Start your free visit for ED treatment. Learn more

Aug 20, 2021
5 min read

Ativan vs. Xanax: differences and similarities

Ativan (lorazepam) and Xanax (alprazolam) are similar medications that healthcare providers commonly prescribe as short-term or as-needed treatments for anxiety. While these medications are very similar, Xanax tablets typically start working sooner than Ativan tablets. But, Ativan’s effects on the body tend to last a little bit longer than the effects of Xanax. It’s best to talk with a healthcare provider if you have questions about whether one of these medications may be helpful for you.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

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.

ADVERTISEMENT

Get help with anxiety and depression

Ro Mind offers access to customized treatment plans and check‑ins with a U.S.-licensed healthcare provider to support your mental health.

Learn more

What are Ativan and Xanax?

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):

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 

Side effects of Ativan and Xanax

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

Drug interactions of Ativan and Xanax

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. 

Comparison of Ativan vs. Xanax

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

References

  1. Ait-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018). A review of alprazolam use, misuse, and withdrawal. Journal of Addiction Medicine, 12(1), 4–10. doi: 10.1097/ADM.0000000000000350. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846112/ 
  2. Bausch Health. (2021). Ativan (lorazepam) tablets. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/017794s048lbl.pdf 
  3. Bounds, C. G. & Nelson, V. L. (2020). Benzodiazepines. [Updated Nov 22, 2020]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470159/ 
  4. Drug Enforcement Agency (DEA). (n.d.). Drug scheduling. Retrieved from https://www.dea.gov/drug-information/drug-scheduling 
  5. Food and Drug Administration (FDA). (2018). Understanding unapproved use of approved drugs “off label”. Retrieved from https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label 
  6. Food and Drug Administration (FDA). (2020). FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. Retrieved from https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class 
  7. George, T. T. & Tripp, J. (2020). Alprazolam. [Updated Jul 19, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK538165/ 
  8. Ghiasi, N., Bhansali, R. K., Marwaha, R. (2021). Lorazepam. [Updated Feb 17, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532890/ 
  9. Matheson, E. & Hainer, B. L. (2017). Insomnia: pharmacologic therapy. American Family Physician, 96(1), 29–35. Retrieved from https://www.aafp.org/afp/2017/0701/p29.html  
  10. Pfizer. (2021). Xanax (alprazolam) tablets, for oral use, CIV. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/018276s055lbl.pdf 
  11. Pfizer. (2021). Xanax XR (alprazolam) extended-release tablets, for oral use, CIV. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/021434s018lbl.pdf