Ativan Vs Xanax: Best Over The Counter Nootropics For Anxiety

Ativan (lorazepam) and Xanax (alprazolam) are benzodiazepines, prescription medications approved to treat symptoms of generalized anxiety disorder, insomnia, seizures, social phobia, and panic disorder.1 While very similar, the drugs have two main differences: Xanax starts working faster than Ativan, but Xanax lasts four to six hours while Ativan lasts eight hours.

Both drugs have comparable side effects, which include drowsiness, dizziness, headache, and confusion. Ativan and Xanax also have the potential for addiction and dependence, so it’s important to only take them as directed by your healthcare provider.

Differences

Ativan (lorazepam) and Xanax (alprazolam) are very similar, and one isn’t stronger than the other. However, they differ in how fast and long they work, as well as their dosage forms. Here’s how:

Onset of action: Xanax is the most rapid-acting benzodiazepine and provides the fastest relief of symptoms.1 Once taken, it starts working within 30 minutes while Ativan may peak in two hours. However, there is an exception: Ativan is available in an injectable formula, which can relieve symptoms within one to three minutes if injected into a vein, and 15 to 30 minutes if injected into a muscle.
Duration of action: Ativan has a half-life of about 12 to 18 hours, meaning it takes that much time for the drug’s active substance to reduce by half in the body.2 Xanax has a half-life of 11.2 hours.3 This longer half-life of Ativan provides longer-lasting effects or duration of action when compared with Xanax.
Formulations: Ativan comes in both oral and injectable formats, the latter of which makes it suitable for specific medical situations like treating seizures. On the other hand, Xanax’s oral formulations include oral disintegrating tablets and extended-release tablets.3 These options provide greater dosing flexibility compared to similar medications.

These drugs also differ slightly in terms of the conditions they are approved to treat. For example:

Xanax is specifically approved to treat panic disorder, while Ativan is not.4 (However, healthcare providers may prescribe Ativan off-label for this use.)
Ativan can treat status epilepticus, a life-threatening medical emergency characterized by seizures that last for more than five minutes at a time or happen repeatedly close together.5

What Is the Safest Benzodiasapine for Anxiety?

Ativan is considered safer than Xanax because of its lower risk of rebound anxiety or withdrawal symptoms. Due to Ativan’s slower onset and longer duration of action, it’s also less likely to be misused and abused than Xanax.6 This may be why hospitals may be more likely to prescribe Ativan than Xanax.

How They Work

Ativan and Xanax belong to the benzodiazepine class of drugs. They work by enhancing the activity of a neurotransmitter called gamma-aminobutyric acid (GABA). In turn, GABA helps calm the activity of neurons and muscles.7 This results in feelings of relaxation, less anxiety, relaxed muscles, and sleepiness.3

Side Effects

Ativan and Xanax can cause the following side effects. Contact your healthcare provider if any of your side effects are severe.

Side Effect	Ativan (lorazepam)	Xanax (alprazolam)
Nausea	Common	Common
Poor coordination	Common	Common
Confusion	Common	Common
Dizziness	Common	Common
Headache	Common	Common
Fatigue	Common	Common
Drowsiness	Common	Common
Slurred speech	Less common	Common
Mood changes	Less common	Common
Appetite change	Less common	Common
Irritability	Less common	Common
Suicidal thoughts	Rare	Rare
Allergic reactions	Rare	Rare

Drug Interactions

Respiratory depression and low blood pressure may worsen if benzodiazepines are combined with other drugs.2 Tell your healthcare provider about all the medicines you take, including over-the-counter products like herbs and supplements.

Do not take Ativan or Xanax with the following:32

Alcohol
Barbiturates
Antidepressants
Narcotic painkillers
Antipsychotics
Sedative/hypnotics
Anxiolytics
Sedative antihistamines
Antiseizure medications (ASMs)
Anesthetics

When to Get Emergency Medical Attention

Some side effects of Ativan and Xanax can be serious and life-threatening. Call 911 or get immediate medical attention if you experience any of the following:8

Shortness of breath
Seizures
Confusion
Yellowing of your eyes or skin
Severe skin rash
Difficulty with speech

Safety

Ativan and Xanax have the potential for addiction, withdrawal, and overdose, so it’s important to take them exactly as they are prescribed by your healthcare provider. In addition:9

Avoid taking other sedatives with these drugs, including opioids and alcohol.
Do not abruptly stop taking these drugs without speaking to your healthcare provider, as this may lead to you experiencing withdrawal symptoms. If you must stop taking any of these medicines, your medical professional may have to taper you off them.
Since Ativan and Xanax are controlled substances, store them out of the sight and reach of pets, children, and other adults, preferably in a locked cabinet, closet, or safe.10
Let your medical provider know if you are pregnant or plan to become pregnant. Benzodiazepines may cause low birth weight, premature birth, and harm to a fetus.1

Tips to Recognize Addiction

The risk of addiction to benzodiazepines exists. Learn to identify the signs of addiction and take appropriate actions accordingly.

Some helpful strategies for recognizing addiction could include the following:

Be aware of changes in behavior, mood, and physical health resulting from taking medication.
Keep track of dosage taken and duration.
Note if more doses seem necessary to get the desired effect.

If addiction is suspected, speak to your healthcare or mental health provider immediately.

Self-Care

While prescription medications may help you manage symptoms of anxiety, self-care can also be beneficial. Three proven ways to decrease anxiety include:

Exercise: Research proves that physical activity, especially aerobic exercise like brisk walking, helps decrease anxiety.11
Prioritize sleep: Adequate restful sleep is vital to overall physical and mental well-being, helping reduce feelings of anxiety. Aim for at least seven hours of sleep a night to promote optimal health.12
Cognitive behavioral therapy (CBT): This form of talk therapy has been linked to improved quality of life for people with anxiety. CBT may include identifying your negative thoughts or behaviors, finding ways to change those thoughts or behaviors, and learning how to maintain the positive change or result.13

Summary

Benzodiazepines like Ativan and Xanax are prescribed for the treatment of anxiety, as well as insomnia, panic disorders, seizures, and muscle spasms. Although both drugs are in the same drug class, they differ in how fast they work, how long their effects last, and how safe they are.

Your healthcare provider will determine which drug is best for you based on your symptoms and health history. Take your medications only as directed and get medical attention if you experience any new or severe side effects.