Ativan vs Xanax

Ativan vs Xanax
November 13, 2015 3:34 PM

This article compares Ativan (Lorazepam) vs Xanax (Alprazolam). These are two popular panic and anxiety fighting medications.The article compares medical indications, side effects, contraindications and other features of both Lorazepam and Alprazolam. Withdrawal symptoms of Xanax and Ativan are also described.


The scientific name for this drug is alprazolam. It is a short acting anxiolytic of the benzodiazepine class. It can be used for the treatment of different panic disorders including the anxiety disorders like social anxiety disorder and generalized anxiety disorder.

A 2010 survey showed that Xanax was the 12th most commonly recommended drug by the doctors (1). This drug binds to specific GABA receptor sites. It has several effects on body including hypnotic, anticonvulsant, sedative, amnestic and skeletal muscle relaxant effects. This drug can be taken orally in the compressed form or in the form of capsule.

The thing that makes this drug quite unique is that it has a strong action and gives quick relief. The peak effects are usually seen in the first few hours of using. The full effects are achieved in about 1.5 to 1.7 hours.

However, it may take a week to see the complete benefits for generalized anxiety disorder. There is some controversy with regards to the tolerance of the drug.

Some people report that people develop tolerance as a result of these drugs while others report no tolerance. The tolerance can form in a couple of days. A person may suffer from rebound or withdrawal symptoms after leaving the drug at once after two or three weeks of regular usage.

Medical uses

There are a number of medical uses of Xanax. It is usually used for the treatment of nausea, panic disorders and anxiety disorders. Xanax is also used for treating anxiety disorder and to treat depression. It is usually recommended by experts to fight hypersomnia and defects in sleep.

1. Xanax for the treatment of anxiety

It is accepted by researchers that Xanax works for anxiety disorders (2). It has been in use for a decade for treating panic and anxiety disorders. Different anxiety disorders can be treated by the consumption of Xanax. Usually Xanax works but the main problem with this drug is that it is given when all other kinds of treatments are stopped. You need to control the intake of this medication because if you don’t then the side effects will come back even stronger than before.

The users may experience two types of dependence following the use of Xanax. The first one is the psychological dependence whereas the other one physical dependence. Both of these dependences have been mentioned below:

  • Physical dependence – the body makes itself used to Xanax and other such benzodiazepines with the passage of time. This effect can lessen or may even stop the effect of medicine. This effect isn’t seen in the start but starts in about six months. The time period however, varies from person to person. The time can also be up to 2 years in some individuals. The body generally becomes fond of the drug till the drug has no effect.
  • Psychological dependence – people who think of medicine as a treatment treat it as something to cope with the anxieties of their daily lives. The reason behind this is that the mind knows no other way to cope with stress. Psychological dependence is actually the time when the drug isn’t needed physically but you still need the drug because it develops as a habit. A time comes when you become depressed if you don’t have a single doze of the drug.

2. Panic disorder

Different panic disorders can also be treated due to Xanax (3). Severe anxiety and panic attacks can be relieved by Xanax. But it should be kept in mind that it isn’t the first in line of the treatment since the formation of serotonin reuptake inhibitors. Xanax isn’t recommended in some countries now and Australia is one of them because of the concerns regarding its dependency and abuse.

There is evidence that supports that Xanax is beneficial against panic disorders. But the study has been limited for a period of 4 to 10 weeks. People having panic disorders have been treated for about 8 months without losing its health benefits.

Studies which support the fact that Xanax is quite beneficial for panic disorders were conducted on certain patients whose diagnosis was similar to DSM-III criteria for panic disorder. Unexpected panic attacks are felt in panic disorder. There are periods of intense discomfort at times. There are four major symptoms of panic disorder which include palpitations, accelerated heartbeat, pounding heart, sweating, trembling, choking sensation, chest pain, nausea, dizziness, fear of dying, fear of losing control, and chills.

3. Easing the effects of depression

People usually underestimate depression. Depression can affect the whole life of an individual. It is usually caused by a variety of factors such as workload, unemployment and disease. It is a big enemy of health and several steps need to be taken to ensure that a person is cured of depression. Xanax medication is one of these measures. Taking Xanax medications can help cure the symptoms of depression (4).

4. Fast acting

Xanax acts quite fast. The reason is that it is quite effective for the nervous system and thus, it is the best medications for people having different nervous system disorders like depression and apprehension. Xanax is quite affordable when compared to its competitive medicines.

Intake methods

Xanax is available in the market in the form of tablets. It is also available in some other forms like orally disintegrating tablet, extended-release tablet and in the form of a concentrated solution which is to be taken through the mouth.

The tablet and the concentrated solution should be used up to three to four times a day. The extended release tablet on the other hand, should only be taken once a day and that is during the morning time.

You should follow the descriptions on the label carefully before taking the medication. You shouldn’t be shy to ask the doctor anything which you don’t understand and take the drug as instructed by the doctor.

You should use only the dropper that comes with prescription. Put the amount of one dose into the dropper. Now empty the dropper in a liquid or a semi solid like soda, applesauce, pudding or juice. Mix the fluid gently for a few seconds. The concentrated liquid will mix completely with the food. You should drink the prepared liquid at once and not leave it for future use.

Now let us see how to eat the oral tablet. Take out the tablet from the bottle just before you are about to eat it. Remove the cap of the bottle with dry hands, remove the tablet and put the lid back on. Now put the tablet on your tongue.

The tablet will easily dissolve with saliva. You can take the tablet with or without water.

You should swallow the extended tablets as they are. Don’t chew or break them into parts (5).

The doctor will start the dosage of Xanax slowly and gradually increase the dosage. The dosage will be about once in every 3 to 4 days. There is a reason behind such a low dosage of Xanax and the reason is that Xanax is a bit addictive.

You shouldn’t take larger doses of this medicine even if you are feeling severe depression or anxiety. You shouldn’t also take it for longer periods of time than indicated by the doctor. You should always consult the doctor before leaving the medicine or decreasing the dosage.

A person may feel some withdrawal symptoms if he leaves the medication without the instructions of doctor. Some common withdrawal symptoms including shaking of a certain part of a body, headache, seizures, sensitivity to light, sweat, difficulty in sleeping, difficulty in concentrating, depression, nervousness, aggressive behavior, muscle cramps, vomiting, numbness, tingling in hands and feet, and loss of appetite. These side effects will be discussed in detail in the next section.


Xanax tablets aren’t recommended for the patients with sensitivity to the drug. Patients receiving therapy should also take Xanax who are receiving open angle glaucoma but patients with narrow angle glaucoma should avoid taking Xanax. Some medications like ketoconazole and itraconazole should be avoided with Xanax because these medications effect the oxidative metabolism.


1. Withdrawal reactions and seizures

Physical dependence to the medication can cause certain life-threating events for a person. Some withdrawal symptoms can be seen and the most important withdrawal symptom is seizures (6). Even small doses for the medications for treating general anxiety and panic have the risk of dependence.

Studies have shown that the risk of dependence is greater in those patients who take greater amount of medication for longer periods of time like 4 mg/day per day. It has also been seen that patients who ate Xanax tablets of more than 4 mg/day faced difficulty in getting used to zero dosage as compared to the patients who ate less than 4 mg/day tablets.

The returning of illness can be defined as the condition of panic disorder when the panic attacks are at the same level or at greater levels as compared to before the treatment. The withdrawal symptoms are those symptoms which aren’t the characteristics of panic disorder and which occur at frequent times.

There haven’t been enough studies done on Xanax as far as the return of symptoms are concerned. A random study however, showed that there are higher rate of returning symptoms in people taking Xanax tablets as compared to those who don’t take the tablets.

2. Harmful effects on pregnant and breast feeding women

Xanax belongs to benzodiazepine group of drugs and it has been seen that the child of a mother who is taking benzodiazepines may be at more risk of the withdrawal symptoms from the drug. The child of the mother taking benzodiazepine may suffer from respiratory problems and neonatal flaccidity. Xanax tablets have no effect or use in the delivery and labor of the child (7).

Research has shown that benzodiazepines are excreted in the milk of breast feeding mothers.

So it is right to say that Xanax can also have the same effect. Taking Xanax tablets can cause the infants to lose weight and become lazy. So, mothers who have to take Xanax tablets should avoid nursing their children and feeding them.

Xanax can cause risks of congenital abnormalities when give to pregnant women during their first trimester. There is no urgency to take these drugs, so women who are in their first trimester should avoid this drug. Doctors should consider a woman’s pregnancy while administering this drug. Patients should also be careful with this drug and should inform the doctor as soon as they find they are pregnant or they have intentions of becoming pregnant.

3. For geriatric use

Older people are quite sensitive to the effects of benzodiazepines. Older people show high plasma concentrations by the reduction in clearance of the drugs in comparison to younger people who receive the same amount of doses. Small doses of Xanax should be used in elderly patients to avoid the development of sedation.

4. Interaction with other drugs

CNS depressant effects are formed by different benzodiazepines and Xanax is one of them. They produce the effects of depressions when administered with other psychiatric medications, ethanol, anticonvulsants and some other drugs which produce the effects of depression.

5. Risks related to dose reduction

Some serious side effects are seen when the dose is reduced due to some reason. These effects can be seen when the patients purposefully leaves the drug or he forgets to take the medicine. The dose of Xanax should therefore, be discontinued slowly.


The scientific name for this drug is Lorazepam. It is also benzodiazepine medicine used to treat disorders and anxiety. There is a long list of medical uses of this drug like reducing agitation, inducing sleep, reducing anxiety, treating seizures, relaxing muscles and treating vomiting and nausea. This drug is used for treating anxiety related issues in a small period of time.

It is used for sedating hospitalized and aggressive patients. The main thing which differs this drug from Xanax is that it is used for short duration of times like two to four weeks.

Ativan can make a person physically addicted to this drug. This drug can also create serious consequences if it is misused like some people use it for enjoyment purposes. Some long term effects of the intake of benzodiazepine medications include dependence to the drug, tolerance, withdrawal symptoms and cognitive impairments.

The cognitive impairment isn’t that much severe in some people.

The withdrawal symptoms of this drug vary widely and can range anywhere between mild anxiety to psychosis. Some other serious side effects of this drug include inability to form new memories, paradoxical effects and depression. These effects however, don’t affect everyone equally. Mostly children and elderly people are more prone to the effects as compared to adults. The body balance is impaired in some serious cases and this drug can also cause hip fractures in elderly people.

Ativan dosage and intake methods

Now let us look at the dosage of this drug (8). The dosage of the drug mainly depends upon the form that whether it is taken in liquid form, orally or in the form of an injection. You should take this drug exactly as instructed by the doctor. The strengths of Ativan tablets are 0.5 mg, 1 mg and 2 mg. The intensity of this drug mainly depends upon the anxiety condition of a patient.

The doctor can prescribe it up to two or three times per day. The doctor will first keep the dose low and then slowly increase the dose to avoid any kind of side effects. The dose is lower for elderly patients. You can take this drug with liquid like a glass of water. It’s your choice to take it with or without food. The ativan bottles are usually available in a dropper with various doses.

You can mix the oral solution with liquids of semi liquids like sodas and beverages.

The ativan injections are given through the vein or muscle. You can get the repeat dose after that. The doctor monitors the drug constantly to see that there are no side effects.

You should be wary before using this drug. You should only take small amounts of this drug. Never use this drug in large amounts. The reason is that this drug can be habit forming. Tolerance to this drug can develop after prolonged use which can make the drug less effective. This drug is best for shorter periods of time. So, you shouldn’t take it for more than 4 months or longer than the instructions of the doctor.

You shouldn’t also stop this drug suddenly because it can cause certain withdrawal symptoms. Leave these kinds of decisions to the doctor. The doctor will stop your medicine gradually.

Medical properties of Ativan

Ativan is a benzodiazepine medication. The drugs which are present in this class have sedating effects on the body. There are six main benefits of using Ativan.

Ativan can be used as:

  • Nausea remedy
  • Anxiety remedy
  • Amnesic
  • Muscle relaxant
  • Sedative
  • Anticonvulsant

Doctors frequently prescribe this medicine for the treatment of anxiety and insomnia. The main benefit of this drug is that it acts fast. Ativan can provide quick relief when panic attacks come to a person without any warning. This drug has strong sedative and anti-anxiety properties. So, it is given to the patients suffering from insomnia and anxiety.

This drug is quite fast acting. Therefore, the FDA recommends the use of this drug for no longer than 4 weeks. It acts fast and is useful against panic anxiety (9).

People on mechanical ventilation should also use Ativan. But propofol is better choice for patients who are critically ill because it is greater in cost and effectiveness. Therefore, ventilation patients should prefer the use of propofol instead of Ativan.

Different seizures are stopped by Ativan due to its anticonvulsant properties. It produces the effect of sedation and the sedation effects are for relatively longer durations of time. This anticonvulsant and depressant properties of Ativan are quite beneficial in the treatment and prevention of alcohol withdrawal syndrome. The impairing of liver function isn’t a problem with Ativan because Ativan doesn’t need oxidation or hepatic for its metabolism.

Agitation can also be reduced significantly by the intake of Ativan. The clinical effects of one dose make it quite effective against the treatment of insomnia. This drug acts quite quickly. That’s why the withdrawal symptoms can occur quickly and can occur within seven days of intake of Ativan (10).

Ativan is also quite useful as a premedication because of its ability to prevent the formation of new memory and its ability to reduce anxiety and agitation. It is administered before general anesthetics in order to reduce the amount of the anesthetics required.

It is also useful for reducing anxiety, inducing amnesia and increasing compliance. Ativan is usually administered about two hours before the procedures when given orally. It is given 10 minutes late in the form of intravenous Ativan.

Side effects of Ativan

The drug Ativan is quite useful for shorter durations of time. But it can cause a number of side effects when consumed for longer periods of time. The long term use of Ativan can result in psychological dependence, physical tolerance and addiction to the drug. Some major side effects of this drug have been mentioned below (11):

1. Physical tolerance

The physical tolerance can be developed when Ativan is consumed for longer durations of time. The reason is that the drug becomes like a habit and the body adapts itself to the drug. Tolerance here means that the drug has no effect on the body.

So, a person would need to eat more of the drug to have some effect. Tolerance isn’t dangerous but withdrawal symptoms that accompany tolerance are quite dangerous; they can even be life threatening. You should always consult your physician every time you decide to make a change in your medication. Some major side effects of discontinuing this medication include physical symptoms like headache, sweating, confusion, irritability, tingling sensation, numbing and dizziness in hands and legs.

2. Addiction to the drug

Addiction is defined as something to which you are so attached that you find it difficult to leave. Many complex processes work in addiction like emotional isolation, physical tolerance, denial, psychological dependence and losing control of oneself. Previously, it was thought that addiction was something related to willpower. But now the experts and researchers agree that it is more of a disease than a matter of determination or will power. There are many different ways to overcome addictions, which include behavioral and cognitive therapy. Addiction can be quite fatal if not properly treated.

3. Psychological dependence

Psychological dependence is a situation in which a person’s mood and emotions are affected by the absence or presence of the drug. The drug doesn’t provide solution but becomes a problem in itself. A person starts believing that only taking medication will make him better. Many psychological problems can be caused by discontinuing the drug like depression, depersonalization and dysphoria. One thing is important to mention here and it is that the patients who are already suffering from depression shouldn’t be administered Ativan without proper anti-depressant therapy (12).


Ativan has many contraindications. This drug should be avoided in the following cases:

  • Allergic people – this drug should be avoided by any such person have allergy or hypersensitivity to benzodiazepine medicines.
  • Ataxia – this is a neurological disease which is marked by unsteady motion of the limbs. People with this neurological disease have difficulty standing and walking. Some experts believe that excess of alcohol causes the disease. Ataxic patients should avoid consuming Ativan in any form.
  • Sleep apnea – sleep apnea can be worsened by the depressant effects of the central nervous system. This drug can reduce a person’s ability to breathe properly during sleep.
  • Respiratory failure – the respiratory system of the body can be depressed due to benzodiazepine containing medications. People with respiratory failures should also avoid this drug. Some people use this drug to relieve themselves from the anxiety associated with severe asthma. This drug should never be used in such a situation because it can be life threatening.
  • Acute intoxication – Ativan has the ability to interact with alcohols and narcotics and worsen their effects. So, this drug shouldn’t be administered to intoxicated or drunk person.
  • Pregnancy and breast feeding – the Food and Drug Administration Authority has ranked Ativan in the D category which basically means that it can provide damage to the baby in the fetus of mother. Experts believe that certain intelligence and neuro developmental problems can be caused in the baby. But the researches are still inconclusive. Some experts believe that administration of Ativan to pregnant women can cause floppy infant syndrome (a state of low muscle strength which leads to reduced strength of the muscles) in the baby. The symptoms of floppy infant syndrome can occur from hours to months after the birth of the child. Ativan can also mix with breast milk, therefore, breastfeeding women should avoid feeding their baby. It is best to consult a doctor in such cases.

Differences between Ativan and Xanax

You should have a detailed knowledge about Ativan and Xanax by now. But the big question is that what is the difference between the two drugs? Both of these drugs come under the category of benzodiazepines, so a normal person might think of them both as same. But there are some difference between the two which will be discussed in this section of the article.

You should know one thing before knowing about the differences between the two. The choice of prescribing Ativan and Xanax mainly depends upon the related condition or disorder. Both of these medications are good options because each of them has its own strength and weakness.

Both Xanax and Ativan are used for treating anxiety. But the main difference is that Xanax is used to treat severe anxiety and panic attacks whereas Ativan is used to treat general anxiety disorder.

You should also know that ativan has a faster effect as compared to xanax. Some people think due to this that ativan is a stronger drug. But the truth is the effects of xanax are longer than that of ativan.

Both Xanax and Ativan are dangerous and addictive. So people who develop addictions to different things should stay away from these drugs. People who are prescribed Xanax and Ativan should watch them closely and under the proper guidance from a doctor.

There is also a difference in the dosage effect of the two drugs. 1 mg of Ativan equals about 0.5 mg of Xanax. This means that 1 mg of Ativan will have the same effect as 0.5 mg of Xanax.

There are many side effects of both Xanax and Ativan. The most important side effect is the dependence on the drug. Some other side effects include short term memory loss or blocking of amnesia. Xanax is long lasting as compared to Ativan and has fewer and mild side effects like lack of attention, drowsiness, general feeling of floating and wooziness. Ativan acts faster but is more addictive. People feel quite sleepy after consuming Ativan.

Xanax vs Ativan: differences summarized in a spreadsheet

The following table will give you a better comparison between Xanax and Ativan:

  Xanax Ativan
Scientific names Alprazolam Lorazepam
Pregnancy unsafe during pregnancy unsafe during pregnancy
Prescription Managing anxiety disorders, panic disorder and depression Used only for anxiety disorders
Half life 11.2 hours 9-16 hours
Restrictions Shouldn’t be used by people with narrow angle glaucoma or those who are taking Nizoral or Sporanix People allergic to benzodiazepines should avoid it.
Excretion renal renal
Bioavailability 80 - 90% 85% oral dose
Effect Slow acting Fast acting


We have completed our detailed comparison of Ativan vs Xanax and described both common features and differences between the two drugs. Some people ask which of these two drugs is better for treatment of anxiety. The answer to this question depends on the actual situation and only your physician can decide on proper treatment. In general Ativan is usually better for people wanting to end the anxiety quickly. However its effects do not last as long as the effects of Xanax.

Depression, anxiety or panic attacks and any other disease can be serious. This is why you should never rely on information found on the web and you should always ask your physician about proper treatment. This article is just a detailed summary of information about Ativan and Xanax and should not be used for self treating.

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Written by: Michal Vilímovský (EN)
Education: Medical student, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
Article resources: See the numbered references within the article.
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Published: November 13, 2015 3:34 PM
Next scheduled update: November 13, 2017 3:34 PM
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