Ativan vs Xanax: The Duel Between Two Benzodiazapines

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Ativan vs Xanax: The Duel Between Two Benzodiazapines

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.

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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, muscle relaxants, and tranquilizers. They will both be prescribed to ease patients with the following disorders:

  • Anxiety.
  • Nervous tension.
  • Psychological symptoms of all kinds.
  • They can stop seizures and tremors.
  • 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 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

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 uses:

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 uses:

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 different 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

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 differences 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’s 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 is 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 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 benzos.

Risks of Continued Ativan Use

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.

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Downfalls of Ativan

The 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 include 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 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

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.

Ativan Risks

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 a drug abuse history.
  • Long-term use.
  • If the patient mixes with alcohol.

Xanax Benefits

Xanax has proven itself to be effective for the relief of short-term anxiety. When Xanax vs. Ativan is compared for the 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 come in an immediate or extended-release form. 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.

Xanax Downfalls

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.
  • Irritable.
  • Extreme anxiety or the onset of panic attacks.
  • Trembling or seizures.
  • Nausea.
  • 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.
  • Fatigue.
  • 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.
  • Exhaustion.
  • 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.
  • Depression.
  • 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 number 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 use also falls 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 into 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

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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.

2019-11-08T14:23:51+00:00June 1st, 2019|22 Comments

About the Author:

Gerard Bullen
Gerard Bullen is a substance abuse and addiction recovery freelance. After many years of writing about recovery, he believes that recovery doesn’t just happen to people. An addict needs to find it, hold on to it, and never let it go.

22 Comments

  1. Avatar
    F.B. March 1, 2019 at 6:02 am

    This is great, clear, concise information! Exactly for what I was looking and presented in an easy to understand method. Sad how we’ve become an infographic society. Anyway, thank you very much! This actually answered all the questions I had regarding each drug. Again, wonderful presentation of information!

    • Avatar
      Evergreen Staff March 6, 2019 at 8:16 pm

      We are glad you found the information helpful! We wish you nothing but the best as you continue your journey!

    • Avatar
      M. Baker March 31, 2019 at 1:49 am

      Very good advice. And as someone who takes these meds therapeutically, I can attest this information is true. To those out there, be careful and remember “less is more” in your treatment regimen. Respect your meds and you will reap the most benefit for a fuller and happier life.

  2. Avatar
    Evergreen Staff April 3, 2019 at 6:03 pm

    Thank you so much for sharing your personal experiences! We wish you all the best!

  3. Avatar
    Danielle April 24, 2019 at 7:15 pm

    This article is well-written and helpful to me. I am about to try Ativan (was just prescribed for me) and it helps me to understand why my Psych picked it for me over Xanax. It also helps me set goals to take as little as possible, watch for signs of dependence, and not plan on taking it indefinitely! Thank you so much!

    • Avatar
      Evergreen Staff April 25, 2019 at 6:15 pm

      Glad you found the article helpful! As with any medication, it is always best to watch for dependency signs and only take as needed. We wish you all the best on your journey!

  4. Avatar
    Anthony Harrell April 26, 2019 at 4:10 pm

    Great information. I am at the front end of an anxiety/panic disorder, and am wanting to make a choice on which medication to use. After 20 very vague articles seemingly written for for the recreational drug user. Finally one that answers the truly clinical questions I had.

    • Avatar
      Evergreen Staff May 15, 2019 at 4:55 pm

      Glad you enjoyed the article! We wish you all the best on your journey!

  5. Avatar
    LILA GOLDBERG May 8, 2019 at 2:14 am

    ARTICLE HAD EVERYTHING I WANTED TO KNOW. THANK YOU

    • Avatar
      Evergreen Staff May 15, 2019 at 4:38 pm

      Glad the article resonated with you!

  6. Avatar
    Jenni May 21, 2019 at 5:43 pm

    Thanks for the balanced and concise information. I am a therapist, and I’m frustrated with how many of my clients have been given long term prescriptions to take Xanax daily. It is especially problematic for Panic Disorder, where benzodiazepine we makes panic symptoms worse over time. And it is unnecessary. Cognitive Behavior Therapy is extremely effective for Panic Disorder. A few months of CBT therapy and most clients no longer meet the criteria for Panic Disorder diagnosis. Many of my clients stopped xperiencing panic attacks within a month of starting weekly CBT therapy.

    • Avatar
      Evergreen Staff June 3, 2019 at 5:12 pm

      Thank you for adding your information and continuing this discussion! We are glad you found the article helpful and wish you all the best!

  7. Avatar
    Ariel May 26, 2019 at 11:09 pm

    Thank you for the information about the medicine it was exactly what I was looking for and will help me get the right one for my condition.

    • Avatar
      Evergreen Staff June 3, 2019 at 5:10 pm

      Glad you enjoyed the article and found what was best for you!

  8. Avatar
    David Rupert June 21, 2019 at 7:50 am

    I’m currently taking Ativan 2 mg. I’m thinking of switching to Xanax as panic attacks are my main concern. Why did my psychiatrist prescribe Ativan knowing I suffer from panic attacks?

    For me, a 61 year old man, I’m thinking Xanax is my best choice. I also take Prozac too.

    • Avatar
      Evergreen Staff August 1, 2019 at 5:33 pm

      You can ask your psychiatrist why they prescribed Ativan. Perhaps they know of other medications or medical history that they wouldn’t want to mix with Ativan?

  9. Avatar
    Victoria June 23, 2019 at 3:08 am

    Great information,, just what I needed to know. Thank you

    • Avatar
      Evergreen Staff August 1, 2019 at 5:26 pm

      Glad you found the article helpful!

  10. Avatar
    Ray. L. July 5, 2019 at 6:51 pm

    Thank you for the simple, yet informative breakdown that all age groups can understand. I would just like to add that while a patient is taking benzos that grapefruit and grapefruit juice should be avoided as well as cigarette smoking, because both can lessen the effectiveness of these meds, which may in turn cause a person to want to increase their dose or take their more frequently. This can up the chances of addiction and dependency to these meds.

    All in all tho, a great read. Thank you!

    • Avatar
      Evergreen Staff August 1, 2019 at 4:59 pm

      Thank you for that tip! Glad you liked the article and wish you all the best!

  11. Avatar
    Melanie July 16, 2019 at 6:16 pm

    I have been using Xanax for the past 20+ years. I am 63 but when I was in my mid twenties, I started having panic attacks. I’ve been in many ERs because I think I am dying. I saw a psychiatrist and she put me on Xanax. I also went to the classes at night. A follow up to the psychiatrist and she asked if either is helping and I told her “no”. She asked how I was taking the Xanax. I told her “every time I have a panic attack”. She then said “You are taking them wrong. You have to take it twice daily. It needs to be in your system”. So I took them daily, went to the night classes and the panic attacks stopped. I kept a full bottle of Xanax in my purse for a year and at that time I threw them away.
    Then, in my mid forties, I started having panic attacks. More trips to the hospital. I started taking Xanax again. I have panic attacks and I am a chronic pain patient. It has taken years to get exactly what works for me. I got it down to 2 prescriptions after a time I was taking 5-6 different pills twice a day. I went to different types of doctors for different things. Neurologist, urinologist, Breast doctor etc… For the past 10 years I’ve tried to figure out which pills I don’t need. And it was after trial and error of many medications. Because I have panic attacks I can’t drink anything that makes my heart race. I stopped drinking caffeine almost 36 years ago. So I’m perfectly happy with the 2 medications I’m taking. No panic attacks, controlled pain and the the DEA comes out with guidelines that freak the doctors and the pharmacist out!!! I have been going to the same primary care doctor for the past 34 years but I haven’t seen him in 2 1/2 days. I have seen 6-7 different doctors at his office. They lowered my daily dosage from 4 to 3 Norcos. I did it but I wasn’t happy about it. At times I need to take 1 1/2 so I’m always counting and figuring out how many I have left before I can get another prescription. I shouldn’t have to worry about that!! Then they wanted to switch me from the Xanax to the Ativan. This on dr. Gave me a prescription of Pristiq!! I took it twice and a horrible reaction to it. My blood pressure spiked!! Now they are telling me that taking Norco and Xanax will kill me. HA I’ve been taking them for 20+ years and I am fine. I brought the Pristiq in and threw it at them ( not really but I felt like it. I did give it to them though). Now they have to put me on blood pressure medicine so they gave me Colonidine. Told me to take a whole in the morning and a whole at night. It brought my pressure down I was falling asleep at work. So now I’ve been on Bystolic for the past 5 days and I have not got a good nights sleep. They also stopped giving me Xanax and gave me Ativan to take twice daily. So now I’m shaking, I have knee jerk responses all over my body. I am hyper and my blood pressure is still high!!! I don’t like to hear my heart beat and I can hear it sleeping AND my heart is fluttering!! My dad has a pacemaker put in. I’m alot like him and I DO NOT want a pacemaker!!! I am so tired of those doctors taking me off and putting me on new medications that don’t know the first thing about me. They do not know how I’m going to get through this month. I was resigned to the fact that I would be on Xanax and Norco for the rest of my life. Yes, it’s tedious and yes, I’m dependent on them but I would like to live my life without pain and anxiety and in peace. So now that it is affecting my heart I’m putting my foot down. They may ask me to get another doctor. I have no idea who to go to. I’d really like to see my doctor. I’m thinking there are going to many people suing doctors until they stop this BS!!!

    • Avatar
      Matthew September 9, 2019 at 11:37 pm

      Hopefully it gives you some relief knowing you aren’t the only one that is going through this (I know it won’t, just kind words). As I’ve gone through the same problem, as well as my father before me. I am going to try and keep this as short as possible as most people won’t read a wall of text, obviously I’m not most people though…

      I had been taking Alprazolam for 8 years before I not only had my dosage split in half, but the medication switched to Lorazepam. In the beginning it took a while to adjust to Ativan, even though it being a benzodiazepine there are a few characteristics that differ from Xanax. Ativan took a couple months to achieve what Xanax does in hours. I personally also find that Ativan is slightly less potent then Xanax, but that may just be because of the time it takes to reach peak levels and half-life i assume.

      I was on the Ativan for a little over 1 year before switching to a doctor that was willing to give me Xanax. I wasn’t looking for one, I had just moved to a new state. Although, my dosage was again reduced from 3 tablets to 2 daily.
      Now for the past year, I’ve been struggling to manage the anxiety and panic attacks with just 2 tablets daily. This is completely unacceptable, but with the way things are i have no choice but to live with it…

      I have been talking to my doctor about an alternative, and of course they recommend anti-depressants or Librium as 2 of the 4 possibilities, and we all know that’s a death wish. The other 2 possible routes would be to switch to Clonazepam (Klonopin) but at the cost of having my dosage cut in half once more, because they somehow figure it to be stronger then Xanax (eg. 1mg xanax = .5mg klonopin) which i very highly doubt. The other route, which i is the one i took, was keep everything the same but instead of immediate release xanax twice a day i take extended release twice a day. Same dosage, just extended release rather immediate.

      I made sure to ask them to give me some assurance as to what if this doesn’t help as much or even worse it doesn’t help at all. The doctor gave me a 2 week prescription with the choice to continue or switch back after.
      I’m hoping this works, as the only other option would be the klonopin at half strength. I would’ve gone with the klonopin if it was the same strength and dosage, but unfortunately science takes precedence over personal experience when it comes to doctors now.

      I have been taking these drugs for sometime now, and have been on all 4 main benzodiazepines. I am not a fool, and i know what works for me. Everyone is different, and doctors see that but are forced to prescribe a “one size fits all” method for whatever reason now. So we are stuck with half-ass help because the patient isn’t as important as the guidelines.

      Good luck to you, and godspeed to all of us in the same situation. Take care!

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