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Last updated: Aug 31, 2021
5 min read

Valium vs. Xanax: differences and similarities

Diazepam (brand name: Valium) and alprazolam (brand name: Xanax) belong to a class of anxiolytic medications called benzodiazepines. They work similarly and may cause some of the same side effects. Diazepam has longer-lasting effects compared to alprazolam. Healthcare providers may prescribe these two medications to treat different conditions. For example, diazepam is sometimes used to treat seizures or muscle spasms, while alprazolam is not. It’s best to talk to 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.

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What are Valium and Xanax?

Valium (generic name: diazepam) and Xanax (generic name: alprazolam) are anti-anxiety medications that belong to a class of drugs called benzodiazepines (“benzos,” for short). 

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).

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) ([email protected], 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). 

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):

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 

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):

  • Drowsiness
  • 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
  • Drowsiness
  • Dizziness
  • Memory problems
  • Depression

Drug interactions

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.

CNS depressants

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:

  • Alcohol
  • 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:

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. 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/
  3. 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/
  4. [email protected]: FDA-Approved Drugs. (n.d.). [email protected]. Retrieved Aug. 31, 2021 from https://www.accessdata.fda.gov/scripts/cder/daf/ 
  5. Drug Enforcement Agency (DEA). (n.d.). Drug scheduling. Retrieved Aug. 31, 2021 from https://www.dea.gov/drug-information/drug-scheduling
  6. 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
  7. 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
  8. George, T.T. & Tripp, J. (2021). Alprazolam. [Updated July 19, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK538165/
  9. 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
  10. 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
  11. Roche. (2021). Valium, brand of diazepam tablets. Retrieved Aug. 31, 2021 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/013263s096lbl.pdf