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Ativan vs Xanax: Which anxiety medication is better for me?

This Minded Medication Guide will take a look at Ativan and Xanax to help you understand which medication may be the better choice for you, whether this is your first time taking one of them, or you are considering switching from one to the other.

September 14, 2021

If you are struggling with anxiety or insomnia, or both, you may have heard that it can take weeks to feel the full effects of some medications, which can be the last thing you want to hear when you feel like you do. Fortunately, there are medications to “bridge the gap,” like Ativan and Xanax, until a longer-term, selective serotonin reuptake inhibitor (SSRI) begins working. 


This Minded Medication Guide will take a look at Ativan and Xanax to help you understand which medication may be the better choice for you, whether this is your first time taking one of them, or you are considering switching from one to the other. The information below can be helpful to you when talking with your doctor, prescribing nurse, or the experts at Minded, in determining the medication used in your treatment plan.


Read on to learn more about the pros and cons of Ativan and Xanax, including:

  • An introduction to Ativan and Xanax
  • A closer look at Ativan vs Xanax
  • Similarities and differences between Ativan and Xanax


Minded Medication Guides, such as this and others, including Zoloft vs Prozac and Wellbutrin vs Lexapro, are intended as educational aids only. They are not intended as medical advice for individual conditions or treatment. They are not a substitute for a medical exam, nor do they replace the need for services provided by medical professionals. Talk to your doctor, nurse, or pharmacist before taking any prescription medication or following any treatment regimen.

Ativan and Xanax overview

Ativan and Xanax are both benzodiazepines, a type of medication typically used to treat anxiety, social phobia, panic disorder, insomnia, and seizures. Klonopin is another commonly prescribed benzodiazepine. Due to their ability to sedate you and ease your anxiety, benzodiazepines often are prescribed “off-label” for insomnia. They also may be given before some medical procedures. Individual benzodiazepines differ in how fast they begin to work and how long their effects last. These medications are, however, thought to all work the same way: By attaching to the gamma-aminobutyric acid (GABA) neuroreceptors in your brain, they slow down your brain’s activity, leaving you feeling calm and/or drowsy. (GABA is a type of neurotransmitter, or small molecule in the brain, that passes messages from nerve to nerve.)


When looking at Ativan vs Xanax, or even Ativan vs Klonopin vs Xanax, all three benzodiazepines are usually prescribed for short-term use—typically weeks or months. You may have read that these types of medications come with a risk of developing a physical or psychological dependence on them (which may become an addiction). While that is true, and the Drug Enforcement Administration has classified them as controlled substances, benzodiazepines are considered safe for most people who take them for anxiety and insomnia. The risk of dependence or abuse is higher in people who already have a history of a substance use disorder and those who do not take the medication as prescribed.


The psychiatrists and nurse practitioners at Minded can prescribe controlled medications like Ativan and Xanax to eligible subscribers in appropriate situations using a video visit. If you are located in New York, New Jersey, or Florida, you may be eligible under temporary authorization in effect during the COVID-19 public health emergency.


A closer look at Ativan

Ativan is the brand name of the generic drug lorazepam. Ativan is used to treat anxiety, difficulty sleeping caused by anxiety or stress, and status epilepticus (continuous seizures). Because it can act as both a sedative and an anti-anxiety medication, it is sometimes given by injection before a person receives anesthesia prior to undergoing a medical procedure. 


The Ativan tablet is available in:

  • 0.5 mg
  • 1 mg
  • 2 mg


The dose of Ativan you take—and how often you take it—will depend on many factors, including your age and the reason you are taking the medication. In general, doses may range from 2 to 6 mg per day, sometimes taken in divided doses. The highest dose generally is taken before bedtime. While the highest dose generally is considered 10 mg per day, some people may need higher doses to achieve symptom relief.


For adults, a starting dose is 2 to 3 mg per day (taken 2 or 3 times a day), typically when taking Ativan prescribed for anxiety. 


When prescribed for insomnia, Ativan may be taken as a once-daily dose (at or before bedtime), with the dosage usually ranging from 2 to 4 mg.


Because elderly people may be more prone to the sedative effects of Ativan, the recommended starting dose is 1 to 2 mg per day (taken in divided doses). 


If your dosage needs to be increased, your prescribing doctor or nurse will do so gradually to minimize your risk of experiencing side effects.


Ativan can be taken daily at regularly scheduled times or on an “as-needed” basis. Your doctor or prescribing nurse will provide you with instructions on how often and when to take this medication, as well as the maximum amount prescribed in a day. 


Whether you are taking Ativan for anxiety or insomnia, you may start to notice your symptoms begin to improve quickly, often within hours or days of first taking it.


While you can take Ativan with or without food, you may want to take it with food if you have an upset stomach after taking it without food. Food slows the absorption of Ativan, resulting in more balanced blood levels of this medication.


If you miss a dose of Ativan, either take the missed dose as soon as you remember, or if it is closer to the time when you would take your next dose, just take the next dose.

Ativan side effects

Ativan side effects

Common side effects of Ativan include:

  • Coordination problems
  • Difficulty concentrating
  • Dizziness
  • Drowsiness
  • Fatigue
  • Lightheadedness


These side effects typically decrease during the first few weeks of taking Ativan.


Talk to your doctor or the experts at Minded if you experience any of these or other side effects.


Rare or serious side effects of Ativan include:

  • Difficulty speaking
  • Extreme tiredness or dizziness
  • Feelings of depression or decreased interest in day-to-day life
  • Headaches
  • Impaired memory
  • Increased heart rate
  • Irritability
  • Passing out (fainting)
  • Restlessness
  • Severe allergic reaction and facial swelling, which can occur even on the first dose
  • Shortness of breath
  • Thoughts of self-harm or suicide


Additionally, some people who take benzodiazepines to help them sleep may perform activities such as driving, eating, or making phone calls while they are either asleep or not completely awake. They do not remember having done these things once they are fully awake.


Seek medical attention right away if you experience any of these (or other) serious side effects.

Warnings

Ativan comes with an FDA “Black Box” warning. This means the FDA has identified certain serious safety risks from taking it. The “Black Box” warning is meant to alert patients and prescribers that there are serious safety warnings. The actual risk may be low, or even rare.


The Black Box warning for Ativan states that benzodiazepines—which include Ativan—may have serious interactions when taken with opioid medications or other sedative medications. Taking these medications together can cause slow or difficult breathing—which may be fatal when high doses of both are consumed.


Let your doctor or a Minded professional know about any other medications you are taking to determine if Ativan might have any problematic interactions with them.


Drinking alcohol is not recommended while taking Ativan. Alcohol can decrease the benefits of medications like Ativan and increase their side effects (such as sedation and coordination problems). Additionally, drinking alcohol may increase your risk of accidentally overdosing from the alcohol combined with Ativan, or other benzodiazepines. Alcohol also can impair memory and judgment, accidentally resulting in taking a higher dose of Xanax than prescribed.

Can you take Ativan while pregnant or breastfeeding?

It is important to discuss your anxiety treatment plan with your doctor if you are pregnant or planning on becoming pregnant. Because Ativan can be passed to your baby through breast milk, taking Ativan while pregnant may harm your baby, who is ingesting the medication in the mother’s breast milk. 


If you need to stop taking Ativan for any reason, work with your doctor or the experts at Minded to develop a plan to do so safely in order to avoid withdrawal symptoms (such as irritability, nausea, tremors, dizziness, changes in blood pressure, rapid heart rate, and seizures).


Wondering if Ativan is right for you?


A closer look at Xanax

Xanax is the brand name of the generic drug alprazolam. It is used to treat generalized anxiety disorder (GAD) and panic disorder with or without agoraphobia. (Agoraphobia is an anxiety disorder characterized by fear and avoidance of places or situations that could cause a person to panic.)


Xanax is also sometimes prescribed for “off-label” use. “Off-label” use means taking a medication for a condition that it has not been approved by the FDA to treat, a common and acceptable medical practice. Benzodiazepines (like Xanax) may also be used “off-label” in treating sleep difficulties.


Xanax is available in multiple forms and doses:

Xanax tablet

  • 0.25 mg
  • 0.5 mg
  • 1 mg
  • 2 mg

Xanax XR (extended release) tablet

  • 0.5 mg
  • 1 mg
  • 2 mg
  • 3 mg


Like Ativan, the dose of Xanax you take will depend on what you are taking it for. Also, like Ativan, you may take Xanax in multiple doses, as prescribed, throughout the day.


For adults, a typical starting Xanax dose of 0.25 to 0.5 mg is taken 3 times per day, taken for generalized anxiety disorder (GAD). If the starting dose is not enough to ease your symptoms, your prescribing doctor or nurse may increase your dose every 3 or 4 days, up to the maximum recommended daily dose of 4 mg (taken as divided doses).

 

When prescribed for panic disorder, you may start off at 0.5 mg of Xanax taken 3 times per day. If needed, your healthcare provider may increase your dose every 3 to 4 days, but likely not by more than 1 mg per day.


As with Ativan, elderly people may be more susceptible to the side effects of Xanax. They may start off at a lower dose of 0.25 mg taken 2 to 3 times per day.


Xanax can be taken daily at regularly scheduled times or on an “as-needed” basis. Your doctor or prescribing nurse will provide you with instructions on how often and when to take this medication, as well as the maximum amount you may take in a day. 


Like Ativan, you might start to notice your symptoms beginning to improve within hours or days of first taking Xanax, whether you are taking it for anxiety or insomnia.


While you can take Xanax with or without food, if you find that you have an upset stomach after taking it without food, you may want to take it with food going forward. Food slows the absorption of Xanax, resulting in more balanced blood levels of this medication.


If you miss a dose of Xanax, you will want to either take the missed dose as soon as you remember or if it is closer to the time when you would take your next dose, just take the next dose.

Xanax side effects

Xanax side effects

Common side effects of Xanax include:

  • Coordination problems
  • Difficulty concentrating
  • Dizziness
  • Drowsiness
  • Fatigue
  • Lightheadedness


These side effects typically decrease during the first few weeks of taking Xanax.


Talk to your doctor or the experts at Minded if you experience any of these or other side effects.


Rare or serious side effects of Xanax include:

  • Difficulty speaking
  • Extreme tiredness or dizziness
  • Feelings of depression or decreased interest in day-to-day life
  • Headaches
  • Impaired memory
  • Increased heart rate
  • Irritability
  • Passing out (fainting)
  • Restlessness
  • Severe allergic reaction and facial swelling, which can occur even on the first dose
  • Shortness of breath
  • Thoughts of self-harm or suicide


Additionally, some people who take benzodiazepines to help them sleep may perform activities such as driving, eating, or making phone calls while they are either asleep or not completely awake. They do not remember having done these things once they are fully awake.


Seek medical attention right away if you experience any of these (or other) serious side effects.

Warnings

Like Ativan, Xanax has an FDA “Black Box” warning, which means the FDA has identified certain serious safety risks from taking it. The “Black Box” warning is meant to alert patients and prescribers that there are serious safety warnings. The actual risk may be low, or even rare.


Benzodiazepines—which include Xanax—may have serious interactions when taken with opioids or other sedative medications. Taking Xanax with a sedative medication can cause slow or difficult breathing—and may be fatal in high doses.


You should not drink alcohol while taking Xanax. Alcohol can decrease the benefits of medications like Xanax and increase their side effects (such as sedation). Additionally, drinking alcohol may also increase your risk of accidentally overdosing from the alcohol combined with Xanax. Alcohol also can impair memory and judgment, accidentally resulting in taking a higher dose of Xanax than prescribed.


Tell your doctor or a Minded professional about any other medications you may be taking to determine if Xanax might have any problematic interactions with them.

Can you take Xanax while pregnant or breastfeeding?

If you are pregnant or planning on becoming pregnant, it is important to discuss your anxiety treatment plan with your doctor. Taking Xanax while pregnant may harm your baby. If you are breastfeeding, Xanax also can be passed to your baby through your breast milk.


As with Ativan, Xanax can cause withdrawal symptoms if you stop taking it suddenly. It is important to talk with your prescribing doctor or nurse to develop a plan to carefully go off of it if needed.

 

Wondering if Xanax is right for you?


What is the difference between Ativan and Xanax?

How long Xanax and Ativan last

Which works faster: Ativan or Xanax?

Ativan and Xanax both usually start to work very quickly—within hours or days of the first dose—regardless of whether they are being taken for anxiety or insomnia. But Xanax may have a slight edge over Ativan in this area: peak concentrations of Xanax in your body typically occur 1 to 2 hours after taking the dose, while it typically takes 2 hours for peak levels of Ativan to accumulate. The effects of Xanax typically last 4 to 6 hours, while Ativan’s effects can last for 8 hours.

Ativan vs Xanax for sleep

Because both Ativan and Xanax have a sedative effect, they may be prescribed to help if you are having trouble sleeping. As noted above, Xanax usually starts working slightly faster than Ativan, so if quick relief is important to you, that may be something to consider when discussing treatment options with your doctor, prescribing nurse, or Minded professional.

Ativan vs Xanax: dosage

Both Ativan and Xanax are generally taken in multiple doses throughout the day unless they are being taken for insomnia. Ativan is typically taken 2 to 3 times per day, with the highest dose taken at bedtime. Xanax is usually taken 3 times per day. The maximum daily recommended dose of Ativan is 10 mg (taken divided throughout the day), and the maximum daily recommended dose of Xanax is 4 mg (also taken as divided doses). 

Ativan vs Xanax: side effects

Even though Ativan and Xanax have many potential side effects in common, they each come with their own list of more common side effects to watch out for.


The most common side effects of Ativan include:

  • Dizziness
  • Sedation
  • Unsteadiness
  • Weakness


The most common side effects of Xanax include:

  • Difficulty saying words clearly (dysarthria) 
  • Low blood pressure (hypotension)
  • Lowering sex drive
  • Trouble with coordination


Both Ativan and Xanax come with a risk of overdose if not taken as prescribed. An overdose can be fatal, so it is important to seek medical care immediately if you are experiencing symptoms of an overdose.


Symptoms of an overdose for both Ativan and Xanax include:

  • Coma
  • Confusion
  • Difficulty breathing
  • Difficulty with coordination
  • Slowed reflexes

Ativan vs Xanax: Which is stronger?

When comparing Ativan vs Xanax for anxiety, both medications have been found effective, according to several studies. For instance, a study published in the Journal of Clinical Psychiatry found both medications to be both safe and effective in treating anxiety, though the authors did note that people taking lorazepam (Ativan) experienced more noticeable side effects—including drowsiness and lightheadedness—at various points throughout the study.


A study in Pharmacopsychiatry found both lorazepam (Ativan) and alprazolam (Xanax) to be similarly effective in treating panic disorder as well.

Can you take Ativan and Xanax together?

Because Ativan and Xanax are both benzodiazepines, they should not be taken together. Both medications can cause similar side effects, such as drowsiness, so taking them together may increase this or other effects. To prevent this or other potentially dangerous interactions, it is important to tell your doctor about all of the medications (and supplements, often called nutraceuticals) you take when you are discussing your treatment plan, as well as only taking medications that are prescribed to you in the way they are prescribed for you to take.

Switching from Ativan to Xanax (or switching from Xanax to Ativan)

Benzodiazepines—including Ativan and Xanax—are typically prescribed for short-term use. As with most medications, your doctor may consider switching you from Ativan to Xanax (or vice versa) if you have been on the medication at the right dose (as determined by you and your doctor or nurse practitioner) long enough to determine that your symptoms have not improved, or if you are experiencing side effects that you find too difficult to tolerate.


To avoid withdrawal symptoms, you should not stop taking either medication without first discussing how to do so safely with your doctor, prescribing nurse, or a Minded professional. They can help you develop a plan, which may involve tapering down the dose of one or the other medication before you stop taking it completely. 

Ativan vs Xanax: withdrawal

Both Ativan and Xanax can cause withdrawal symptoms if stopped suddenly. 


Symptoms of withdrawal from Ativan include:

  • Difficulty sleeping
  • Hallucinations
  • Headaches
  • Seizures
  • Stomach or muscle cramps
  • Tremors
  • Unusual behaviors


Symptoms of withdrawal from Xanax include:

  • Difficulty concentrating
  • Difficulty sleeping 
  • Feeling discouraged, sad, or empty
  • Feeling irritable
  • Hallucinations
  • Lack of interest or pleasure
  • Loss of appetite
  • Nausea or vomiting
  • Seizures or tremors
  • Stomach or muscle cramps
  • Suicidal thoughts
  • Sweating
  • Unusual behaviors

Final thoughts on Ativan vs Xanax

Ativan and Xanax are both medications you may want to consider as part of your anxiety or insomnia treatment plan, keeping in mind that each comes with its own pros and cons.


For example, while both medications can effectively treat anxiety, at least one study found that the side effects of Ativan were more noticeable than the side effects of Xanax. On the other hand, Xanax has more potential and common side effects. And while both medications usually begin to work very quickly after ingestion, Xanax may work slightly faster (1 to 2 hours after taking the dose, compared to 2 hours for Ativan).


Seeking medical advice from your health care provider or the experts at Minded can help you understand and decide which medication may be the better fit for you.


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