Ativan vs. Xanax: differences and similarities

If you have intense or persistent anxiety, you understand how debilitating it can be. It can interfere with your work, sleep, relationships, and day-to-day responsibilities. When anxiety affects your overall quality of life, your healthcare provider might suggest a treatment plan that includes short-term or as-needed use of a medication like Ativan or Xanax.

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Ativan (generic name: lorazepam) and Xanax (generic name: alprazolam) are anxiolytic (anti-anxiety) medications. They both belong to a class of drugs called benzodiazepines (sometimes called “benzos”); as such, Ativan and Xanax are very similar medications.

Benzodiazepines work in your brain, boosting the activity of a neurotransmitter called gamma-aminobutyric acid (GABA). GABA blocks specific brain signals, which slows down your central nervous system (CNS). The result is a calming, sedating effect (Bounds, 2020). 

It’s important to note that other treatments, such as antidepressants and non-drug therapies, are preferred for the long-term treatment of anxiety disorders. This is because these other therapies generally carry fewer risks compared to controlled substances like benzodiazepines. They may cause addiction and can be abused (DEA, n.d.).

Because of these risks, benzodiazepines including Ativan or Xanax are usually recommended as short-term or “as needed” treatments to quickly relieve anxiety symptoms such as panic attacks.

What is Ativan (lorazepam)?

Here’s some at-a-glance information about Ativan (lorazepam) (Bausch Health, 2021; Ghiasi, 2021):

• Generic name: lorazepam

• Drug class: Benzodiazepine

• Controlled substance? Yes, schedule IV (DEA, n.d.)

• First approved by the Food and Drug Administration (FDA) in 1977

Lorazepam is available as an oral tablet, an oral solution, and an injection. However, the rest of this article will focus on the lorazepam oral tablet, which is the most commonly prescribed form. Lorazepam tablets come in three strengths: 0.5 milligrams (mg), 1 mg, and 2 mg. It starts working within 30 minutes after taking a dose, reaching its maximum effects within two hours. Its effects usually last six to eight hours.

What is Ativan used to treat?

Healthcare providers prescribe Lorazepam tablets to treat anxiety disorders in adults. It’s FDA-approved to relieve short-term anxiety and anxiety symptoms related to depression. It’s also approved to treat short-term insomnia due to anxiety or situational stress (Bausch Health, 2021).

Lorazepam has additional “off-label” uses. Off-label use is when a healthcare provider prescribes a drug to treat conditions other than what it was FDA-approved to treat. Off-label prescribing is at the discretion of healthcare professionals when they deem a medication appropriate for their patient (FDA, 2018). 

Some common off-label uses for lorazepam tablets include (Ghiasi, 2021; Bounds, 2020):

• Panic disorder

• Relieving delirium and agitation that can happen with mental health conditions 

• Alcohol withdrawal symptoms—like anxiety and tremors—that occur when someone stops consuming alcohol after a period of heavy drinking.

• Long-term insomnia, a sleep disorder in which you have trouble falling asleep or staying asleep. However, according to the American Academy of Family Physicians, benzodiazepines are not typically recommended for this use because there are other options available that carry fewer risks (Matheson, 2017).

What is Xanax (alprazolam)?

Here’s a quick summary about Xanax (Pfizer-a, 2021; Pfizer-b, 2021):

• Generic name: alprazolam

• Drug class: Benzodiazepine

• Controlled substance? Yes, schedule IV (DEA, n.d.)

• First approved by the FDA in 1981

Alprazolam is available as a regular oral tablet, an extended-release tablet, an orally dissolving tablet, and an oral solution. The rest of this article will focus on the oral tablet since it’s the most commonly prescribed form. Xanax (alprazolam) tablets are available in the following strengths: 0.25 mg, 0.5 mg, 1 mg, and 2 mg. It starts working within 30 minutes after taking a dose, reaching its maximum effects within one to two hours. Its effects usually last around six hours (George, 2020).

What is Xanax used to treat?

Healthcare providers prescribe Alprazolam tablets to treat anxiety disorders in adults. Alprazolam is specifically FDA-approved for these uses (Pfizer-a, 2021):

• Short-term treatment of generalized anxiety disorder (GAD) in adults

• Treatment of panic disorder with or without agoraphobia in adults

Alprazolam has other off-label uses (Bounds, 2020), such as:

• Short-term treatment of sleep problems like insomnia

• To relieve severe symptoms such as delirium and agitation 

Ativan and Xanax cause some similar side effects. The following lists include the most common side effects reported in separate clinical trials, during which researchers compared each drug to a placebo (Bausch Health, 2021; Pfizer, 2021).

Side effects of Ativan (lorazepam)

The most common side effects reported with taking lorazepam include (Bausch Health, 2021):

• Drowsiness

• Dizziness

• Weakness

• Problems with coordination or unsteadiness

Side effects of Xanax (alprazolam)

The most common side effects reported with taking alprazolam include (Pfizer, 2021; Ait-Daoud, 2018):

• Problems with coordination or unsteadiness

• Reduced blood pressure

• Trouble speaking words clearly

• Increased libido or sex drive

• Drowsiness

• Dizziness

• Memory problems

• Depression

Ativan and Xanax both belong to the same class of drugs called benzodiazepines, so they carry similar interaction risks. This section includes a few examples of the most important types of interactions to be aware of before taking Ativan or Xanax. 

Healthcare providers do not advise people to take Ativan or Xanax with alcohol, opioid drugs, other benzodiazepines, or sleep aids. These combinations can increase the risk of addiction, excessive sedation, or overdose (FDA, 2020). 

Some examples of opioids include prescription painkillers like hydrocodone, oxycodone, tramadol, and illicit drugs like heroin. Any medications that cause you to become drowsy, such as sleep aids, can also cause harmful effects when combined with Ativan or Xanax. Some examples of sleep aids are zolpidem (Ambien) and eszopiclone (Lunesta). 

For more detailed interaction information, you can read Health Guide’s in-depth articles about Ativan (lorazepam) and Xanax (alprazolam), or you can ask your pharmacist or healthcare provider. And, it’s always a good idea to consult with your pharmacist or healthcare professional before taking any other prescription drugs, over-the-counter medications, or supplements with your current medications. 

We’ve given you a lot of information regarding the differences and similarities between these two medications. Here is a summary:

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

August 20, 2021

Written by

Patricia Weiser, PharmD

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.