Ativan vs. Xanax

The decision of whether to prescribe Ativan vs. Xanax is one I face frequently, but really the more important decision is whether using any short acting benzodiazepine is the appropriate choice. As a family doctor I am the first physician many patients see when they are faced with acute anxiety, panic disorder or phobias for which a short acting benzodiazepine is often the appropriate therapy. Ativan (lorazepam) and Xanax (alprazolam)  are the most commonly used medications in this class for these indications, although Klonapin, clonazepam is also used in some settings.  I tend to feel that both Ativan and Xanax are somewhat faster acting and possibly more effective for acute anxiety than Klonapin, so tend to use these for patients where I anticipate infrequent or occasional use, and use Klonapin more often when I anticipate the need for longer term use or more frequent dosing.  The faster onset of action and somewhat shorter serum half-life of Ativan and Xanax make them have a higher abuse potential and addiction potential, so I often try to use Klonapin in these circumstances.

The bigger question is when to use Ativan and when to use Xanax.  Actually this is really splitting hairs, as these meds are very similar. Let’s look at the details of the similarities and differences in Ativan vs. Xanax.

Ativan Xanax
Serum Half Life 14 hours 11.2 hours
Potency Starting dose 0.5 mg Starting dose 0.25 mg
Onset of Action Rapid Rapid
Addiction Potential High High
Side Effects Sedation, abuse potential, addiction/dependency, Nearly identical to Ativan
Cost ( 0.5 mg #30  $14.99 0.25 mg  #30  $11.99
FDA approved indications Anxiety, insomnia short term Rx, status epilepticus, chemotherapy induced nausea, post-operative sedation Anxiety, panic disorder

As you can tell from the above comparisons, Ativan and Xanax are much more alike than they are different. Both are fast acting, short half-life benzodiazapines with indications for anxiety.  Although Ativan lacks an FDA indication for panic disorder it is commonly used off label for panic. Ativan has specific indications for chemotherapy induced nausea, status epilepticus and post-operative sedation and to my knowledge Xanax is not often used for these niche indications.

For the primary indication that both Ativan and Xanax are prescribed, various types of anxiety disorder, the choice is often based on the prescribing physician’s personal preference.  I tend to use Xanax a bit more because I have more experience with Xanax, but other physicians may choose Ativan in the same circumstances.  I tend to choose Ativan when the primary problem facing a patient is anxiety leading to insomnia, and tend to choose Xanax when depression is a major factor and I’m adding an as needed drug to an antidepressant. I tend to choose Klonapin when I suspect a patient may need to take the medication regularly for more than a few days because I have found that patients have less trouble tapering an stopping Klonapin than either Ativan of Xanax. The incidence and spectrum of Ativan side effects, Xanax side effects and Klonapin side effects are similar enough that side effects are not a major factor in choosing a medication.

All benzodiazapines are best used for short term management of anxiety and panic disorder.  For ongoing treatment medications like the selective serotonin reuptake inhibitors are best used to prevent panic attacks and keep anxiety at bay, using drugs like Ativan and Xanax for acute episodes of anxiety and panic.


3 Responses to Ativan vs. Xanax

  1. Jerry: I cannot give personal medical advice in this forum. You need to discuss this with your physician. Generally after the period of xanax use you describe a patient can stop the xanax without withdrawal symptoms. Alternative medications that are not habit forming might include buspirone or a different SSRI. You have probably tried some other things as Viibryd is not usually a first line medication to try. Good luck. Dr. P.

  2. I had a possible medical issue that I was being tested for. I tend to panic through the process so in order to calm me down and be able to work through this period I was given a prescription for Xanax. The mg was 0.5 and for 3 days during the height of the issue I was taking 3, possibly 4 a day or roughly 1 pill every 8 hours. It did help calm me down after the results came back I was still jittery so for the next 5 days I took any where from 0.5 to 1.0 mg per day depending on how long I could hold out. After a total of 8 days I decided to try and stop all together and for 4 days I took nothing. Unfortunately that did not last and for the past 4 days I cut the pill in half and been taking anywhere from 1 to 3 pills a day (so max would be 0.75mg in a day). I had also started taking Viibryd around the same time but after 3 days of taking one 10mg pill I stopped that but was not sure if doing that added to my anxiety and drove me back to Xanax. I have not taken Viibryd in 6 days and will not start again but I also want to stop Xanax and wondered how to do that and whether there was something non additive I could take to offset the panic feelings that come and go while I am quitting

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