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Lorazepam vs. diazepam: Differences, similarities, and which is better for you

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

Lorazepam and diazepam are generic drugs that work to treat anxiety disorders, among other mental health conditions. Both drugs are classified as benzodiazepines. They work by increasing the activity of GABA, or gamma-aminobutyric acid, in the brain. The neurotransmitter GABA is an inhibitory chemical that blocks certain nerve signals, boosting the mood, and promoting a sense of calm.

Both lorazepam and diazepam are Schedule IV drugs, according to the Drug Enforcement Administration (DEA). This means that these drugs, like other benzodiazepines, carry a risk of dependence and abuse. Therefore, they should only be used as short-term therapy under the supervision of a healthcare provider.

Read on to learn about other differences between lorazepam and diazepam.

What are the main differences between lorazepam vs. diazepam?

The main difference between lorazepam and diazepam is that diazepam stays in the body longer than lorazepam. Lorazepam (Lorazepam coupons | What is Lorazepam?), which is the generic name for Ativan, has a half-life of up to 18 hours. On the other hand, diazepam, which is the generic name for Valium, has a half-life of up to 48 hours. Therefore, lorazepam is considered an intermediate-acting benzodiazepine, and diazepam is considered a long-acting benzodiazepine.

Lorazepam and diazepam are also metabolized, or processed, in the body differently. Lorazepam is metabolized in the liver by a process known as glucuronidation. Diazepam (Diazepam coupons | What is Diazepam?) is metabolized in the liver by cytochrome enzymes. As a result, diazepam has more of a potential to interact with other drugs than lorazepam.

Lorazepam is available in generic oral tablets with strengths of 0.5 mg, 1 mg, and 2 mg. It also comes as an oral solution and a solution for injection. Ativan is available in generic oral tablets with strengths of 2 mg, 5 mg, and 10 mg. Ativan can also be administered as an oral solution, solution for injection, and rectal gel.

Main differences between lorazepam vs. diazepam
Lorazepam Diazepam
Drug class Benzodiazepine Benzodiazepine
Brand/generic status Brand and generic version available Brand and generic version available
What is the brand name? Ativan Valium
What form(s) does the drug come in? Oral tablet
Oral solution
Solution for injection
Oral tablet
Oral solution
Solution for injection
Rectal gel
What is the standard dosage? For anxiety:
Starting dose: 2 to 3 mg by mouth 2 to 3 times per day
Maintenance dose: 2 to 6 mg 2 to 3 times per day
For anxiety:
2 to 10 mg by mouth 2 to 4 times per day
How long is the typical treatment? No longer than 4 months No longer than 4 months
Who typically uses the medication? Adults and children 12 years old and older Adults, children, and infants 6 months and older

Conditions treated by lorazepam vs. diazepam

Lorazepam and diazepam act as anxiolytics to reduce anxiety symptoms, such as overwhelming stress and difficulty thinking clearly. Lorazepam and diazepam are both FDA approved to treat anxiety and anxiety disorders, such as panic disorders and panic attacks.

Like other benzodiazepines, lorazepam and diazepam can be used to treat seizure disorders, or epilepsy. They can also be used as a premedication before surgery for the purpose of sedation.

Diazepam is also FDA approved to treat alcohol withdrawal syndrome and muscle spasms. In addition to treating anxiety, lorazepam is also approved for treating insomnia caused by anxiety. Other off-label uses can be found in the table below.

Condition Lorazepam Diazepam
Anxiety disorders Yes Yes
Insomnia caused by anxiety Yes Off-label
Alcohol withdrawal syndrome Off-label Yes
Muscle spasms Off-label Yes
Seizure disorders Yes Yes
Status epilepticus Yes Yes
Sedation or premedication before surgery Yes Yes

Is lorazepam vs. diazepam more effective?

Compared to placebo, or no medication, both lorazepam and diazepam are effective for treating anxiety. The more effective benzodiazepine will depend on the condition being treated, other medications being taken, and any treatments that have been previously tried.

Randomized, controlled clinical trials have largely shown that lorazepam and diazepam are comparable in effectiveness for treating anxiety. One double-blind clinical trial comparing lorazepam and diazepam in 134 anxious patients over four weeks found that both drugs were more effective than placebo. However, lorazepam was found to be more effective in patients who had worse symptoms initially. Sedation was reported to be a more significant side effect in the group taking lorazepam.

In a network meta-analysis, midazolam, lorazepam, and diazepam were compared for treating status epilepticus, a severe prolonged seizure, in children. Data compiled from 16 different clinical trials found that midazolam and lorazepam were more effective than diazepam.

This comparison is for general informational purposes. Seek medical advice from a doctor or healthcare provider before using a benzodiazepine. Your healthcare provider will conduct a thorough medical evaluation to determine the severity of your condition and to rule out other possible mental health conditions.

Coverage and cost comparison of lorazepam vs. diazepam

Generic lorazepam is generally covered by most Medicare and insurance plans. Without insurance, the average cash price can be $25 for 30, 0.5 mg tablets. A SingleCare lorazepam coupon could bring the cost down to about $9.

Try the SingleCare prescription discount card

Like other generic drugs, diazepam is often covered by Medicare and insurance plans. The average cash price of generic diazepam is approximately $24 for 30, 0.5 mg tablets. Compared to lorazepam, diazepam may be slightly cheaper depending on your pharmacy. Using a SingleCare diazepam coupon could lower the cost to $7 at participating pharmacies.

  Lorazepam Diazepam
Typically covered by insurance? Yes Yes
Typically covered by Medicare Part D? Yes Yes
Standard dosage 2 to 6 mg 2 to 3 times per day 2 to 10 mg by mouth 2 to 4 times per day
Typical Medicare copay $0–$25 $0–$12
SingleCare cost $8+ $6+

Common side effects of lorazepam vs. diazepam

Lorazepam and diazepam, like other benzodiazepines, primarily cause side effects in the central nervous system (CNS). The most common side effects of lorazepam, or Ativan, are sedation, dizziness, weakness, and unsteadiness, or loss of coordination. The most common side effects of diazepam, or Valium, are drowsiness, fatigue, muscle weakness, and loss of coordination.

Other possible side effects may include memory problems. The occurrence of side effects is usually dependent on the dosage of the medication taken. More serious side effects are reported with high doses of benzodiazepines. Serious side effects, including respiratory depression, or shallow breathing, could indicate a medical emergency.

  Lorazepam Diazepam
Side effect Applicable? Frequency Applicable? Frequency
Sedation Yes 16% Yes *
Drowsiness Yes * Yes *
Fatigue Yes * Yes *
Dizziness Yes 7% Yes *
Weakness Yes 4% Yes *
Impaired coordination Yes 3% Yes *
Memory problems Yes * Yes *

*not reported
Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.
Source: DailyMed (Lorazepam), DailyMed (Diazepam)

Drug interactions of lorazepam vs. diazepam

Lorazepam and diazepam primarily interact with other drugs that affect the central nervous system (CNS). Taking these benzodiazepines with drugs like opioids, barbiturates, antipsychotics, antidepressants, and anticonvulsants can lead to increased CNS-depressant effects, such as dizziness, confusion, and drowsiness. The antigout medication probenecid can affect the metabolism of benzodiazepines and lead to increased side effects.

The use of theophylline or aminophylline can counteract the sedative effects of benzodiazepines. Tell your doctor if you take either of these drugs before starting a benzodiazepine.

Diazepam is processed by certain P450 enzymes whereas lorazepam is not. Some drugs can block these enzymes, which affects how well diazepam is processed in the body. This may result in increased sedative side effects of diazepam. Drugs like ketoconazole, cimetidine, and omeprazole can interact with diazepam and lead to increased sedation.

Antacids like calcium carbonate and magnesium hydroxide can decrease the absorption of diazepam in the body. This effect may alter how well diazepam works.

Drug Drug class Lorazepam Diazepam
Opioid Yes Yes
Barbiturate Yes Yes
Antipsychotic Yes Yes
Antidepressant Yes Yes
Anticonvulsant Yes Yes
Probenecid Antigout agent Yes Yes
Methylxanthine Yes Yes
Ketoconazole Antifungal agent No Yes
Cimetidine H2-receptor antagonist No Yes
Omeprazole Proton pump inhibitor No Yes
Calcium carbonate
Magnesium hydroxide
Antacid No Yes

Consult a healthcare professional for other possible drug interactions.

Warnings of lorazepam vs. diazepam

The use of opioids with benzodiazepines should be avoided. When used together, benzodiazepines and opioids can increase the risk of respiratory depression, coma, and even death. Patients should be monitored closely when these two classes of drugs are taken together.

Lorazepam and diazepam are Schedule IV drugs. Those with a past history of alcohol or substance abuse may be at a higher risk of dependence and abuse with benzodiazepines. Dependence and abuse may increase the risk of an overdose with benzodiazepines. Signs and symptoms of a benzodiazepine overdose include severe loss of coordination, dangerously low blood pressure (hypotension), respiratory depression, and coma.

Only the lowest effective dose of lorazepam or diazepam should be used. Consult a doctor or healthcare professional on other possible warnings and precautions.

Frequently asked questions about lorazepam vs. diazepam

What is lorazepam?

Lorazepam is the generic name for Ativan. It is part of a class of medications known as benzodiazepines. Lorazepam is available as an oral tablet in strengths of 0.5 mg, 1 mg, and 2 mg. It can also be administered as an oral solution or injection. Lorazepam is approved to treat anxiety and insomnia caused by anxiety. It can also be used as a treatment for seizure disorders or premedication before surgery.

What is diazepam?

Diazepam is also known by its brand name, Valium. It is a benzodiazepine that is FDA approved to treat anxiety, alcohol withdrawal syndrome, and muscle spasms. It can also be used for seizure disorders and sedative purposes before surgery. Diazepam is available in 2 mg, 5 mg, and 10 mg oral tablets. It also comes as an oral solution, injection, and rectal gel.

Are lorazepam vs. diazepam the same?

Lorazepam and diazepam are both benzodiazepines, but they are not the same. They come in different formulations and have different FDA-approved uses. They also have different age restrictions: Lorazepam is not recommended in children under 12 years old while diazepam is not recommended in infants younger than 6 months.

Is lorazepam or diazepam better?

Lorazepam and diazepam are both effective drugs. Diazepam lasts in the body longer than lorazepam. However, this doesn’t mean it’s a better drug. The effectiveness of the benzodiazepine will depend on the condition being treated, among other factors. Consult a healthcare provider to determine the best treatment for you.

Can I use lorazepam or diazepam while pregnant?

It is not recommended to take lorazepam or diazepam while pregnant. Although diazepam may be slightly safer than lorazepam during pregnancy, not enough studies have shown that benzodiazepines are completely safe while pregnant. Consult a healthcare provider before taking a benzodiazepine during pregnancy.

Can I use lorazepam or diazepam with alcohol?

Combining alcohol and benzodiazepines is not recommended. Both alcohol and benzodiazepines can cause CNS side effects such as drowsiness and dizziness. Taking these substances together can increase the risk of side effects and overdose.

Is 3 mg lorazepam too much?

The right dosage of lorazepam will depend on the condition being treated. Consult a doctor for professional medical advice and proper instructions on how to use this medication. A standard dose of lorazepam could be anywhere from 2 to 6 mg by mouth two to three times per day.

Does diazepam last longer than lorazepam?

Diazepam lasts longer than lorazepam. It is considered a long-acting benzodiazepine with a half-life of up to 48 hours. Long-acting benzodiazepines include Valium (diazepam), Librium (chlordiazepoxide), and Dalmane (flurazepam).

Is it bad to take Ativan every day?

It is not generally recommended to take Ativan (lorazepam) long term. Not enough studies have been conducted on the safety and effectiveness of Ativan past four months of use. Some people develop a dependence and tolerance to Ativan, which can affect how well it works over time. Ativan should only be used as prescribed by a healthcare provider.

Is lorazepam fast acting?

Lorazepam is an intermediate-acting benzodiazepine. The effects of lorazepam may be felt within 1 to 1.5 hours after taking it. The half-life of lorazepam is around 10 to 20 hours. Other intermediate-acting benzodiazepines include Xanax (alprazolam), Klonopin (clonazepam), and Restoril (temazepam).