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Drug vs. Drug

Ativan vs. Xanax: Differences, similarities, and which is better for you

Karen Berger medical writer and reviewer headshot By | February 10, 2020

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Ativan (lorazepam) and Xanax (alprazolam) are two prescription drugs indicated for the treatment of anxiety. Both drugs are available in brand or generic. They are classified in a group of medications called benzodiazepines, which work in the CNS (central nervous system). They work by increasing activity at receptors for a neurotransmitter called gamma-aminobutyric acid (GABA). By doing this, benzodiazepines produce a relaxing and calming effect and help promote sleep when taken at bedtime.

Ativan starts working within an hour, and the effects last for up to eight hours. Xanax starts working within an hour, and the effects last for about five hours (the extended-release version lasts up to about 11 hours). Both drugs have a half-life (the time it takes for the amount of drug to decrease by half) of about 12 hours. Both medications are therapeutically known as benzodiazepines; however, they do have some notable differences, as outlined below. Both drugs are controlled substances and classified as Schedule IV drugs.

What are the main differences between Ativan and Xanax?

Ativan and Xanax, both classified as benzodiazepines, are both available in brand name as well as generic. The generic of Ativan is lorazepam, and the generic of Xanax is alprazolam. Ativan is available in tablet form, injection, and oral concentrate. Xanax is available as both immediate-release and extended-release tablets, as well as an oral concentrate. Ativan is used in children 12 years and older; Xanax is used in adults. Both drugs are intended to be used for a short period of time, but often, patients continue long-term based on the doctor’s instruction, and with careful monitoring.

When either drug is being used, the dosage should be increased slowly, and when the drug is discontinued, it should be done by tapering slowly.

Main differences between Ativan and Xanax
Ativan Xanax
Drug class Benzodiazepine Benzodiazepine
Brand/generic status Brand and generic Brand and generic
What is the generic name? Lorazepam Alprazolam
What form(s) does the drug come in? Tablet
Oral concentrate
Injection
Immediate-release tablet
Extended-release tablet
Oral concentrate
What is the standard dosage? Usual range is 2 to 6 mg per day in divided doses (for example, 1 mg tablet taken 3 times daily) Usual range is 0.25 mg to 0.5 mg taken 3 times daily; dosage varies
How long is the typical treatment? Short-term; some patients use longer under doctor supervision Short-term; some patients use longer under doctor supervision
Who typically uses the medication? Adults; children 12 and older Adults

Conditions treated by Ativan and Xanax

Ativan and Xanax are both indicated in the management of anxiety disorders. Both drugs are indicated for the short-term relief of the symptoms of anxiety, and short-term relief of anxiety associated with depressive symptoms. Xanax is also indicated for the treatment of panic disorder, with or without agoraphobia. Both medications also have several off-label uses, outlined below.

Condition Ativan Xanax
Management of anxiety disorders Yes Yes
Short-term relief of the symptoms of anxiety Yes Yes
Short-term relief of anxiety associated with depressive symptoms Yes Yes
Treatment of panic disorder, with or without agoraphobia Off-label Yes
Rapid tranquilization of the agitated patient Off-label Off-label
Alcohol withdrawal delirium/alcohol withdrawal syndrome Off-label Off-label
Insomnia Off-label Off-label
Chemotherapy-associated anticipatory nausea and vomiting Off-label Off-label
Delirium Off-label Off-label
Depression No Off-label
Essential tremor Off-label Off-label
Ringing in the ears Off-label Off-label
Premenstrual syndrome Off-label Off-label

Is Ativan or Xanax more effective?

A placebo-controlled, double-blind study compared Ativan and Xanax in the treatment of patients with severe anxiety. Both drugs were found to be more effective than placebo, with Xanax being slightly more effective in later weeks of the study. However, another study of the two drugs for anxiety showed both drugs to be effective, with Ativan being slightly more effective.

Another study compared the two drugs in the treatment of panic disorder and found Ativan and Xanax to be equally effective.

The most effective medication for you should only be determined by your doctor, who will take into account your medical condition(s), history, and other medications you take.

Coverage and cost comparison of Ativan vs. Xanax

Ativan is typically covered by insurance and Medicare Part D in its generic form of lorazepam. The brand-name Ativan may not be covered or have a high copay. A typical prescription of lorazepam would be for 30 tablets of 1 mg and cost about $24 out-of-pocket. Xanax is also typically covered by insurance and Medicare Part D in the generic form of alprazolam. The brand-name Xanax may not be covered or have a high copay. A typical prescription of alprazolam would be for 60 tablets of 0.5 mg and cost about $33 out-of-pocket. You can save money using a SingleCare coupon on generic Ativan or Xanax.

Ativan Xanax
Typically covered by insurance? Yes Yes
Typically covered by Medicare? Yes Yes
Standard dosage #30, 1 mg tablets of lorazepam #60, 0.5 mg tablets of alprazolam
Typical Medicare copay $0-$24 $0-$33
SingleCare cost $7-$17 $10-$20

Common side effects of Ativan vs. Xanax

Side effects of Ativan and Xanax tend to be greater at higher doses. The most common side effects of Ativan are sedation, dizziness, and weakness. Patients taking Xanax often experience sedation, dizziness, and weakness.

Other side effects that may occur with either drug include fatigue, lightheadedness, drowsiness, amnesia/memory impairment, confusion, disorientation, depression, euphoria, suicidal ideation/attempt, incoordination, lack of energy, dry mouth, tremor, convulsions/seizures, vertigo, visual disturbance (double or blurred vision), slurred speech, change in libido, impotence, decreased orgasm, headache, coma, respiratory depression, apnea/worsening of sleep apnea, worsening of obstructive pulmonary disease, and gastrointestinal (GI) symptoms including nausea, constipation, or diarrhea.

Other side effects may occur. Consult a healthcare professional for a complete list of side effects.

Ativan Xanax
Side Effect Applicable? Frequency Applicable? Frequency
Sedation Yes 15.9% Yes 41-77%
Dizziness Yes 6.9% Yes 1.8-30%
Weakness Yes 4.2% Yes 6-7%

Source: DailyMed (Ativan), DailyMed (Xanax)

Drug interactions of Ativan vs. Xanax

Benzodiazepines, such as Ativan and Xanax, should not be taken in combination with opioid painkillers, due to increased risk of sedation, respiratory depression, and overdose, possibly leading to death. If no other combination is possible, the patient should receive the drugs at the lowest possible dose and for the shortest duration, and be closely monitored. Benzodiazepines also should not be taken with other CNS depressants such as alcohol, antipsychotics, antidepressants, sedating antihistamines, and anticonvulsants.

An especially dangerous combination, nicknamed the “holy trinity,” is an opioid (usually a form of hydrocodone or Oxycontin) plus a benzodiazepine (usually Xanax) plus Soma (carisoprodol, a muscle relaxant). These drugs should never be prescribed together; the use of these three medications can result in very serious respiratory depression, overdose, or even death.

Other drug interactions may occur. Consult your healthcare provider for a full list of drug interactions.

Drug Drug Class Ativan Xanax
Oxycontin (oxycodone)
OxyIR (oxycodone)
Percocet (oxycodone/acetaminophen)
Ultram (tramadol)
Tylenol with codeine (acetaminophen/codeine)
Opioids Yes Yes
Alcohol Alcohol Yes Yes
Prozac (fluoxetine)
Paxil (paroxetine)
Zoloft (sertraline)
Desyrel (trazodone)
Effexor (venlafaxine)
Pristiq (desvenlafaxine)
Cymbalta (duloxetine)
Antidepressants Yes Yes
Soma (carisoprodol)
Flexeril (cyclobenzaprine)
Skelaxin (metaxalone)
Lioresal (baclofen)
Muscle relaxants Yes Yes
Phenobarbital
Dilantin (phenytoin)
Tegretol (carbamazepine)
Depakote (divalproex sodium)
Keppra (levetiracetam)
Neurontin (gabapentin)
Lamictal (lamotrigine)
Lyrica (pregabalin)
Topamax (topiramate)
Anticonvulsants Yes Yes
Benadryl (diphenhydramine) Sedating antihistamines Yes Yes
Clozaril (clozapine) Antipsychotics Yes Yes
Theophylline Methylxanthine Yes No
Benemid (probenecid) Uricosuric Yes No
Tofranil (imipramine)
Norpramin (desipramine)
Elavil (amitriptyline)
Pamelor (nortriptyline)
Tricyclic antidepressants Yes Yes
Nizoral (ketoconazole)
Sporanox (itraconazole)
Azole antifungals No Yes
Lo-Loestrin Fe Oral contraceptives No Yes

Warnings of Ativan and Xanax

Ativan and Xanax have many similar warnings. Both drugs come with a boxed warning, which is the strongest warning required by the FDA. Benzodiazepines such as Ativan or Xanax should not be used in combination with opioid painkillers due to the risk of extreme sedation, severe respiratory depression, coma, or even death. If the combination cannot be avoided, the patient should take the lowest dose for the shortest period of time and be closely monitored. Patients should not drive or operate machinery until effects are known.

Other warnings for both drugs include:

  • Benzodiazepines may cause physical and psychological dependence—the risk is higher with higher doses, longer duration of use, or a history of drug or alcohol abuse. If you take a benzodiazepine, take the medication only as prescribed.
  • Benzodiazepines should be used for the short-term, and when discontinuing, the drug should be slowly tapered to avoid withdrawal symptoms. Withdrawal symptoms may include seizures, along with many other symptoms such as agitation, confusion, rapid heartbeat, vertigo, and other symptoms.
  • Patients with seizure disorders are at higher risk for withdrawal symptoms.
  • In patients with depression, there is a risk of suicide. Patients with depression should also be treated with an antidepressant and should be closely monitored.
  • Benzodiazepines should be used with caution in patients with impaired respiratory function (COPD, sleep apnea).
  • Use with caution and use lower doses in patients with severe hepatic insufficiency and/or encephalopathy.

Xanax has some additional warnings:

  • Patients with panic disorder often use higher doses of Xanax, so there may be a higher risk of dependence.
  • Early morning anxiety or anxiety symptoms between doses have occurred in patients with panic disorder. In these situations, it is recommended that the drug be given in smaller doses, more frequently, adding up to the same total daily dose.

Ativan or Xanax should not be used in pregnancy; both drugs are classified as pregnancy category D, meaning there is a risk to the fetus. If you are taking Ativan or Xanax and find out that you are pregnant, consult your doctor immediately.

Both drugs are on the Beers’ List (drugs that may be inappropriate in older adults). Older adults have increased sensitivity to benzodiazepines and there is an increased risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults when Ativan or Xanax is used.

Frequently asked questions about Ativan vs. Xanax

What is Ativan?

Ativan, also known by its generic name, lorazepam, is a benzodiazepine drug used to treat anxiety.

What is Xanax?

Xanax, also known by its generic name, alprazolam, is a benzodiazepine drug used to treat anxiety and panic disorder.

Are Ativan and Xanax the same?

Both drugs have many similarities, as well as some differences, as outlined above. Your healthcare provider can help you decide if Ativan or Xanax is right for you or a loved one.

Other drugs in the benzodiazepine category of medications that you may have heard of include Valium (diazepam), Dalmane (flurazepam), Restoril (temazepam), Klonopin (clonazepam), and Halcion (triazolam). All of these drugs are approved by the FDA.

Is Ativan or Xanax better?

Ativan and Xanax are both effective for anxiety and other psychological conditions and have similar side effects, warnings, and drug interactions. Consult your healthcare provider to see if one of these medications is appropriate for you and your condition.

Can I use Ativan or Xanax while pregnant?

Ativan or Xanax may cause fetal abnormalities and should not be used during pregnancy. If you are already taking Ativan and Xanax, and find out that you are pregnant, contact your healthcare provider for guidance.

Can I use Ativan or Xanax with alcohol?

No. The combination of Ativan or Xanax with alcohol is very dangerous and can lead to respiratory depression, extreme sedation, coma, or even death.

Is Ativan milder than Xanax?

It’s hard to categorize Ativan as milder or not; however, we do know that a dose of Xanax wears off faster than a dose of Ativan. Therefore, Xanax may be dosed more frequently than Ativan.

Which is better for anxiety, Xanax or Ativan?

Both medications are effective for anxiety. Ask your doctor if one of these drugs is right for you, taking into account your medical history and condition(s) and other medications you take.

What is the difference between Lorazepam and Xanax?

Both drugs, Ativan (lorazepam) and Xanax (alprazolam) are used to treat anxiety and a variety of other mental health conditions. They have many similarities, and some differences, too, outlined above.

Will Ativan stop a panic attack?

Ativan is used in the treatment of anxiety disorders and is also used off-label to treat panic disorders.

Is Ativan a narcotic?

Ativan is not a narcotic. It is classified as a benzodiazepine. It can be habit-forming and has the potential for abuse and dependence, so it is very important to take it as prescribed.