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Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
There are several medication options available if you have anxiety. Lexapro (escitalopram) and Xanax (alprazolam) are two different prescription drugs that can treat general anxiety as well as anxiety with depression. Lexapro is an SSRI (selective serotonin reuptake inhibitor) drug while Xanax is a benzodiazepine. Both drugs work differently from each other, although they can be used for similar mental health conditions.
What are the main differences between Lexapro vs. Xanax?
Lexapro is an FDA-approved medication that is also available as a generic. The generic name for Lexapro is escitalopram. It works by blocking the reuptake of serotonin so that there is an increased level in the brain. Serotonin is an important neurotransmitter responsible for mood and well being. Lexapro is usually taken once daily and may take a few weeks to reach maximum therapeutic potential.
Xanax is a brand name medication that is FDA approved to treat anxiety and panic disorders. The generic name for Xanax is alprazolam. It works by increasing the effects of GABA, an inhibitory molecule that can calm nerve activity in the brain. Xanax is usually taken 3 to 4 times per day for anxiety or panic attacks.
RELATED: Lexapro details | Xanax details | Escitalopram details | Alprazolam details
| Main differences between Lexapro vs. Xanax | ||
|---|---|---|
| Lexapro | Xanax | |
| Drug class | Selective serotonin reuptake inhibitor | Benzodiazepine |
| Brand/generic status | Brand and generic available | Brand and generic available |
| What is the generic name? | Escitalopram | Alprazolam |
| What form(s) does the drug come in? | Oral tablet | Oral tablet Extended-release oral tablet |
| What is the standard dosage? | 10 or 20 mg daily | 0.25 to 0.5 mg three times per day |
| How long is the typical treatment? | Long term depending on your doctor’s instruction | Short term or long term depending on your doctor’s instruction |
| Who typically uses the medication? | Adults and children 12 years and older | Adults |
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Conditions treated by Lexapro vs. Xanax
Lexapro and Xanax are two brand name medications that are commonly used for anxiety in adults. They are both indicated to treat anxiety alone or anxiety associated with depression.
Lexapro is also approved to treat major depression in adults and adolescents. Off-label uses for Lexapro include obsessive compulsive disorder (OCD), panic disorders, and insomnia.
Xanax is also approved for panic disorder in adults. It may sometimes be used off-label for depression although it’s commonly used for adults with both anxiety and depression. It is also sometimes used off label for insomnia.
| Condition | Lexapro | Xanax |
| Generalized anxiety disorder | Yes | Yes |
| Anxiety with depression | Yes | Yes |
| Major depressive disorder | Yes | Off-label |
| Panic disorder | Off-label | Yes |
| Insomnia | Off-label | Off-label |
Is Lexapro vs. Xanax more effective?
Lexapro and Xanax are both effective for treating anxiety. Although benzodiazepines are not commonly used first for anxiety, some studies show that they may be more effective than SSRIs. However, benzodiazepines are usually only recommended for short-term purposes.
Sometimes SSRI drugs and benzodiazepines are prescribed for anxiety and depression. Because SSRIs may take some time to feel its full effects, a benzodiazepine may help when starting therapy with an SSRI like Lexapro. In a literature review, it was found that benzodiazepines improved control of anxiety and helped with initial anxiety when starting an SSRI.
Other case reports have found that when taken together, benzodiazepines may boost the efficacy of SSRIs. In one report however, a patient taking a benzodiazepine and SSRI together experienced mania, or an excitable mood often characterized by increased energy and irrational decision making. Patients should be monitored closely by their medical professionals when taking these types of medicines, whether alone or together.
Treatment with Lexapro and/or Xanax is personalized to an individual’s condition and symptoms. It’s important to consult a doctor or mental healthcare professional to explore the different treatment options available.
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Coverage and cost comparison of Lexapro vs. Xanax
Lexapro can be purchased with a prescription and is covered by many Medicare and insurance plans. A 30-day supply of Lexapro tablets can cost around $400. Buying generic escitalopram with a SingleCare discount card can save you money and bring the cost down to $9-$37 depending on which pharmacy you use.
If you’re looking to purchase Xanax from your local pharmacy, most Medicare insurance plans will cover the generic version of it. The average retail price is $400 but you can purchase a 60 count bottle of 0.5 mg alprazolam generic tablets for around $9-$21.
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| Lexapro | Xanax | |
| Typically covered by insurance? | Yes | Yes |
| Typically covered by Medicare? | Yes | Yes |
| Standard dosage | 10 mg tablets (30-day supply) | 0.5 mg tablets |
| Typical Medicare copay | $0-$30 | $0-$362 |
| SingleCare cost | $9-$37 | $9-$21 |
Common side effects of Lexapro vs. Xanax
Lexapro and Xanax can both affect the central nervous system (CNS). Both medications can cause common CNS side effects such as headache, dizziness, and insomnia. However, sleep problems such as drowsiness or sleepiness are more common side effects of taking Xanax.
Lexapro and Xanax can also cause other side effects such as dry mouth, nausea, vomiting, and constipation. Changes in weight such as weight loss or weight gain are also possible side effects with either drug. Lexapro is more likely to cause gastrointestinal side effects such as indigestion and gas (flatulence). Side effects of Xanax are more likely to involve sedation.
Lexapro and Xanax are each linked to sexual side effects. More specifically, each are linked to a decrease in sexual libido, or desire.
More serious adverse effects of Lexapro can include serotonin syndrome, a serious medical condition that requires immediate attention. Other adverse effects of Xanax can include memory problems or cognitive dysfunctions when used long term.
| Lexapro | Xanax | |||
| Side Effect | Applicable? | Frequency | Applicable? | Frequency |
| Dry mouth | Yes | 9% | Yes | 15% |
| Headache | Yes | 24% | Yes | 13% |
| Dizziness | Yes | 5% | Yes | 2% |
| Drowsiness | No | – | Yes | 41% |
| Nausea | Yes | 18% | Yes | 10% |
| Vomiting | Yes | 3% | Yes | 10% |
| Diarrhea | Yes | 8% | Yes | 10% |
| Constipation | Yes | 5% | Yes | 10% |
| Indigestion | Yes | 3% | No | – |
| Flatulence | Yes | 2% | No | – |
| Decreased libido | Yes | 7% | Yes | 14% |
| Depression | No | – | Yes | 14% |
| Nervousness | Yes | – | Yes | 4% |
| Decreased appetite | Yes | 3% | Yes | 28% |
| Nasal congestion | Yes | <1% | Yes | 7% |
| Blurred vision | Yes | <1% | Yes | 6% |
| Insomnia | Yes | 9% | Yes | 9% |
This may not be a complete list. Consult your doctor or pharmacist for other side effects.
Source: DailyMed (Lexapro), DailyMed (Xanax)
Drug interactions of Lexapro vs. Xanax
Lexapro and Xanax can interact with some of the same medications such as monoamine oxidase inhibitors (MAOIs), opioids, anticonvulsants, triptans, and serotonergic drugs. Taking these drugs together may affect the level of drug in the body which can increase the risk of adverse effects.
SSRIs like Lexapro can also interact with NSAIDs and other blood thinners like warfarin. Taking these medications together may cause an increased risk of bleeding.
Xanax can also interact with birth control medications. Oral contraceptives may increase the side effects of benzodiazepines.
Because Lexapro and Xanax are processed by certain liver enzymes, they can interact with other drugs that affect these enzymes. Lexapro and Xanax can interact with CYP3A4 enzyme inhibitors and inducers. Consult a doctor or pharmacist to determine which drugs may interact with Lexapro or Xanax.
| Drug | Drug Class | Lexapro | Xanax |
| Rasagiline Selegiline Isocarboxazid Phenelzine |
Monoamine oxidase inhibitors (MAOIs) | Yes | Yes |
| Hydrocodone Oxycodone Tramadol |
Opioids | Yes | Yes |
| Carbamazepine | Anticonvulsant | Yes | Yes |
| Fluoxetine Imipramine Desipramine |
Serotonergic drugs | Yes | Yes |
| Sumatriptan Almotriptan Rizatriptan |
Triptans | Yes | Yes |
| Aspirin Ibuprofen Diclofenac Naproxen |
NSAIDs | Yes | No |
| Warfarin | Anticoagulant | Yes | No |
| Ketoconazole Itraconazole |
Antifungal | Yes | Yes |
| Levonorgestrel ethinyl estradiol Drospirenone ethinyl estradiol Norethindrone |
Oral contraceptives | No | Yes |
This may not be a complete list of all possible drug interactions. Consult a doctor with all medications you may be taking.
Warnings of Lexapro vs. Xanax
Taking Lexapro can increase the risk of suicidal thoughts and behavior, especially in children and young adults. Adolescents taking Lexapro for depression may have an increased risk of suicidal ideation. Lexapro should not be used in children younger than 12 years old. Any patient taking antidepressant medication should be monitored for clinical worsening of depression symptoms, especially shortly after starting a new treatment as the risk of suicidality may be highest in the time period.
Xanax should not be used with opioids due to the increased risk of respiratory depression, coma, and even death in severe cases. These drugs should only be used together in limited doses and with close monitoring by a healthcare professional.
Treatment with Lexapro or Xanax should not be abruptly stopped. Both medications carry a risk of withdrawal symptoms if they are discontinued. Withdrawal symptoms can include irritability, nausea, vomiting, and headache. Make sure you discuss all of your medical conditions with your prescriber. Stopping the use of Xanax may also lead to an increased risk of seizures. Instead, these medications should be tapered off slowly with the medical advice of a doctor.
Frequently asked questions about Lexapro vs. Xanax
What is Lexapro?
Lexapro is an SSRI medication that is prescribed for anxiety and depression. Lexapro is available as a generic drug. It may take 1 to 2 weeks to experience the maximum benefits of Lexapro.
What is Xanax?
Xanax is a benzodiazepine that is prescribed for anxiety and panic disorders. It is available as a generic drug, alprazolam. Xanax works quickly with effects experienced within 1 to 2 hours after taking it.
Are Lexapro vs. Xanax the same?
No. Lexapro and Xanax are not the same. Lexapro is an SSRI drug that is taken once daily for depression and anxiety. Xanax is a benzodiazepine that can be taken up to 3 or 4 times per day for anxiety and panic disorders.
Is Lexapro vs. Xanax better?
Xanax is more effective for short-term relief of anxiety. Lexapro is often prescribed for depression and can take a few weeks to fully work. Sometimes Lexapro and Xanax are taken together for anxiety with depression.
Are Lexapro and Xanax safe to take while pregnant or breastfeeding?
It is not recommended to take Lexapro while pregnant. Taking Lexapro during the third trimester may cause persistent pulmonary hypertension in the newborn (PPHN). Xanax is not recommended for pregnant women.
Breastfeeding while taking Lexapro is not recommended. There have been reports of excessive sedation, restlessness, agitation, and decreased appetite in breastfed infants. This has resulted in poor weight gain. Breastfeeding is also not recommended when receiving treatment with Xanax. It does cross into the breast milk and can cause sedation and withdrawal in breastfed neonates and infants. The mother’s clinical need for these medications must be weighed against the potentially dangerous side effects to the breastfed child.
Can I use Lexapro vs. Xanax with alcohol?
No. Consuming alcohol while on Lexapro or Xanax can increase the risk of CNS side effects such as drowsiness, dizziness, and headache. It is not recommended to drink alcohol while using SSRIs or benzodiazepines.
Does Lexapro reduce anxiety?
Yes. Lexapro can help treat anxiety. It is often prescribed for people with anxiety and depression.
How long does it take for Lexapro to work for anxiety?
As an SSRI, Lexapro may take a few weeks to reach maximum effectiveness for anxiety. Lexapro helps balance neurotransmitters over time to help reduce symptoms of anxiety.
Does Lexapro make you sleepy?
Lexapro can cause fatigue and somnolence in some people. These side effects are most common when first starting the drug. However, most side effects of Lexapro resolve on their own over time.
Can Lexapro help you get off Xanax?
Lexapro may help with anxiety while discontinuing Xanax. Consult a doctor for your best options when getting off Xanax.
Is Xanax ok to take with Lexapro?
Lexapro and Xanax belong to two distinct classes of medications and have significant differences. They can be administered concurrently. Lexapro is considered a safe long-term treatment for generalized anxiety disorder, but it does take some time for it to begin working, sometimes up to 6 weeks after starting. Xanax begins relieving anxiety symptoms almost immediately and may provide an effective short-term bridge in therapy until the effects of Lexapro are realized.
Treatment guidelines published by the American Psychiatric Association recommend that SSRI antidepressants like Lexapro are first line treatment for major depressive disorder. They also recommend that benzodiazepines such as Xanaz be added when there are multiple psychiatric disorders occurring. For example, patients who are suffering from a major depressive episode and are in a catatonic state should be administered a benzodiazepine such as Xanax. They also recommend that patients being treated for depression with an SSRI like Lexapro and also concurrently suffering from anxiety should be administered a benzodiazepine like Xanax as well.
Xanax can cause serious side effects like extreme sedation. Lexapro is generally regarded as a safe long-term treatment while Xanax is generally intended to be short-term due to its ability to cause dependence and be linked to abuse. There are some cases, however, where long-term, concurrent treatment with both drugs is necessary and appropriate.
