Anxiety disorders are the most common mental health problem in the United States. Millions of people deal with anxiety symptoms each year. They can get in the way of important goals in your life or generally lower your quality of life. In some cases, severe anxiety and panic disorders can be difficult to live with without help. However, anxiety is treatable with multiple therapeutic options, including medications. Ativan and Xanax are both common drugs used to treat anxiety disorders in the United States. How do these similar drugs compare, and what is the difference between them?

What Is Ativan?

Ativan is a popular brand name in the United States for a drug containing lorazepam as its main active ingredient. Lorazepam is in a category of drugs called benzodiazepines, a group of central nervous system depressants. Benzodiazepines slow down central nervous system activity, so they may be used to treat a wide variety of issues that an overactive nervous system causes.

Ativan is primarily used to treat anxiety disorders, but it can also be used to treat sleep disorders, severe agitation, seizures, epilepsy, nausea caused by chemotherapy, and even alcohol withdrawal. Lorazepam may also be used as a sedative during certain surgical procedures. Lorazepam can be given as an injection and by mouth. Ativan is available as an intramuscular injection and a tablet.

The medication can come with uncomfortable side effects, including weakness, low blood pressure, drowsiness, and slowed breathing. Side effects may be more intense when the drug is taken in high doses or misused. In some cases, Ativan can worsen depression, leading to suicidal thoughts or actions. If you have a mood disorder, ask your doctor if Ativan is right for you or if there are safer options. If you experience suicidal thoughts, speak to your doctor or therapist immediately. Adjusting or changing medications can help you to feel better.

As with other benzodiazepines, Ativan comes with a risk of physical dependence and addiction. Taking the drug for too long can cause your body to adapt to it. When you stop using suddenly, it can cause uncomfortable and even dangerous withdrawal symptoms. Dependence and addiction may be even more dangerous when the drug is used as a recreational substance. As a central nervous system depressant, Ativan may be used to achieve a relaxing high similar to alcohol.

Ativan is also not recommended in older adults. Benzodiazepines may be more difficult to process as people age. Older adults may be more likely to experience side effects like dizziness, drowsiness, and falls, which can lead to serious injuries.

What Is Xanax?

Xanax is one of the most popular benzodiazepine brands in the United States. It’s a brand-name drug that contains the active ingredient alprazolam, a central nervous system depressant. Alprazolam is a specific subcategory of benzodiazepines called triazolobenzodiazepine, which are benzodiazepines that are fused with a compound called triazole. This distinction makes alprazolam chemically unique, but it works in a way that is very similar to other benzodiazepines.

Xanax is used for its ability to provide fast-acting relief for anxiety disorders, including panic disorder and generalized anxiety disorder. Like Ativan, it can also be used for other purposes like nausea caused by chemotherapy. Xanax is available in tablet form, and alprazolam is generally taken by mouth. The effects can be felt within an hour, and a therapeutic regimen for anxiety can yield results within a week.

The drug can also come with its fair share of side effects, including drowsiness, depression, headaches, fatigue, dry mouth, and memory impairment. As with many prescription drugs, the side effects are more likely if the drug is misused or taken in high doses.

Like Ativan and other benzodiazepines, Xanax can be abused as a recreational drug. Prescription pills may be bought and sold illegally for recreational use. In many cases, drug dealers are able to press their own pills to look identical to Xanax. These counterfeit pills may contain Xanax and a host of other potentially dangerous substances.

Chemical dependence can happen when the drug is taken consistently for a few weeks in a row. If you quit cold turkey after becoming dependent, you could experience potentially dangerous withdrawal symptoms, including seizures. Withdrawal commonly comes with rebound symptoms, which involve a return of symptoms that the drug was intended to treat. Like Ativan, Xanax can cause suicidal thoughts in people with depression.

What Are the Side Effects of Ativan?

Like most prescription drugs, Ativan can come with some side effects. When you start taking the medication, it’s important to monitor your side effects and to let your doctor know if any of them are persistent, worsening, or difficult to stand. If you’re experiencing side effects, your doctor may be able to help by adjusting your dose or changing your prescription.

According to the Food and Drug Administration (FDA) label for Ativan can cause the following symptoms as side effects:

  • Depression
  • Sedation
  • Muscle weakness
  • Dizziness
  • Unsteadiness
  • Dependence
  • Withdrawal

The FDA points out that pre-existing depression may emerge or get worse while you’re on Ativan. Since Ativan acts as a depressant, it can lower your mood. If you have a mood disorder, that could mean depressive symptoms and even suicidal thoughts.

Quitting Ativan after a period of consistent use could cause withdrawal symptoms. If you’ve become chemically dependent and you quit suddenly, you could experience dangerous side effects that require medical attention and supervision. Withdrawal symptoms can include seizures, insomnia, depression, anxiety, and other issues. Ativan withdrawal may be worse if you’ve gone through withdrawal from another depressant before.

What Are the Side Effects of Xanax?

Though Xanax is a popular choice and it’s relatively safe to use, it can come with side effects. As with any prescription, it’s important to keep your doctor up to date with any persistent or worsening symptoms you may have. Treatment with medications is another trial and error process in which you work with your doctor to find the medication and dose that’s right for you.

According to the FDA, common side effects of Xanax appear after you first start taking the drug, but they fade as you get used to it. Common Xanax side effects can include:

  • Drowsiness
  • Lightheadedness
  • Dizziness
  • Fatigue
  • Headache

Like Ativan, Xanax can cause withdrawal symptoms after a period of consistent use and chemical dependence. During withdrawal, you may experience mild symptoms like insomnia, anxiety, and depression. Severe symptoms can include seizures and heart palpitations. If you’ve become dependent on Xanax, you should speak to your doctor about tapering off of the drug safely. Like other depressants, withdrawal may be worse if you’ve gone through depressant withdrawal before.

According to the FDA, Xanax can also cause mania symptoms in people with depression. Mania is a heightened state of mood that can cause racing thoughts, excitement, anxiety, and a sense of empowerment. Mania is often associated with the mood disorder bipolar disorder, but it may occur in some people who take Xanax.

What Are the Similarities Between Xanax and Ativan?

Xanax and Ativan are similar in many ways. Both are central nervous system depressants in the benzodiazepines class of drugs. They are also used to treat the same issues. They are both FDA-approved for use in treating anxiety disorders. Xanax is specifically indicated for use in panic disorders. Both drugs may also be used off-label to treat other issues like chemotherapy-induced nausea.

Ativan and Xanax work in the brain in similar ways. Like other benzodiazepines, they work with a natural chemical called gamma-aminobutyric acid (GABA). GABA is a neurotransmitter that works to slow down activity in your central nervous system. It’s involved in your body’s rest and digestion response. It facilitates sleep and relaxation.

It also causes anxiolysis, which is relief from anxiety and vigilance that keeps your mind working and your body ready for action. Xanax and Ativan are able to bind to GABA receptors in the brain, but not so that they block GABA from binding. When GABA binds to its receptors, the drugs increase the natural chemical’s potency, causing more intense relaxation. Xanax and Ativan work in this way, but other depressants can also work in a similar way, including alcohol.

What Are the Differences Between Xanax and Ativan?

Xanax and Ativan have many similarities because they both work very similarly in the brain. However, they do come with some differences to consider as you are looking for an anxiety treatment with your doctor. Both drugs last for a similar amount of time, around five to eight hours. But Xanax is available in an extended-release form called Xanax XR. This can last as long as eleven hours. There is an extended-release form of lorazepam under another brand name called Loreev XR.

Lorazepam is the older of the two medications. It was patented in 1963, in the early years of benzodiazepine use. It went on sale in the United States in 1977. Alprazolam was later patented in 1971, and it was FDA-approved in 1981. Though Ativan came first, Xanax is more prevalent. In 2019, more than 17 million prescriptions were dispensed in the United States, while Ativan saw 10 million prescriptions.

Though they work in the same way, they are chemically distinct. As a triazolobenzodiazepine, alprazolam is technically an analog of the benzodiazepine class that lorazepam belongs to. That means it is a slight variation on benzodiazepines.

While both are used to treat anxiety disorders, Xanax is more commonly used to treat panic disorders, and it is specifically approved by the FDA to do so. Ativan is approved to treat anxiety disorders, but it may be reserved for generalized anxiety. However, if Xanax is ineffective in treating anxiety, your doctor may want to try Ativan.

Does Ativan Feel the Same as Xanax?

Xanax and Ativan can have similar effects on your body, but your experience with the two drugs may vary. Every person is different, and you may respond to one drug differently than another. When you’re working with your doctor to find effective relief from anxiety, you may try several options before finding the medication that’s right for you.

For instance, you may experience more side effects on Xanax than you do with Ativan or vice versa. One may be more effective at treating your particular symptoms than the other. Though they have the same potential effects and side effects because they work so similarly in the brain, your experience with each drug may be unique.

Which Drug Is More Addictive?

Both lorazepam and alprazolam come with the risk of physical and psychological dependence. The dependence occurs when your brain and body adapt to the presence of a drug over time. As a depressant, benzodiazepines can cause your brain to adapt to the drug’s nervous system suppressing effects. Your brain may produce fewer inhibitory chemicals and increase its excitatory effects. Dependence will cause uncomfortable withdrawal symptoms when you miss a dose or cut back. It will also cause intense drug cravings. If you quit cold turkey, you may experience dangerous withdrawal symptoms like seizures and hypertension.

The FDA label warns that Ativan should be prescribed for short, therapeutic use for around two to four weeks. The label for Xanax warns that the risk of dependence is higher after 12 weeks. Bezodiapaines are capable of causing dependence after a period of consistent drug use. Your doctor can help you mitigate that risk by recommending tolerance breaks, which is a break from taking the medication to allow your brain chemistry to return to normal.

Addiction is often related to dependence, but it’s more complex. Addiction is a disease that affects the reward center of the brain. It’s often linked to neurotransmitters like dopamine, which are responsible for reward and motivation. Ativan and Xanax can increase dopamine levels. With long-term use or recreational misuse, your brain may learn to seek out the elevated dopamine levels provided by benzodiazepines.

Is Xanax or Ativan Stronger?

The strength of these two drugs can be revealed by looking at their effective doses. The drug with the lower effective dose is generally considered to be stronger, producing more intense effects at lower doses. Ativan is administered in 0.5-mg, 1-mg, and 2-mg tablets. When treating anxiety, it’s typical for 2 mg to 3 mg to be taken per day, with the dose spread across two or three doses per day. Larger doses may be taken before bedtime if you also struggle with insomnia. Very large daily doses may be as high as 10 milligrams. Lower doses are recommended for older patients.

Xanax is administered in 0.25-mg and 0.5-mg doses three times per day. Four milligrams is the maximum daily dose that is recommended. It’s also recommended to start with a low dose of 0.5 mg. Because Xanax is typically effective in smaller doses, it’s generally considered to be the stronger of the two drugs. However, their effective doses are similar, and just because Xanax is stronger doesn’t mean it will be more effective for your needs.

What Are the Contraindications of Ativan vs. Xanax?

As with any prescription drug, the FDA warns that you should avoid using Ativan or Xanax if you’ve experienced sensitivity to them in the past. If you’ve found that you are sensitive to another benzodiazepine or depressant mediation in the past, let your doctor know before you take either of these medications.

People of certain age groups should also avoid benzodiazepines. Of course, like many prescriptions, benzodiazepines are not appropriate for use in children. Also, older adults may also react poorly to the drugs. They may lose their ability to process benzodiazepines efficiently. Taking Ativan or Xanax may lead to more intense side effects than they would in other people. Elderly patients may also experience drowsiness and sedation that leads to falls, which can cause serious injuries.

People with respiratory problems should also avoid Xanax and Ativan. Depressants can cause respiratory depression, which is when your breathing slows down because the central nervous system is depressed. When the drug is taken normally, most people won’t experience effects on breathing, but high doses can cause side effects. However, people with respiratory problems may be more vulnerable to slowed breathing. This also applies to people with sleep apnea, which is a disorder in which your breathing will pause sporadically while you sleep.

Benzodiazepines can cause your muscles to relax, so people with myasthenia gravis should avoid Xanax and Ativan. Myasthenia gravis is a condition that causes muscle weakness, which can be worsened by muscle relaxants.

Both drugs should not be taken by someone with the condition that affects the eyes called acute narrow-angle glaucoma. Lorazepam and alprazolam have effects that dilate the pupils, which can worsen some of the effects of this disease, leading to worsening vision.

What Are the Drugs That Should be Combined with Ativan or Xanax?

Ativan and Xanax are similar drugs, so they shouldn’t be combined with each other or other benzodiazepines. Likewise, they shouldn’t be combined with other central nervous system depressants like barbiturates and non-benzodiazepine sedative-hypnotics. Alcohol is among the most commonly misused substances alongside benzodiazepines, but mixing alcohol and benzos can be dangerous.

Combining alcohol and other depressants can cause the substances to potentiate. Potentiation is when similar drugs combine to cause more intense effects. Like benzodiazepines, alcohol can slow down activity in your nervous system in the same way that benzos can. When they are mixed, they can slow down the nervous system to the point of interrupting the unconscious functions of the brain. Depressants can have a particular effect on your breathing. Mixing Ativan or Xanax with other depressants could risk respiratory depression and deadly overdose.

Opioids are technically not respiratory depressants, but they can slow central nervous system activity. Even though they work differently from alcohol and prescription depressants, mixing them with benzodiazepines can also lead to dangerous respiratory depression.

Other medications can cause drowsiness that Ativan or Xanax can worsen. Antihistamines, which are common in allergy medications, could cause drowsiness when mixed with benzos. Benadryl is a common antihistamine medication. If you take Ativan or Xanax and then take Benadryl, you could experience drowsiness, dizziness, and sedation. It could make it more difficult to get through tasks that require your attention. But it could lead to accidents and injuries as well.

What Are the Effects of a Xanax or Ativan Overdose?

Drugs like Xanax and Ativan can cause uncomfortable and even dangerous overdose symptoms. You’re more likely to experience the side effects of either of these medications when taking a high dose or mixing the drugs with similar substances. Drowsiness, sedation, and depression are among the most common. However, severe overdose can include respiratory depression, loss of consciousness, slowed heart rate, coma, and death.

Deadly overdoses of Xanax or Ativan usually involve a second substance like alcohol or opioids. However, it is possible to experience a life-threatening overdose of either drug on their own. Very high doses can slow or stop your breathing, which can cause brain damage, rapid muscle breakdown, coma, or death. Xanax is more commonly taken as a recreational drug, so it may be associated with overdoses more often. Taking illegally sourced Xanax can also increase your risk of overdose since dealers can press their own Xanax pills with other dangerous additives. An Ativan or Xanax overdose is a medical emergency.

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