brains’ activity, Ativan helps:
- Relieve anxiety
- Relieve restlessness
- Relieve tension
- Relieve feelings like irrational fears.
It works well with other antidepressants to help manage anxiety disorders. Antidepressants take some time to become effective. Potentially, it can take weeks. This is where Ativan can be helpful because it staves off anxious feelings until the antidepressants kick in.
Ativan use is primarily to help a person manage anxiety symptoms almost immediately for the short-term. Ativan is less likely to have drug interactions compared to Xanax. If someone has to take several medications, Ativan will be at an advantage over Xanax and other benzo’s.
Risks of Continued Ativan Use
In just a few weeks however, the nervous system gets used to Ativan effects. Tolerance to the drug then develops. The user will need higher doses to get to the same place of relaxation and calmness. If the person continues to use Ativan, they can become dependent. This is true for a patient who has taken their Ativan dosage and time frame instructed by their doctor.
The Ativan high can cause people to abuse the drug recreationally. Its tranquilizing effect, which is used to relax someone with anxiety, is the high people are seeking. The Ativan high includes a euphoric feeling when taking larger doses. It can cause adverse effects when mixed with alcohol or other substances. It can cause dizziness and drowsiness, which might be what a user is hoping for from their Ativan high.
Downfalls of Ativan
Cumulative effects of Ativan use or abuse can cause health problems. It can have an impact on a person’s memory. Ativan can be habit forming so using it as long-term treatment isn’t advised. Ativan is one of the more challenging benzodiazepines to withdraw from. Taking it for long periods of time is especially risky, potentially causing addiction.
For those with alcohol or substance abuse problems, they should not be prescribed Ativan. It can cause serious health problems, which includes falling into a coma or death. People who have taken Ativan for long periods of time say that it gets less effective over time. This can cause people to abuse the drug to obtain the benefits.
Ativan Side Effects
Ativan come with side effects such as
- Problems with sleeping.
- Cognitive memory problems.
- Temporary drowsiness, dizziness, and confusion.
- Physical and mental exhaustion.
Serious Ativan Side Effects
Serious Ativan side effects can put people at risk. If a person experiences the following, they should call their doctor immediately:
- They become confused.
- As benzodiazepines are a depressant to the CNS, they may become depressed.
- The depressive feelings can lead to thoughts of suicide or hurting oneself.
- They may experience hyperactivity.
- They may become agitated which can turn to hostility.
- They may experience hallucinations.
- They may become light-headed which can lead to fainting.
The benzo family will produce an increase of central nervous system depressant effects when mixed with other substances. This means that a person can become highly depressed or their brain may function very slowly. It can also cause fatal respiratory depression when combined with CNS depressants. If a person is already depressed and they take Ativan regularly, their condition may worsen. If someone has been diagnosed with a depressive disorder, they shouldn’t be treated with Ativan.
Occurrences of risk include:
- Taking more Ativan than recommended.
- Using it for longer than a month.
- If the patient has drug abuse history.
- Long-term use.
- If the patient mixes with alcohol.
Xanax has proven itself to be effective for relief of short-term anxiety. When Xanax vs. Ativan is compared for efficacy of managing anxiety, both are similar. Xanax can also be used in conjunction with slower acting antidepressants. Xanax use is effective when used for the short-term until the long-term antidepressant treatment kicks in.
Xanax does what most benzodiazepines do, acts on the nerves to create a calming effect. Its anxiolytic properties comes in immediate or extended release. The main benefit of Xanax is the compressed tablet that helps someone relax from a panic attack immediately. Due to its ability to onset immediately, Xanax is the drug of choice for controlling panic attacks.
It doesn’t take long before Xanax use begins to reveal negative effects on the person. Medically assisted withdrawal from the drug may be necessary which includes tapering off slowly. If someone uses Xanax for too long, they may even require a supervised detox. Someone with bipolar disorder may find it challenging to sleep if they take Xanax. It can also cause mania or excitability.
Common withdrawal symptoms include:
- Inability to sleep.
- Extreme anxiety or onset of panic attacks.
- Trembling or seizures.
- Heart palpitations.
Risks of Continued Xanax Use
When taking Xanax, the body produces far less GABA. This is the body’s natural calming capabilities. The dependency is swift and it’s not particularly safe to withdraw from benzodiazepines alone. The Xanax high comes with its own risks as well. As with any benzodiazepine, it can offer a nice, sedative high that people are drawn to.
Overdose of Xanax is possible when someone takes more than the recommended dose. It may also occur when someone stops and then restarts using Xanax. Mixing Xanax with other depressants like alcohol or other benzos can be extremely risky, causing death.
Xanax Side Effects
Common Xanax side effects include:
- Potential tolerance and habit forming tendencies.
- Can cause slurred speech.
- A change in sex drive.
- Respiratory depression which leads to shortness of breath.
Regardless of whether a person follows their Xanax dosage or not, these serious side effects may occur. If someone experiences these symptoms, they should seek out medical assistance:
- Chronic headaches.
- Difficulty concentrating.
- Dry mouth or an increase in salivation.
- Inability to sexually perform.
- Rapid changes in weight.
- A problem urinating.
- Skin rashes.
- Seizures may occur.
- Rapid, extreme mood changes.
Comparing Ativan vs. Xanax as Effective Prescription Medications
Both Ativan and Xanax are fast-acting benzodiazepines. This does make them an effective part of anxiety treatment. It also makes both of them risky to take because of the amount of pills needed on a daily basis. This can make both drugs more susceptible to being abused.
Xanax is primarily treated for anxiety disorders and short-term relief of anxieties. Xanax uses also fall into the category of helping with panic disorders that involve agoraphobia (or not). It is also helpful with anxiety that is specifically associated with depression.
Ativan is FDA approved for managing anxiety disorders also. It is only approved as a short-term treatment for up to 4 months. It relieves anxiety symptoms that are associated with depression or stress that is associated with insomnia.
What’s important to point out is that Xanax is approved for panic disorder while Ativan is not. Xanax is more likely to be abused because of its fast acting absorption in to the blood stream. If someone uses Ativan for longer than 4 months, it can be more challenging than Xanax to withdraw from. In fact, it may take assistance from an addiction treatment clinic to help a person abstain. This is because intense withdrawal symptoms like seizures or uncontrollable anxiety may occur. The rebound effect can be difficult to manage.
Dangers of Benzodiazepines in General
Statistics make it clear that there is a high use of benzodiazepine abuse. Millions of Americans have gone to the emergency room for recreational benzo use. People are abusing the drug in combination with other substances that can cause adverse effects. The Drug Abuse Warning Network (DAWN) stated that fatalities and addiction admissions have been steadily increasing over the years.
For many that start using Ativan and Xanax, there will be withdrawal symptoms. It’s not always easy to get off these prescription drugs. The body gets a tolerance to them quickly and dependence sets in even if a person follows the doctor’s instructions.
When it comes to Ativan vs. Xanax, they share characteristics that are similar. They both have the ability to be abused, are highly addictive, and come with the same risks. It’s a matter of what type of anxiety the person has and whether it includes panic attacks. Whatever drug a person is prescribed, they should be used as instructed and taken with caution.
NCBI, Pharmacotherapy (April 1984) Long-term comparison of alprazolam, lorazepam and placebo in patients with an anxiety disorder. Retrieved from, https://www.ncbi.nlm.nih.gov/pubmed/6144090NCBI
NCBI, Yale Journal of Biology and Medicine (Sept. 2015) Prescription Sedative Misuse and Abuse. Retrieved from, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553644/
NCBI, Addiction. (Nov. 1994) The benzodiazepine withdrawal syndrome. Retrieved from, https://www.ncbi.nlm.nih.gov/pubmed/7841856
NCBI, Psychopharmacology Berlin. 1995 Mar .Comparison of acute alprazolam (0.25, 0.50 and 1.0 mg) effects versus those of lorazepam 2 mg and placebo on memory in healthy volunteers using laboratory and telephone tests. Retrieved from, https://www.ncbi.nlm.nih.gov/pubmed/7597114