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Xanax or Ativan: Which Is Better for Anxiety?

Both alprazolam (Xanax) and lorazepam (Ativan) are considered short-acting benzodiazepines and when used for the right reasons, are quite effective for anxiety. Many of you wonder if they’re the same, which works better, and which works faster for anxiety. Let’s take a look.

What are they used for?

Xanax (alprazolam) is used for:

  • anxiety disorders
  • short-term relief of anxiety symptoms
  • anxiety associated with depression
  • panic disorder

Ativan (lorazepam) is used for:

  • anxiety disorders
  • short-term (4 months or less) relief of anxiety symptoms
  • anxiety associated with depression
  • anxiety- or stress-associated insomnia

An important distinction here is Xanax is approved for use in panic disorder; Ativan is not.

Which one is better for anxiety?

Numerous research studies have found that both Xanax (alprazolam) and Ativan (lorazepam) work well—and quickly—for panic disorder. Benzodiazepines like these two drugs initiate anti-panic effects very rapidly, within the first week of treatment. Compare that to other anxiety meds like Zoloft (sertraline) and Prozac (fluoxetine), which take a few weeks to work. That’s why Xanax and Ativan are so popular, especially for people with severe symptoms who need rapid relief.

A note about panic disorder: Of the benzodiazepines, only Xanax and the longer-acting benzodiazepine, Klonopin (clonazepam), are officially approved by the FDA for the treatment of panic disorder—Ativan is not. Don’t miss out on savings! Get the best ways to save on your prescriptions delivered to your inbox.

What are the forms and dosages?

There are some differences here.

Ativan is available as 0.5 mg, 1 mg, and 2 mg tablets, as is Ativan’s generic, lorazepam. For anxiety disorder, lorazepam 1 – 2 mg is used daily in 2 – 3 divided doses throughout the day. For insomnia, lorazepam is dosed at 2 – 4 mg at bedtime.

Xanax is also available as a generic: alprazolam. Both the brand and generic are available in immediate- and extended-release (XR) forms. Immediate-release forms comes in 0.25 – 2 mg tablets, and is usually dosed at 0.25 – 0.5 mg every 8 hours as needed. Extended-release forms come in 0.5 – 3 mg tablets dosed at 0.5 – 1 mg twice a day.

How fast do they work and how long do they last?

There are some subtle differences between Xanax and Ativan here, and might be important if you’re right about to do something that triggers anxiety—like getting on a plane, having a root canal, or getting into an MRI scanner.

With alprazolam (Xanax), BOTH the immediate-release and extended-release formulations start working in an hour. Regular alprazolam will work for about 5 hours. Extended-release alprazolam will work for about 11 hours.

Lorazepam (Ativan) works even sooner at 30 – 60 minutes after taking it, with effects lasting up to 8 hours.

Both are broken down by the liver, so folks with liver disease will need to watch out for these drugs lasting longer than expected. Interestingly, Xanax lasts about 25% longer in Asians compared to Caucasians, and obesity and older age tend to make Xanax last longer, too.

What are their side effects?

Side effects of Xanax and Ativan are pretty much the same, with most coming from the fact that these drugs act on the nervous system. Side effects include cognitive dysfunction, depression, dizziness, drowsiness, dysarthria (a motor speech disorder), fatigue, irritability, memory impairment, and sedation.

The big downside, psychological dependence

Because they don’t work as long as long-acting benzodiazepines like clonazepam, Xanax and Ativan carry a higher risk of abuse. Essentially, they may require more pills to consistently alleviate anxiety, thus enhancing the potential for abuse.

Long-term use of either Xanax or Ativan carries the risk of withdrawal symptoms when discontinuing them. Studies show that when either drug is used for more than one month, dependence will occur in about half of those taking them.

The same warnings apply for both drugs here. Don’t stop either drug abruptly if you’ve been taking it for more than 2 weeks. Instead, lower your daily dose by 0.5 mg every 3 days to slowly taper off.

In addition, both shouldn’t really be used long term. At 4 months, treatment should be re-evaluated to see if the patient needs to continue the drug.

Which one is cheaper?

Both Xanax and Ativan are expensive based on cash price, running upwards of several hundred dollars for 60 tablets. But remember, your generics will always be cheaper than your brand-name drugs. With a GoodRx coupon, 60 0.5 mg tablets of either alprazolam or lorazepam costs around $10.  

Another option for lowering the price of these medications may be pill splitting. Xanax and Ativan tablets are both scored, so pill splitting is an option. However, extended-release tablets should never be broken or split.

This Post Has 17 Comments

  1. SteveWeedo

    What a great write-up. I’ve sometimes tried both. Xanax works perfectly well for for anxiety disorder. But I don’t know if will works well for Depression, Xanax is the best for all my anxiety problems. Yes most people react differently, Ativan don’t just help me in anyway, I guess it works for some people.

  2. Isaacedupe

    Amazing. Personally I think Xanax is great. Anytime I have a panic attack, I take Xanax and it works like magic

  3. AaronLauct

    I’ve tried both, I didn’t notice any difference. I was prescribed Xanax for Anxiety. Though I do sometimes take Ativan and it serves the very purpose.

  4. Allenbyday

    Great post there. Personally, I’m cool with Xanax

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