Comparing Anxiety Medications: Ativan vs Xanax

What you will learn

• Ativan and Xanax are used to treat anxiety disorders and panic disorders.
• Ativan and Xanax are classified as Schedule IV substances due to their risk of dependence.
• Common but serious side effects include drowsiness, dizziness, and unsteadiness.
• Ativan and Xanax should never be mixed with alcohol as it increases the likelihood of respiratory depression, extreme drowsiness, and possible death.
• An overdose of Ativan or Xanax can be fatal; medical attention should be sought immediately by dialing 911
• Work closely with your healthcare provider when you are taking Ativan and Xanax

Ativan (lorazepam) and Xanax (alprazolam) are both in the drug category of benzodiazepines and are used to treat anxiety disorders. Ativan and Xanax both bind to the benzodiazepine receptors in the central nervous system; this increases gamma-aminobutyric acid (GABA) in your brain, resulting in you feeling calmer and more relaxed. [1,2] The main difference between Ativan and Xanax is the speed at which you feel the effects of the medication. Xanax (alprazolam) generally has a quicker onset of action compared to Ativan, with effects typically felt within 15 to 30 minutes, but Ativan has a longer duration of action, typically lasting 8 to 24 hours.

Ativan

Ativan is the brand name of the drug lorazepam. It has been approved by the Food and Drug Administration since 1977 as a short-term (up to 4 months) anxiety disorder treatment.

Lorazepam works by binding to the benzodiazepine receptors in the central nervous system. It enhances the effects of the neurotransmitter gamma-aminobutyric acid (GABA). The increase in GABA in the brain has a calming effect.[3]

Lorazepam is a Schedule IV classified drug due to its risk of misuse, dependence, and addiction.[4]

Xanax

Xanax is the brand name of the drug alprazolam.[5] It has been approved by the Food and Drug Administration since 1981 to treat Generalized Anxiety Disorder and Panic Disorders. Xanax is the most often prescribed psychotropic medication in the United States.

Xanax also binds to the benzodiazepine receptors in the nervous system, leading to an increase in GABA. When GABA is raised, nerve reactions are slowed, and you feel calmer. [6]

Alprazolam is a Schedule IV controlled substance due to its risk for misuse, dependence, and addiction.[7]

Side Effects of Ativan and Xanax

Ativan Side Effects

Common side effects of taking Ativan include [8]

• Sleepiness
• Dizziness
• Weakness
• Unsteadiness

The following are severe side effects that are sometimes experienced when taking Ativan.[9] Should you experience any of these, you should contact your doctor or emergency medical services.

• Extreme drowsiness
• Changes in mood or behavior
• Feeling bursts of restlessness or excitement
• Seizures
• Depressed mood and/or thoughts of suicide or self-harm
• Confusion
• Aggression
• Hallucinations
• Insomnia
• Memory problems
• Vision changes
• Symptoms of jaundice, including dark urine and yellowing of the skin or eyes.

Until you know how Ativan affects you and what side effects you may or may not experience, you should not drive, operate machinery, or participate in any potentially hazardous activities. The common side effects of sleepiness, dizziness, and unsteadiness can lead to falls, injuries, and accidents. [10]

Xanax Side Effects

Common side effects of taking Xanax include [11]

• Drowsiness
• Light-headedness

The following are severe side effects that are sometimes experienced when taking Xanax.[12] Should you experience any of these, you should contact your doctor or emergency medical services.

• Weak or shallow breathing
• Feeling like you might pass out
• Seizures
• Hallucinations
• Risk-taking behavior
• Increased energy, including decreased need for sleep
• Racing thoughts
• Being agitated or talkative
• Memory problems
• Double vision
• Symptoms of jaundice (dark urine, yellowing of the skin or eyes

Until you know how Xanax affects you and what side effects you may or may not experience, you should not drive, operate machinery, or participate in any potentially hazardous activities. There is a risk of falls, injuries, and accidents due to the common side effects of drowsiness and light-headedness.[13]

Things to Know When Taking Ativan vs Xanax

Ativan and Xanax can cause overdose and death if misused. [14] You should not stop taking Ativan or Xanax without talking to your doctor first to minimize the risks of withdrawal symptoms. If you have been taking either of these medications for a long period of time, stopping them abruptly can cause life-threatening withdrawal symptoms.[15]

Your healthcare provider should monitor how these medications affect your physical and mental health through regular check-ups, including blood work to check blood counts and liver function.

Food and Beverages to Avoid when taking Ativan or Xanax

Alcohol should not be consumed if you are taking Ativan or Xanax. The combination of alcohol and medication increases the likelihood of extreme drowsiness, respiratory depression, and possibly death.

Consider avoiding caffeine while taking Ativan or Xanax. Caffeinated drinks include coffee, tea, soda, and energy drinks. Chocolate should be eaten in moderation. Caffeine is a stimulant and can counteract the calming effects of Ativan and Xanax [16].

Some studies have shown grapefruit and grapefruit juice change how your body processes benzodiazepines, increasing the amount of Ativan or Xanax in your bloodstream. It is recommended to avoid grapefruit and grapefruit juice while taking Ativan or Xanax [17].

Considerations Before Taking Ativan Or Xanax

Ativan and Xanax are common short-term treatment options for anxiety and panic attack symptoms. They should not be considered for long-term treatment due to their high risk of misuse, dependence, and abuse. If you are prescribed Ativan or Xanax, it is crucial to take the medication only as prescribed and avoid consuming alcohol, as combining these substances can significantly increase the risk of severe side effects, including respiratory depression and death.

You should contact your healthcare provider immediately if you have any side effects. You should also reach out to a medical professional if you begin to find it difficult to follow the prescription instructions (taking more frequently, taking more doses at once, or taking with alcohol or other drugs).

Misuse of Ativan and Xanax is common and it is important to seek help if you are addicted to these drugs. There are other medications available to treat anxiety disorders and panic disorders that are not habit-forming. The most effective treatments for generalized anxiety disorder and panic disorders are a combination of medication and counseling. Seek medical advice from your healthcare provider to determine the best treatment options.

Amanda is a prolific medical content writer specializing in eating disorders and addiction treatment. She graduated Magna Cum Laude from Purdue University with a B.S. in Social Work. Read more