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The Difference Between Ativan and Xanax

Orange prescription pill bottle with a pile of xanax pills around it  

Ativan and Xanax are two of the most popular prescription anti-anxiety medications in the country. Both are included in the class of drugs known as benzodiazepines (commonly called benzos), and both exert their actions by enhancing signaling of an inhibitory neurotransmitter called gamma-aminobutyric acid (GABA) which reduces brain excitability. Ativan and Xanax are most often prescribed to help people manage anxiety disorders, and Xanax is also used to treat panic disorders. In addition, both drugs have unique off-label uses.

In 2016, Xanax (generic name alprazolam) was the 19th most prescribed drug in the country, with over 27 million prescriptions being written. Ativan (generic name lorazepam) was the 57th most prescribed drug in the country, with over 14 million prescriptions being written. Despite warnings from some members of the medical community about abuse and addiction risks, prescriptions for benzos more than doubled between 2003-2015.

Teenagers may be prescribed Ativan or Xanax, which can substantially improve social anxiety and allow them to better engage with their peers. When used appropriately (i.e. short term, intermittently and at the lowest effective dose), benzos are generally safe for teens. However, benzodiazepine use disorders that occur in teenagers may impact normal brain development and increase the risk of future substance use disorders.

Ativan and Xanax: The Dangers of Benzodiazepines

Because they are commonly prescribed with surprisingly little oversight, there is a common misperception that benzodiazepines are safe and have a low risk associated with regular use. Unfortunately, this is far from true and while opioids have been in the spotlight as drugs associated with irresponsible prescribing rates, benzodiazepines are often as addictive and as dangerous as opioids. In fact, many medical professionals have suggested that benzos are America’s “other prescription drug epidemic.”

Prescribing guidelines for benzodiazepines clearly indicate that they are for short-term, intermittent use only and should never be prescribed for more than several consecutive weeks. In spite of these clear guidelines, an alarming fraction of prescribers have been comfortable prescribing their clients benzodiazepines for years.

Among benzodiazepines, both Xanax and Ativan are especially addictive, with Xanax generally being associated with a higher risk for dependence and addiction. Even when taken as prescribed, dependence and addiction can set in within a matter of weeks.

People who try to quit using benzos after developing dependence may face a challenging, even dangerous detox and withdrawal process. Benzos cause significant changes in brain chemistry and, once the brain has become dependent on their presence, quitting “cold turkey” can be incredibly dangerous, even lethal. Because benzos reduce brain excitability when someone suddenly stops taking them their brain will rapidly try to re-establish normal chemical levels. This often causes hyperexcitability which can lead to seizures and, in extreme cases, may be fatal.

It is incredibly important that anyone who has developed a dependence on any type of benzodiazepine consult with an addiction specialist before quitting. By working with a rehab professional, an appropriate dose tapering schedule can be designed. Tapering the dose over time is the safest and most effective way to quit using benzos.

Combining benzos and alcohol can be incredibly dangerous, even lethal. Both drugs are central nervous system depressants, meaning that they slow normal brain activity. When they are taken together, they act synergistically, meaning that the combined effect is greater than would be expected based on the effects of either drug used alone. Consequences of combining Xanax or Ativan with alcohol can include respiratory depression, coma, and death. Benzo overdose is substantially more likely when alcohol is present. This is especially relevant to teenagers, who may consume large amounts of alcohol in unsupervised environments.

Differences Between Ativan and Xanax

Ativan and Xanax are both most commonly prescribed to treat anxiety disorders, but they also have unique off-label uses. Whether someone should take Ativan or Xanax is something that should be considered with a medical professional who is familiar with benzodiazepines.

Teen Xanax abuse is usually more common than Ativan abuse, but both drugs are associated with substantial risk, and teens who abuse benzos will rarely discriminate between the high of Ativan versus Xanax.

The following table outlines Ativan compared to Xanax:

Ativan Xanax
Conditions treated FDA approved: Anxiety disorders, insomnia, seizure disorders Off-label: Alcohol withdrawal syndrome, insomnia, panic disorder, delirium, chemotherapy-associated nausea and vomiting FDA approved: Anxiety disorders and panic disorders Off-label: Insomnia, premenstrual syndrome, depression
Dosage Average 2-3 mg/day in divided doses, up to 10 mg/day Average 0.75-4 mg/day in divided doses, up to 10 mg/day
Strength 0.5 mg, 1 mg, 2 mg tablets 0.25 mg, 0.5 mg, 1 mg, 2 mg tablets
Duration of action Up to 8 hours Up to 5 hours; Extended-release up to 11 hours
Drug interactions Ativan drug interactions can be very dangerous, even fatal. Do not combine Ativan with other drugs or alcohol without consulting with your doctor. Interactions may occur with: Opioids, other benzos, alcohol, barbiturates, antipsychotics, sedative/hypnotics, antidepressants, anxiolytics, narcotics, anticonvulsants, anesthetics Xanax drug interactions can be very dangerous, even fatal. Do not combine Xanax with other drugs or alcohol without consulting with your doctor. Interactions may occur with: Opioids, other benzos, alcohol, barbiturates, antipsychotics, sedative/hypnotics, antidepressants, anxiolytics, narcotics, anticonvulsants, anesthetics, CYP3A inhibitors, imipramine, desipramine, antibiotics
Side effects Sedation, dizziness, muscle weakness, fatigue, memory impairment, depression, suicide, impaired coordination, decreased libido, trouble concentrating Drowsiness, hypotension, appetite changes, impaired coordination, decreased libido, trouble concentrating, constipation
Abuse potential & addiction Intermittent, short term use: Lower risk Prolonged regular use: High risk for physical and psychological dependence; addiction is common Intermittent, short term use: Lower risk Prolonged regular use: High risk for physical and psychological dependence; addiction is common

Getting Help with Teen Addiction

Ativan and Xanax are both associated with a high risk of abuse. Regular use of these drugs, even as directed, can lead to physical and psychological dependence and addiction. Teenagers are at particular risk for negative consequences associated with benzodiazepine use disorders due to the fact that their brains are still maturing. The development of a chemical dependence during the teenage years can cause substantial structural and functional abnormalities that may persist throughout adulthood.

Teen drug rehab is best addressed by addiction experts who specialize in helping teenagers overcome substance use disorders. Next Generation Village offers exceptional drug rehab in Florida and has demonstrated excellence in helping teens aged 13-17 regain control of their lives. If you are concerned that your teenager is struggling with a benzodiazepine or other substance use disorder, we can help. Contact us today to learn more about our comprehensive teen substance abuse rehab programs.

Medical Disclaimer: Next Generation Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

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