If you experience anxiety or other mental health conditions, you are not alone. Anxiety affects 40 million adults in the United States every year—that’s 18% of the population.
Klonopin (clonazepam) and Valium (diazepam) are two benzodiazepine medications used in the treatment of anxiety and other conditions. Both prescription drugs are approved by the U.S. Food and Drug Administration (FDA).
Benzodiazepines work in the central nervous system (CNS) by increasing the activity of the neurotransmitter gamma-aminobutyric acid (GABA). By doing so, the medication slows down the brain and nervous system, which results in a relaxing and calming effect, and can help aid sleep when taken at bedtime. Because benzodiazepines (sometimes referred to as benzos) have the potential for substance abuse or dependence, they are classified by the Drug Enforcement Agency (DEA) as controlled substance Schedule IV drugs.
What are the main differences between Klonopin and Valium?
Klonopin and Valium are both anxiety medications, also called anxiolytics. Klonopin is a benzodiazepine drug also known by its generic name, clonazepam. It is available in the form of an oral tablet and an orally disintegrating tablet. Klonopin is an intermediate-acting benzodiazepine. It takes about one to four hours to reach its maximum effect. The half-life of a drug is the time it takes for half of the drug to leave the body, and it takes five to six half-lives to eliminate a drug from the body. The half-life of Klonopin is 30-40 hours.
Valium is also a benzodiazepine drug, and its generic name is diazepam. It is available in tablet, injection, and oral solution form, as well as a rectal gel. The rectal gel is used for seizure treatment. Valium is considered a long-acting benzodiazepine. It starts working quickly—the maximum effect can be felt within an hour, and it stays in the body for a longer time. The half-life is up to 100 hours.
|Main differences between Klonopin and Valium|
|Brand/generic status||Brand and generic||Brand and generic|
|What is the generic name?||Clonazepam||Diazepam|
|What form(s) does the drug come in?||Tablet, orally disintegrating tablet||Tablet, injection, oral solution, rectal gel (Diastat AcuDial)|
|What is the standard dosage?||Varies; a common dose is 1 mg by mouth twice a day||Varies; a common dose is 5 mg by mouth 2 to 4 times a day|
|How long is the typical treatment?||Varies; length of treatment is not established, so patients should be closely monitored||Varies; length of treatment is not established, so patients should be closely monitored|
|Who typically uses the medication?||Adults and children||Adults and children|
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Conditions treated by Klonopin and Valium
Klonopin is indicated in the treatment of seizure disorders and panic disorder (with or without agoraphobia). Valium is indicated for anxiety disorders, short-term relief of anxiety symptoms, acute alcohol withdrawal, and muscle spasm conditions (skeletal muscle spasm, spasticity, athetosis, and stiff-person syndrome).
|Seizure disorders||Yes||Diazepam rectal gel is used in certain patients with epilepsy|
|Panic disorder (with or without agoraphobia)/panic attacks||Yes||Off-label|
|Anxiety disorders/short-term relief of the symptoms of anxiety||Off-label||Yes|
|Symptoms of alcohol withdrawal (agitation/tremors)||Off-label||Yes|
|Skeletal muscle spasm, spasticity, athetosis, and stiff-person syndrome||Off-label||Yes|
|Adjunctively in convulsive disorders (not as sole therapy)||No||Yes|
Is Klonopin or Valium more effective?
Klonopin and Valium have different indications—for example, Valium is indicated for symptoms of alcohol withdrawal, while Klonopin is not (but may be used off-label). The selection of Klonopin or Valium, therefore, will depend on the indication. Also, the prescriber will likely take into account that Klonopin is intermediate-acting and Valium is long-acting. There are no head-to-head studies comparing Klonopin and Valium.
The most effective medication for you should be determined by your healthcare provider, who can take into account your medical condition(s) and medical history as well as any medications you take that may interact with Klonopin or Valium.
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Coverage and cost comparison of Klonopin vs. Valium
Klonopin is generally covered by insurance and Medicare Part D. The generic form of clonazepam is less expensive. The brand name may not be covered or may have a much higher copay. A common prescription would be for 60 tablets of 1 mg generic clonazepam, and the out-of-pocket price can be more than $40. You can purchase it for around $15 at participating pharmacies with a SingleCare coupon.
Valium is also usually covered by insurance and Medicare Part D in its generic form of diazepam. The brand-name product would be much more expensive or may not be covered. A typical prescription would be for 60 tablets of 5 mg generic diazepam. The out-of-pocket price is approximately $23 but is less than $10 with a SingleCare discount.
|Typically covered by insurance?||Yes (generic preferred)||Yes (generic preferred)|
|Typically covered by Medicare Part D?||Yes (generic preferred)||Yes (generic preferred)|
|Standard dosage||#60, 1 mg tablets||#60, 5 mg tablets|
|Typical Medicare Part D copay||$0-$24||$0-$12|
Common side effects of Klonopin vs. Valium
Side effects vary widely, depending on the dose and condition being treated.
The most common side effects of Klonopin are drowsiness, fatigue, upper respiratory infection, depression, lack of muscle control, and weakness. The most common side effects of Valium are drowsiness, fatigue, muscle weakness, and ataxia. The percent of the incidence of side effects was not reported with Valium.
This is not a full list of side effects. Other side effects may occur. Consult your healthcare provider for a full list of adverse effects.
|Muscle weakness||Yes||Not reported||Yes||Not reported|
|Upper respiratory infection||Yes||8%||No||—|
Drug interactions of Klonopin vs. Valium
Benzodiazepines should not be taken with opioids because of the risk of overdose, severe respiratory depression, coma, or even death. If the combination cannot be avoided, the patient should take the lowest dose for the shortest duration of time, and should be closely monitored by the prescriber. Benzodiazepines also interact with other CNS depressants, including alcohol, antidepressants, muscle relaxants, and anticonvulsants. This is not a full list of drug interactions. Other drug interactions may occur. Consult your healthcare provider for a full list of drug interactions.
|MAOIs (monoamine oxidase inhibitors)||Yes||Yes|
Warnings of Klonopin and Valium
Any time you fill a prescription for Klonopin or Valium, you will receive a medication guide with important information about side effects and warnings. Because they are both benzodiazepines, Klonopin and Valium have similar warnings. Both drugs have a boxed warning, which is the strongest warning required by the FDA. Benzodiazepines such as Klonopin or Valium should not be used in combination with opioids, due to the risk of extreme sedation, severe respiratory depression, coma, or even death. If the combination of an opioid and a benzodiazepine cannot be avoided, the patient should take the lowest dose for the shortest period of time and be closely monitored by the prescriber.
Other warnings include:
- Benzodiazepines may cause both physical and psychological dependence, and 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. Do not take extra doses, and do not take the medication for any other reason than for which it was prescribed. Keep the medication out of the reach of children, and under lock and key if possible.
- Patients should use caution when driving or operating machinery until effects are known.
- Avoid alcohol and other CNS depressant medications when taking a benzodiazepine.
- Use with caution in patients with a history of alcohol or drug abuse.
- When discontinuing a benzodiazepine, the drug should be tapered slowly to avoid withdrawal symptoms. Withdrawal symptoms may include seizures, agitation, confusion, rapid heartbeat, vertigo, and other symptoms. Patients with seizure disorders are at higher risk for withdrawal symptoms.
- When used in patients who have certain types of seizure disorders, Klonopin or Valium may increase the incidence or precipitate the onset of generalized tonic-clonic seizures, possibly requiring the addition of anticonvulsants or an increase in their dosage.
- Patients, their caregivers, and families should be aware that benzodiazepines may cause an increased risk of suicidal thoughts or behavior. Be alert to any signs and symptoms of depression, changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts of self-harm. Any concerning behavior should be reported immediately to the healthcare provider.
- Benzodiazepines should be used with caution in patients with impaired respiratory function (such as COPD and sleep apnea).
- Use with caution/use lower doses in patients with liver or kidney problems.
- Klonopin or Valium should not be used in pregnancy. Both drugs are classified as pregnancy category D, meaning there is a risk of harm to the fetus. If you are taking Klonopin or Valium and find out that you are pregnant, contact your healthcare provider immediately for guidance.
- Both drugs are on the Beers’ List of drugs that may be inappropriate for use 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 Klonopin or Valium is used.
Frequently asked questions about Klonopin vs. Valium
What is Klonopin?
Klonopin, or clonazepam, is a benzodiazepine drug used in the treatment of certain types of seizures and panic disorder with or without agoraphobia.
What is Valium?
Valium is a benzodiazepine drug used for anxiety, alcohol withdrawal symptoms, and muscle spasms.
Are Klonopin and Valium the same?
No. Klonopin and Valium are both benzodiazepines, but they are not exactly the same. Read above to find out more about the differences between Klonopin and Valium. Other common benzodiazepines you may have heard of include Xanax (alprazolam) and Ativan (lorazepam).
Is Klonopin or Valium better?
There are no studies directly comparing the two drugs. Your healthcare provider can determine if one of these drugs is appropriate for you, taking into account your medical conditions, history, and other medications you take.
Can I use Klonopin or Valium while pregnant?
Both drugs are category D and should not be used in pregnancy. They could cause harm to the developing fetus. If you are already taking Klonopin or Valium and find out that you are pregnant, consult your healthcare provider immediately.
Can I use Klonopin or Valium with alcohol?
No. Combining Klonopin or Valium with alcohol is dangerous and can cause respiratory depression (slowed breathing, not getting enough oxygen), extreme sedation, coma, or even death.
Is Klonopin a muscle relaxant?
Klonopin is not indicated for use as a muscle relaxant. Valium does have an indication as an adjunct in the relief for skeletal muscle spasms, for patients with muscle spasm due to inflammation; spasticity due to certain conditions such as cerebral palsy or paraplegia; athetosis; and stiff-person syndrome. Occasionally, Klonopin may be used off-label for muscle spasms, but it is not a first-line or common treatment for muscle spasms.
Does Valium help with sleep?
Drowsiness is one of the most common side effects of Valium. However, Valium may cause the opposite effect—insomnia or sleep disturbances—in some patients. Although Valium often causes drowsiness, it is not prescribed (or indicated) to help with sleep. If you are having trouble sleeping, consult your healthcare provider for medical advice.