Ativan vs. Xanax: Similarities and Differences

Ativan (lorazepam) and Xanax (alprazolam) are two benzodiazepine medications often used to treat generalized anxiety disorder, panic disorders, and other anxiety symptoms. Though these drugs are similar, Ativan has a longer-lasting effect on the body compared to Xanax. Conversely, Xanax acts quickly and can promote relaxation in as little as 30 minutes.

Explore the similarities and differences between Ativan and Xanax, their uses, how they work, and their adverse effects.

What Are Ativan and Xanax?

Ativan is the brand name for lorazepam, a benzodiazepine drug that binds to receptors in the brain to produce a calming effect. Ativan comes in tablets and injections, the former of which is used to treat anxiety disorders and the latter of which is used to treat seizures or may be used as a premedication for anesthesia.

Xanax is the brand name for alprazolam, another benzodiazepine that works similarly to Ativan. Xanax is primarily used to treat anxiety and panic disorders. Xanax also comes in an extended-release formulation, Xanax XR.

Both Xanax and Ativan may have off-label uses. They work similarly to enhance the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that can produce feelings of calm and relaxation.

Benzodiazepines like Xanax and Ativan have amnesic effects, which means they disrupt short-term memory. Because of this, they may be used before surgery.

Ativan and Xanax Dosages

Ativan is available in tablet form in 0.5 mg, 1 mg, and 2 mg dosages.[1] The maximum daily dose is 10 mg.

Xanax comes in regular and extended-release tablets, Xanax XR. The Xanax dosage is available in 0.25 mg, 0.5 mg, 1 mg, and 2 mg, while Xanax XR is available in 0.5 mg, 1 mg, 2 mg, and 3 mg.[2] The dose may be adjusted every 3 or 4 days, with a maximum daily dosage of 4 mg.

How Long Do Ativan and Xanax Last?

Ativan acts slower than Xanax and stays in the body longer, so the effects take longer to kick in but last for longer periods than Xanax. As a result, Ativan may be taken less frequently than Xanax.

Because Xanax is absorbed more quickly, it reaches peak concentrations about 1 to 2 hours after use, and the effects last for 4 to 6 hours.[3] Ativan takes about 2 hours to reach peak concentration, and the effects last about 8 hours.[4] However, there may be individual differences that affect how long Xanax and Ativan last.

Side Effects with Xanax and Ativan

Both Ativan and Xanax have common side effects, including:[5,6]

• Drowsiness
• Memory problems
• Slurred speech
• Confusion
• Fatigue
• Decreased libido
• Increase appetite
• Weakness
• Impaired balance and coordination
• Impaired driving skills
• Euphoria

There may be additional side effects with either drug. Ativan is less likely to cause drowsiness than Xanax. Based on research, Xanax causes drowsiness in 41% of people taking it for anxiety and 76.8% of people taking it for panic disorder.[7] Ativan causes sedation in 15.9% of people taking it for anxiety.

Severe Effects of Ativan and Xanax

Ativan and Xanax have risks of serious side effects like vision changes, trouble speaking, and memory problems. Severe allergic reactions may occur with itching, rash, and swelling of the face, lips, tongue, or throat.

The severe side effects of Ativan and Xanax may include:[8,9]

• Excessive drowsiness
• Suicidal thoughts or actions
• Syncope or missed heartbeat
• Respiratory failure
• Excessive restlessness
• Confusion
• Difficulty staying awake
• Seizures
• Skin rash
• Jaundice

Benzos shouldn’t be used if you’re pregnant or breastfeeding. The safety of these drugs during pregnancy is not well established, and both drugs have the potential to cross the placenta and cause low birth weight or premature birth.

Older adults can experience issues with cognition, mobility, and driving skills, increasing the risk of falls or automotive accidents. Lorazepam may worsen hepatic encephalopathy in people with existing liver problems.

Drug Interactions with Xanax and Ativan

Mixing benzodiazepines like Xanax and Ativan can cause severe central nervous system depression with extreme sedation, slowed breathing (respiratory depression), coma, and death. Benzos should never be combined with alcohol, opioids, or other depressants.

Speak with your doctor about the other medications or substances you take, including illicit drugs, over-the-counter medications, and herbal or vitamin supplements.

Misuse and Addiction Potential of Ativan and Xanax

Benzodiazepines of all types have addiction potential. However, the properties of Ativan and Xanax may affect their potential for misuse and addiction.

Overall, Ativan has fewer withdrawal symptoms compared to Xanax and less potential for misuse. This is due to the slower elimination rate. Stopping Xanax suddenly can cause rapid withdrawal effects like insomnia, anxiety, and panic attacks.

The withdrawal symptoms for benzodiazepines may include:[10]

• Anxiety
• Panic
• Nausea or vomiting
• Hallucinations
• Insomnia
• Cravings
• Twitching muscles
• Cognitive deficits
• Tingling in the arms and legs
• Mood swings

The severity and duration of withdrawal depend on the length of treatment, the specific drug, the dosage, the use of other substances, and underlying medical conditions. It’s possible to develop dependence when the drug is taken as prescribed, but it’s more likely if you take high doses of benzos or take them for long periods.

If you’ve been taking Xanax or Ativan for long periods, it’s important to reduce your dose to minimize withdrawal symptoms slowly. This should be done using a taper schedule as recommended by a doctor. Never change your dose or stop taking this medication without talking to your doctor. Severe withdrawal symptoms like psychosis and seizures may occur.

Ativan vs. Xanax: Which Is Right for You?

Ativan and Xanax are similar drugs, but they have some important differences to consider. Xanax acts faster, while Ativan stays in the body longer. Both drugs have the potential for misuse and abuse, as well as withdrawal symptoms that can be intense and dangerous. Speak to your doctor about each medication’s pros and cons to see which is right for you.