Ativan vs Xanax

What is Ativan? What is Ativan used for?

Ativan is a Brand name for a medicine that contains short-acting benzodiazepine drug named lorazepam as an active ingredient. This drug works by affecting chemicals in the brain known as neurotransmitters that are unbalanced in patients with different types of anxiety disorders.

Ativan’s main indications are:  all types of anxiety disorders, insomnia caused by anxiety or stress and status epilepticus. Ativan is also use in surgery to interfere with memory formation, to sedate patients who are being mechanically ventilated, for the therapy of alcohol withdrawal, and chemotherapy that include nausea and vomiting.

In some cases Ativan may be used for the treatment of acute coronary syndrome due to cocaine use.  This medicine is available in the form of immediate-release and sublingual tablets in doses of: 0.5 mg, 1 mg and 2 mg and in the form of solution for intramuscular or intravenous injection in concentrations of 2 mg/ml and 4 mg/ml.

When Ativan is given by injection, its onset of action is between 1-30 minutes and effects can last for up to a day.  FDA approved lorazepam in 1977. Ativan is originally manufactured by Valeant Pharmaceuticals. It is also available in Generic form.

What is Xanax? What is Xanax used for?

Xanax is a Brand name for a medicine originally manufactured by Pfizer drug company that contains as an active ingrdient short-acting benzodiazepine substance named alprazolam. This drug works by affecting chemicals in the brain known as neurotransmitters that are unbalanced in patients with different types of anxiety disorders.

Xanax indications are:  generalized anxiety disorder, panic disorders with or without agoraphobia, and anxiety linked with depression. This medicine is available in the form of immediate release tablet in doses of: 0.25, 1, 2 and 5 mg and in form of extended release tablet, known as Xanax XR in doses of 3 and 5 mg.  FDA approved alprazolam in 1981. Xanax is also available as a generic drug.

Differences and similarities between Ativan and Xanax

Ativan and Xanax are central nervous system depressants classified into the class benzodiazepines drugs. Ativan’s active ingredient is lorazepam while alprazolam is active ingredient of Xanax. Chemically they are similar. Both contain benzodiazepine structure (alprazolam is triazolobenzodiazepine) however lorazepam has 2 oxygen and 1 chloride atom more than alprazolam, instead of triazolo heterocyclic structure.

In theory, lorazepam should be more reactive than alprazolam. Both drugs works by affecting GABA neurotransmitter, which is a major inhibitory neurotransmitter in the brain. This causes nerve impulses to slow down, resulting in a sedating and calming effect.

Is Ativan milder than Xanax

Both drugs have almost same bioavailability of 80-90% after oral administration; and they are excreted via kidneys. But, alprazolam is metabolized via CYP3A4 oxidation in the liver, while lorazepam’s main metabolic reaction is hepatic glucuronidation.

Both medicines are available only with a doctor’s prescription for short-term use. Alprazolam is available only in tablet form while lorazepam is also formulated as sublingual tablet and as an intramuscular and intravascular injection.  Lorazepam is approved for patients who are at least 12 years old. Xanax is approved only for adults over 18.

Both drugs are addictive and may cause dependency and withdrawal symptoms if they are abrupt suddenly.

Xanax and Ativan are both indicated for the treatment of anxiety and panic disorders. Studies showed that the efficacy of alprazolam and lorazepam are similar in reducing panic attacks and phobic behavior with a much higher efficacy compared to the placebo. Xanax is prescribed more often than Ativan for the acute treatment of anxiety disorders linked with depression, while Ativan is prescribed more often for insomnia caused by anxiety.

Ativan is prescribed off-label for the treatment of epileptic disorders including status epilepticus, alcohol withdrawal, pre-surgery sedation, chemotherapy-induced vomiting, irritability and mania. Xanax has some other off-label indications such as:  irritable bowel syndrome, extreme premenstrual syndrome, essential tremor and ringing in the ears.

While both drugs may have several side effects, such as drowsiness, sedation and dizziness, lorazepam is known to have the exact opposite of its desired effect, especially on older people +65 years old.

When these drugs are taken during pregnancy, they may cause harm to the fetus. Newborns could also develop a tolerance to the medication when born and require treatment. Both drugs can also pass into breast milk and may cause slowed heartbeat, drowsiness, and breathing problems in nursing infants. It is never recommendable to take these drugs during pregnancy.

Which drug stay longer in the body, Xanax or Ativan?

Xanax’s elimination half-life time is estimated of approximately 9 hours to 16 hours in normal circumstances. So, the most patients will eliminate 50% of the drug from their body after 9 to 16 hours of ingestion. However, in elderly patients the elimination half-life time may be more than 16 hours, but also among patients with liver disease, the average half-life is estimated to 19.7 hours.

The average half-life of Xanax is around 12 hours for most patients.  So in such cases Xanax will be fully eliminated from their body within 4 days. However, term average clearance time is never exact term and doesn’t apply to everyone. Some patients may eliminate Xanax from their system much faster than others and vice versa.

This means that fast metabolizers may fully eliminate Xanax within 2 days and poor metabolizers may need 4 or even more days. Many factors may influence on how much Xanax will stay in system. Those factors include: age, sex, body weight, deposition of fats, liver and kidney function, genetics, metabolic rate, urinary pH, dosage and frequency of use and other drugs used at the same time.

According some data the average half-life for Ativan is an approximate 12 hours.  So, the most patients will eliminate 50% of the drug from their body after 12 hours of ingestion.  According to this, it could take up to 2.75 days for the drug to have been fully eliminated from the body.  Other data suggest that half-life for the drug may be slightly longer at 15.7 hours.

According to this it would take nearly 3.59 days to fully eliminate the drug from the system. But, it is important to know that lorazepam’s metabolite called lorazepam glucuronide has a longer half-life time of approximately 18 hours.  To fully eliminate lorazepam glucuronide from the body it may take longer than the lorazepam itself.

Lorazepam glucuronide will remain in your system and can be detected in your urine for more than 4 days of post-ingestion.  Factors that may have an influence on lorazepam elimination include: age, body weight,  liver and kidney function, genetics, metabolic rate, urinary pH, dosage and frequency of use and other drugs used at the same time.

Ativan and Xanax side effects

Ativan possible side effectsXanax possible side effects
SedationDrowsiness (41%)
DizzinessDepression (10-15%)
UnsteadinessHeadache (10-15%)
WeaknessDiarrhea (10-15%)
FatigueConstipation (10-15%)
DrowsinessDry mouth (10-15%)
AmnesiaConfusion (5-10%)
ConfusionInsomnia (5-10%)
DisorientationTachycardia (5-10%)
DepressionBlurred vision (5-10%)
Suicidal ideation/attemptNausea/vomiting (5-10%)
VertigoNasal congestion (5-10%)
AtaxiaHypotension (1-5%)
Sleep apneaSyncope (1-5%)
AstheniaAkathisia (1-5%)
Extrapyramidal symptomsDizziness (1-5%)
Respiratory depressionNervousness (1-5%)
TremorIncreased salivation (1-5%)
Convulsions/seizuresTremor (1-5%)
Visual disturbancesWeight change (1-5%)
Blood dyscrasias
Change in libido
Increased bilirubin
Increased liver transaminases
Increase in ALP
Hypersensitivity reactions
Change in appetite
Paradoxical reactions (anxiety, excitation, agitation, hostility, aggression, rage)

Ativan and Xanax withdrawal effects

Ativan and Xanax may cause withdrawal symptoms. However in lower rate, because these drugs are rarely used for a long-term. Patients who abruptly discontinued Ativan or Xanax, in most cases experience rebound symptoms for which the drug was originally prescribed. These symptoms may include:

  • more frequent panic attacks
  • insomnia
  • increased anxiety
  • convulsions
  • tremors
  • nausea
  • headaches
  • loss of appetite
  • fatigue
  • irritability

Many of these symptoms pass with time, however some of them require medical help.  One thing is certainly known, Ativan and Xanax should never be discontinued abruptly. The best method for drug discontinuation is a slow, methodical decrease, over a period of time, under doctor’s supervision.

Which one is expensive, Ativan or Xanax?

According to

  • The cost for Ativan tablet 0.5 mg is around $2 090 for a supply of 100 tablets
  • The cost for Ativan tablet 1 mg is around $2 790 for a supply of 100 tablets
  • The cost for Ativan tablet 2 mg is around $4 445 for a supply of 100 tablets
  • The cost for Xanax tablet 0.25 mg is around $323 for a supply of 100 tablets
  • The cost for Xanax tablet 0. 5 mg is around $400 for a supply of 100 tablets
  • The cost for Xanax tablet 1 mg is around $533 for a supply of 100 tablets
  • The cost for Xanax tablet 2 mg is around $902 for a supply of 100 tablets

Prices depend on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans.

What are Ativan and Xanax interactions with other drugs?

Xanax and Ativan may interact with following drugs:

  • Opioid analgesics such as:  Codeine, Morphine, Lortab, Vicodin and OxyContin.  These drugs may cause sedation and increase drowsiness in patients..
  • Acid Reducers such as:  Prilosec, Prevacid, Zantac, Nexium, Mylanta,  Tums or Rolaids  and Maalox. These drugs may reduce acid amount in the stomach preventing Xanax absorption in bloodstream.
  • Allergy and Cold preparations such as:  Benadryl, Diabetic Tussin Night Time and Contac Day and Night Cold and Flu. Active ingredient in these products is diphenhydramine, which increases the risk of drowsiness
  • Prescription sleep aids such as:  Ambien, Sonata, Lunesta,  and Halcion.  Taking these drugs with Xanax or Ativan may increase the risk of severe side effects such as respiratory depression, bradycardia, coma and even death.
  • OTC Sleep Aids such as: Melatonin, Simply Sleep, Unisom and Sleep Ease.  These products may increase risk of causing sedation.
  • Medications Containing Propoxyphene such as:  Darvocet, Darvon, Balacet and Propacet.

Warnings and precautions during Ativan and Xanax use

  • It is recommended for the patients to give a detailed medical history to their doctors before using Ativan. Patients should especially mention if they have or ever had some kidney or liver disease, lung or breathing problems such as sleep apnea, glaucoma,  mental or mood disorders such as depression and any history of drug or alcohol abuse. Ativan may cause allergies in patients who were allergic to other benzodiazepines, such as alprazolam, diazepam or clonazepam. Ativan can sometimes have the complete opposite of its intended effect on elderly people.
  • Patients should give a detailed medical history to their doctors before taking Xanax. Severe lung or breathing problems such as COPD and sleep apnea, liver disease, kidney disease, glaucoma and any drug or alcohol abuse should especially be mentioned. Xanax can cause allergic reactions in people who have allergies to other benzodiazepines, such as alprazolam, clonazepam or diazepam. Older adults may be more sensitive to the drug’s side effects.

Why Ativan or Xanax should never be taken with alcohol?

Mixing Ativan with other CNS depressants such as alcohol, cannabis and different drugs may result in impaired thinking, loss of motor coordination and balance, and in some rare cases it may cause severe breathing problems, changes in heart rhytm, coma and death.

It also increases the risk for following side effects:

×          Dizziness

×          Drowsiness

×          Changes in mood and behavior

×          Loss of balance and coordination

×          Memory problems

Tolerance of alcohol may also be reduced and you may develop unwanted side effects after taking small amounts. It may not be safe for you to consume usual amount of alcohol.

If you have consumed alcohol while taking Xanax or Ativan, you may also experience decreased mental alertness and focus. Make sure that you do not engage in activities that require focus, fast reactions and concentration such as driving and operating heavy machinery and equipment. If you experience any of the side effects mentioned above, particularly difficulty of breathing, seek medical attention immediately.

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