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Living with extreme anxiety is hard; there’s no way around it. When your personal and professional relationships, sleep, and day-to-day tasks are affected by anxiety, it may be time to consider seeking the help of a healthcare professional who can come up with a treatment plan that works for you. One of the things they may include in your treatment plan is the short-term use of an anti-anxiety medication like Valium or Xanax.
What are Valium and Xanax?
Benzos create a calming and sedating effect by boosting the activity of the neurotransmitter GABA (gamma-aminobutyric acid), which blocks specific brain signals and slows the activity of your CNS or central nervous system (Bounds, 2020).
Because diazepam and alprazolam are controlled substances that may be addictive, leading to symptoms of withdrawal, as well as drug abuse, healthcare providers usually recommend other medications—like antidepressants in the form of SSRIs—for the long-term treatment of anxiety disorders (DEA, n.d.).
To minimize the risks of taking benzodiazepines, healthcare providers may prescribe Valium or Xanax for short-term use or as a treatment that you only take “as needed.” For example, a healthcare provider may instruct you to take a dose only when necessary to quickly stop a seizure or ease an anxiety or panic attack (Roche, 2021; Pfizer, 2021).
Your guide to anxiety medications
What is Valium (diazepam)?
Here’s a quick summary of information about Valium (Roche, 2021):
- Generic name: diazepam
- Drug class: benzodiazepine
- Controlled substance? Yes, schedule IV (DEA, n.d.)
- First approved by the Food and Drug Administration (FDA): 1963
Diazepam comes in several different forms and brands. It’s most commonly prescribed as an oral tablet (Valium) in one of three strengths: 2 mg, 5 mg, and 10 mg. The drug is also available as an intravenous or intramuscular injection, an oral solution, a rectal gel (Diastat), and a nasal spray (Valtoco) (Drugs@FDA, n.d.).
Diazepam typically starts working within 15 to 60 minutes after you take an oral dose. The drug reaches its maximum effects within 1 to 1.5 hours, and its effects usually last 12 hours or longer (Dhaliwal, 2021; Roche, 2021).
What is Valium used to treat?
Valium (diazepam) is FDA-approved for the following uses (Roche, 2021):
- Short-term relief of anxiety symptoms and management of anxiety disorders
- Acute alcohol withdrawal symptoms such as agitation, tremor, delirium tremens, and hallucinations
- Muscle spasms
- Seizure disorders, with other anti-epileptic drugs
Diazepam (Valium) can also be prescribed “off-label” to treat tension headaches. A healthcare provider can prescribe medications for off-label use if they determine that it’s an appropriate treatment for their patient (Paiva,1982; FDA, 2018).
Diazepam (Valium): dosage, uses, side effects, and risks
What is Xanax (alprazolam)?
Here’s a quick summary about Xanax (Pfizer, 2021):
- Generic name: alprazolam
- Drug class: benzodiazepine
- Controlled substance? Yes, schedule IV (DEA, n.d.)
- First approved by the FDA in 1981
Alprazolam is only available as an oral medication (a drug that you take by mouth). It’s most commonly prescribed in tablet form (Xanax), available in 0.25 mg, 0.5 mg, 1 mg, and 2 mg strengths. Alprazolam also comes in an extended-release tablet, an orally dissolving tablet, and a liquid solution.
Xanax starts working within 30 minutes after you take a dose. It reaches its maximum effects within 1–2 hours. Its effects usually last around six hours (George, 2020).
Alprazolam’s effects on the body do not last as long as the effects of diazepam.
What is Xanax used to treat?
Xanax (alprazolam) tablets are prescribed to treat anxiety disorders in adults. Specifically, it was FDA-approved for these uses (Pfizer, 2021):
- Short-term treatment of generalized anxiety disorder (GAD)
- Treatment of panic disorder with or without agoraphobia
Alprazolam has additional off-label uses (Bounds, 2020):
- Short-term treatment of sleep problems like insomnia
- To relieve severe symptoms such as delirium and agitation
Alprazolam (Xanax): dosage, uses, side effects
Side effects: Valium vs. Xanax
Valium and Xanax can cause some similar side effects, which are listed below. Because of these side effects, you should not drive or engage in potentially dangerous tasks after taking diazepam or alprazolam. Also, alcohol can enhance the drowsiness side effect of these medications and should be avoided.
The following lists include the most common side effects reported in separate clinical trials when each drug was compared to a placebo (Roche, 2021; Pfizer, 2021).
Side effects of Valium (diazepam)
The most common side effects of diazepam include (Roche, 2021):
- Muscle weakness
- Fatigue (feeling drained of energy)
- Ataxia, which is a lack of muscle coordination that makes it difficult to move or talk normally
Side effects of Xanax (alprazolam)
The most common side effects of alprazolam include (Pfizer, 2021; Ait-Daoud, 2018):
- Problems with coordination or unsteadiness
- Reduced blood pressure
- Trouble speaking words clearly
- Increased libido or sex drive
- Memory problems
Lorazepam (Ativan): dosage, uses, side effects
Valium and Xanax belong to the same class of drugs called benzodiazepines, so they carry similar interaction risks. This section covers just a few examples of the most important types of interactions to be aware of before taking Valium or Xanax.
While taking Valium or Xanax, healthcare providers do not advise taking medications or substances known as CNS depressants or “downers.” These are drugs or substances that slow down the central nervous system (CNS). These combinations can increase the risk of severe side effects like excessive sedation, low blood pressure, or overdose (FDA, 2020).
Some examples of CNS depressants include:
- Opioids such as codeine, oxycodone, tramadol, and heroin
- Other benzodiazepines like lorazepam (Ativan)
- Sedatives (“sleeping pills”) such as eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien)
Other drug interactions are possible with these medications. Valium and Xanax can potentially interfere with the way your body metabolizes or breaks down other medications, including some that are used to treat seizures or anxiety disorders. So, it’s always a good idea to check with your pharmacist or healthcare professional before taking any other prescription drugs, over-the-counter medications, or herbal supplements with Valium or Xanax.
Comparison of Valium vs. Xanax
We’ve given you a lot of information regarding the differences and similarities between these two medications. Here is a summary:
- 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/
- Bounds, C.G. & Nelson, V.L. (2020). Benzodiazepines. [Updated Nov. 22, 2020]. In: StatPearls [Internet]. Retrieved from Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470159/
- Dhaliwal, J.S., Rosani, A., & Saadabadi, A. (2021). Diazepam. [Updated Aug. 6, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537022/
- Drugs@FDA: FDA-Approved Drugs. (n.d.). Drugs@FDA. Retrieved Aug. 31, 2021 from https://www.accessdata.fda.gov/scripts/cder/daf/
- Drug Enforcement Agency (DEA). (n.d.). Drug scheduling. Retrieved Aug. 31, 2021 from https://www.dea.gov/drug-information/drug-scheduling
- Food and Drug Administration (FDA). (2018). Understanding unapproved use of approved drugs “off label”. Retrieved Aug. 31, 2021 from https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label
- Food and Drug Administration (FDA). (2020). FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. Retrieved Aug. 31, 2021 from https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class
- George, T.T. & Tripp, J. (2021). Alprazolam. [Updated July 19, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK538165/
- Paiva, T., Nunes, J. S., Moreira, A., Santos, J., Teixeira, J., & Barbosa, A. (1982). Effects of frontalis EMG biofeedback and diazepam in the treatment of tension headache. Headache, 22(5), 216–220. doi: 10.1111/j.1526-4610.1982.hed2205216.x. Retrieved from https://headachejournal.onlinelibrary.wiley.com/doi/abs/10.1111/j.1526-4610.1982.hed2205216.x?sid=nlm%3Apubmed
- Pfizer. (2021). Xanax (alprazolam) tablets, for oral use, CIV. Retrieved Aug. 31, 2021 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/018276s055lbl.pdf
- Roche. (2021). Valium, brand of diazepam tablets. Retrieved Aug. 31, 2021 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/013263s096lbl.pdf
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.