Ativan vs. Xanax: Differences, Similarities, Side Effects, and More

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Intense worrying, a racing heartbeat, and trouble concentrating can be day-altering anxiety symptoms. Many people experience them, and making them more manageable is a common priority. And while anxiety medications are far from the only answer, they're helpful treatments when needed.

When used as directed, benzodiazepines, such as Ativan (lorazepam) and Xanax (alprazolam), are effective for treating anxiety. But there's a time and place for benzodiazepines to be used. Many people turn to them for short-term anxiety relief. In other cases, they're prescribed alongside other anxiety medications, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs), that haven't worked well to control anxiety symptoms on their own.

If you're considering taking Ativan versus Xanax, there are a few differences to consider before picking which might be right for you.

VIDEO: Understanding treatment for generalized anxiety disorders

Top similarities between Ativan and Xanax

Ativan and Xanax have a lot in common. Check out these summarized similarities:

• They're each effective for multiple types of anxiety.

• They're controlled substances with potential for dependence and misuse.

• Ideally, they should only be used for a short period of time.

• Their side effects tend to be similar.

• Overdoses can happen - especially when taken in combination with opioids or alcohol.

Top differences between Ativan and Xanax

While Ativan and Xanax are similar at their core, they do have some differences. Here's a high-level summary:

• Xanax generally starts working faster than Ativan.

• Ativan's effects last slightly longer.

• They come in different dosages and formulations.

• Ativan is preferred over Xanax in older adults.

• Xanax is specifically approved for panic disorder (PD), while Ativan is not.

• Ativan can treat status epilepticus, or seizures that last for a long time or happen close together.

These similarities and differences are broken down in detail below.

What can Ativan and Xanax be used for?

Ativan and Xanax are both FDA approved to treat a few types of anxiety.

Ativan is approved to treat short-term anxiety from a variety of causes. It can also treat overlapping symptoms of anxiety and depression. The Ativan injection is approved to treat status epilepticus.

Xanax treats anxiety too, but its labeled uses are more specific. It can treat generalized anxiety disorder (GAD) and PD with or without agoraphobia - an intense fear of certain situations or places.

What's more, medical professionals may recommend taking one of these medications off-label for other mental health conditions. If you're taking one of these medications and aren't sure of the specific purpose, your medical professional is a go-to resource who can help.

Ativan vs. Xanax side effects

Ativan side effects and Xanax side effects are similar. This is because they both affect the central nervous system (brain and spinal cord).

Common side effects of Ativan and Xanax include:

• Confusion

• Dizziness

• Drowsiness

• Depression

• Difficulty speaking

• Poor coordination, weakness

• Constipation

• Changes in sexual desire

• Changes in appetite

• Skin rash

Are Ativan and Xanax riskier in older adults?

Yes. The side effects of Ativan and Xanax may be worse in older adults than younger adults. If someone age 65 or older takes one of these benzodiazepines, they're more likely to have:

• Difficulty thinking

• Confusion

• General loss of awareness

• Falls

• Crashing a motor vehicle

However, in older adults, many medical professionals may prefer to prescribe Ativan over Xanax. This is because as you get older, your liver may work less effectively. And Ativan isn't as affected by how well your liver is working. It's also less likely to build up in the body than Xanax.

Ativan dosage vs. Xanax dosage

Ativan and Xanax are available as oral medications that can be taken at home. They're typically only used for a short time (about 2 to 4 weeks), but they can also be taken daily depending on the situation. Your medical professional usually starts off by prescribing the lowest dose possible and then may increase it depending on how you respond.

Ativan dosages

Ativan is available as a brand name and generic medication. It's most commonly dispensed as a generic, immediate-release (IR) tablet in 0.5 mg, 1 mg, and 2 mg formulations.

For anxiety disorders, a common dose of Ativan is 2 mg to 6 mg per day in divided doses (2 to 3 times a day) as needed. Some people take daily doses as high as 10 mg.

An extended-release (XR) version is available, too. But it comes under a different brand name - Loreev XR. Loreev XR capsules are taken once a day by mouth in the morning.

What's more, Ativan comes as a 2 mg per mL oral liquid. It's also available as an injection given into a vein or muscle. The injection is administered by a medical professional.

Xanax dosages

Xanax is available as a brand name and generic medication, too. Both versions of these tablets are available in IR and XR dosage forms. The medication is also supplied as oral liquids and orally dissolving tablets.

The IR tablets are generally the most common form that's prescribed. They come in strengths ranging from 0.25 mg to 2 mg. The typical starting dose for GAD is 0.25 mg to 0.5 mg by mouth 3 times a day as needed. If you have PD, you'll generally start off by taking 0.5 mg by mouth 3 times a day.

The XR tablets come in strengths ranging from 0.5 mg to 3 mg. These longer-acting tablets are especially common for PD, and a common dose is 0.5 mg to 1 mg by mouth once daily in the morning.

Ativan vs. Xanax: How long do they take to work?

Ativan and Xanax both start working quickly.

Between the two, Xanax tablets generally kick in faster than Ativan tablets. It takes about 30 minutes for Xanax to work once you take it. Ativan may take up to 2 hours, but some people feel its effects within 30 minutes. These time frames vary from person to person.

How long do they stay in your system?

Ativan and Xanax can stay in your system for quite a while. But Ativan may stay in your system for slightly longer.

One dose of Ativan may take at least 60 to 90 hours (about 2 to 4 days) to fully leave your body. A dose of Xanax IR may take over 48 hours (more than 2 days) to exit.

Xanax XR tablets linger for longer - one dose may take up to 80 hours (about 3 days) to clear your system. It's a similar case for Loreev XR; a dose may stay in your body for up to 100 hours (about 4 days).

Keep in mind: These time frames are different for everyone. They vary depending on your medical conditions and how many doses you've taken.

Ativan vs. Xanax: Which is better for treating anxiety?

It's hard to say. In general, one isn't considered better than the other. The best option between Ativan and Xanax will likely boil down to your personal preferences and the symptoms that you're experiencing. Reach out to your medical professional to see which option is the best fit for you.

Are the risks for dependence, misuse, and overdose the same between Ativan and Xanax?

In short, yes. This is a main reason why it's recommended to only use these medications temporarily when possible.

Long-term use of benzodiazepines carries the risk of experiencing withdrawal symptoms if you stop taking them suddenly. Nausea, vomiting, and tremors are a few examples. Don't stop taking Ativan or Xanax abruptly, especially if you take it every day. Instead, your medical team can assist you with lowering your daily dose slowly over time before stopping the medication.

If you have too much Ativan or Xanax in your system, it can lead to an overdose. Overdose symptoms are serious and may include:

• Severe drowsiness or dizziness

• Trouble breathing

• Slurred speech

• Blurry vision

• Hallucinations

• Physical weakness

• Low blood pressure (hypotension)

• Confusion

Certain factors may raise your risk of experiencing a benzodiazepine overdose. For instance, an overdose is more likely to happen if you also have substances like opioids or alcohol in your system. If you're taking an opioid such as oxycodone (OxyContin) with Ativan or Xanax, it's important to have the opioid reversal medication Narcan (naloxone) on hand. That's because benzodiazepines - like Ativan and Xanax - can also raise the risk of experiencing an opioid overdose. Narcan is available over the counter and without a prescription.

If you're experiencing overdose symptoms, or think someone else is having an overdose, call 911 right away. And if you or someone you know struggles with substance use, help is available. Call SAMHSA's National Helpline at 1-800-662-4357 to learn about resources in your area.

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