Ativan vs. Xanax: Differences, similarities, and more

In this article:

• Key differences
• Conditions treated
• Which is more effective for anxiety?
• Cost and coverage
• Side effects
• Drug interactions
• Drug warnings
• FAQ

In this article

• Key differences
• Conditions treated
• Which is more effective for anxiety?
• Cost and coverage
• Side effects
• Drug interactions
• Drug warnings
• FAQ

Ativan (lorazepam) and Xanax (alprazolam) are brand-name prescription drugs used to manage anxiety disorders and symptoms. They are classified into a group of medications called benzodiazepines, which slow down the central nervous system (CNS) to produce sedation, relieve anxiety and muscle spasms, and reduce seizures. Both drugs are controlled substances and classified as Schedule IV drugs by the Drug Enforcement Administration (DEA).

Although both medications are therapeutically known as benzodiazepines, they have some notable differences, which we’ll cover below. 

Key differences between Ativan and Xanax

Ativan and Xanax are brand-name drugs that are both available in generic form. The generic of Ativan is lorazepam, and the generic of Xanax is alprazolam. Ativan is available as a tablet, injection, and oral concentrate. Xanax is available as both an immediate-release (IR) tablet and an extended-release (ER) tablet, as well as an oral concentrate. Ativan is used in children 12 years and older, and Xanax is used in adults. Both drugs are intended to be used for a short period of time, but patients may continue to use them long-term based on the healthcare provider’s instructions and with careful monitoring. 

Ativan starts working within an hour, and the effects last for up to eight hours. Xanax starts working within an hour, and the effects of the IR tablet last about five hours, whereas the ER tablet effects last about 11 hours. Both drugs have a half-life (the time it takes for the amount of the drug to decrease by half) of about 12 hours, and they can stay in the body for about 60 hours after the last dose. 

Ativan vs. Xanax: Compare key differences
	Ativan	Xanax
Drug class	Benzodiazepine	Benzodiazepine
Brand/generic status	Brand and generic	Brand and generic
What is the generic name?	Lorazepam	Alprazolam
What form(s) does the drug come in?	Tablet Oral concentrate Injection	IR tablet ER tablet Oral concentrate
What is the standard dosage?	Typical dose is 2–6 mg per day in divided doses (for example, 1 mg tablet taken 3 times daily)	Typical dose is 0.25–0.5 mg taken 3 times daily; dosage varies
How long is the typical treatment?	Short-term; Some patients use longer under healthcare provider supervision	Short-term; Some patients use longer under healthcare provider supervision
Who typically uses the medication?	Adults and children 12 years and older	Adults

Conditions treated by Ativan and Xanax

Ativan and Xanax are both used to treat anxiety disorders, but they have some differences in their approved indications. The Food and Drug Administration (FDA) has approved both drugs for the short-term relief of anxiety symptoms and short-term relief of anxiety associated with depressive symptoms. Xanax is also indicated for the treatment of panic disorder, with or without agoraphobia. Both medications also have several off-label uses, which are outlined below.

Ativan vs. Xanax: Compare conditions treated
Condition	Ativan	Xanax
Management of anxiety disorders	Yes	Yes
Short-term relief of the symptoms of anxiety	Yes	Yes
Short-term relief of anxiety associated with depressive symptoms	Yes	Yes
Relief of anxiety before surgery	Off-label	Off-label
Seizures	Off-label	No
Treatment of panic disorder, with or without agoraphobia	Off-label	Yes
Rapid tranquilization of the agitated patient	Off-label	Off-label
Alcohol withdrawal delirium/alcohol withdrawal syndrome	Off-label	Off-label
Insomnia	Off-label	Off-label
Chemotherapy-associated anticipatory nausea and vomiting	Off-label	Off-label
Delirium	Off-label	Off-label
Depression	No	Off-label
Essential tremor	Off-label	Off-label
Ringing in the ears	Off-label	Off-label
Premenstrual syndrome	Off-label	Off-label

Ativan vs. Xanax for anxiety: Which is more effective?

Studies have found that Ativan and Xanax have a similar level of effectiveness in treating anxiety and panic disorder. However, choosing which medication to take can be determined by each person’s needs. For example, Xanax has been shown to work slightly quicker than Ativan, so it may be the preferred choice for plane rides. Lorazepam tends to have less active metabolites build up in the body and, therefore, is a safer option for older adults. 

The most effective medication for you should only be determined by your healthcare provider, who will take into account your medical conditions, history, and other medications or supplements you take.

Ativan vs. Xanax cost and insurance coverage

Ativan is typically covered by insurance and Medicare Part D in its generic form, lorazepam. The brand-name Ativan may not be covered or may have a high copay, depending on the details of your prescription drug plan. The average retail price of lorazepam is $28 for 30, 0.5 mg tablets. 

Xanax is also typically covered by insurance and Medicare Part D in its generic form, alprazolam. The brand-name Xanax may not be covered or may have a high copay. Again, coverage varies by plan. The average retail price of alprazolam is about $80 for 90, 1 mg tablets. 

Using a SingleCare coupon for generic Ativan (lorazepam) or Xanax (alprazolam) can help you save on your prescriptions. 

Ativan vs. Xanax: Compare insurance and cost
	Ativan	Xanax
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare Part D?	Yes	Yes
Quantity	30, 0.5 mg tablets	90, 1 mg tablets
SingleCare cost*	$4 for generic Ativan (lorazepam)	$6 for generic Xanax (alprazolam)

*Cost at the time of publication. Costs fluctuate and vary by pharmacy.

Common side effects of Ativan and Xanax

Side effects of Ativan and Xanax tend to be greater at higher doses. The most common side effects of Ativan are sedation, dizziness, weakness, and unsteadiness. The most common side effects of Xanax are problems with coordination, hypotension, trouble saying words clearly (dysarthria), and changes in sex drive. 

Other side effects that may occur with either drug include:

• Fatigue
• Lightheadedness
• Drowsiness
• Amnesia, or memory impairment
• Confusion and disorientation
• Depression
• Euphoria
• Suicidal thoughts
• Lack of energy
• Dry mouth
• Tremor
• Convulsions or seizures
• Vertigo
• Disturbed vision
• Change in libido
• Sleep apnea
• Worsening of chronic obstructive pulmonary disease (COPD)
• Gastrointestinal (GI) symptoms such as nausea, constipation, or diarrhea

Other side effects may occur. Consult a healthcare professional for a complete list of side effects.

Ativan vs. Xanax: Compare side effects
	Ativan		Xanax
Side effect	Applicable?	Frequency	Applicable?	Frequency
Sedation	Yes	15.9%	Yes	41%
Dizziness	Yes	6.9%	Yes	1.8%–30%
Weakness	Yes	4.2%	Yes	6%–7%
Unsteadiness or problems with coordination	Yes	3.4%	Yes	40%
Hypotension	Yes	Undetermined	Yes	5%
Trouble saying words clearly	Yes	Undetermined	Yes	2.1%
Changes in sex drive	Yes	Undetermined	Yes	2%

Ativan vs. Xanax drug interactions

Benzodiazepines, such as Ativan and Xanax, should not be taken in combination with opioid painkillers due to the increased risk of sedation, respiratory depression, and overdose, possibly leading to death. If no other combination is possible, healthcare providers may prescribe the lowest possible dose for the shortest duration and closely monitor their patients. Benzodiazepines also should not be taken with other CNS depressants, such as alcohol, antipsychotics, antidepressants, sedating antihistamines, and anticonvulsants. 

An especially dangerous combination, nicknamed the “holy trinity,” is an opioid (usually a form of hydrocodone or Oxycontin), a benzodiazepine (usually alprazolam), and Soma (carisoprodol, a muscle relaxant). These drugs should never be prescribed together since the use of these three medications can result in very serious respiratory depression, overdose, or even death. 

Other drug interactions may occur. Consult your healthcare provider for a full list of drug interactions.

Ativan and Xanax warnings

Ativan and Xanax have many similar warnings. Both drugs come with a boxed warning, which is the strongest warning required by the FDA, stating that benzodiazepines, such as Ativan and Xanax, should not be used in combination with opioid painkillers due to the risk of extreme sedation, severe respiratory depression, coma, or even death. Patients should not drive or operate machinery until the effects are known.

Both drugs include other warnings:

• Benzodiazepines may cause physical and psychological dependence—the risk is higher with higher doses, longer duration of use, or a history of drug or alcohol abuse. If you take a benzodiazepine, take the medication only as prescribed.
• Benzodiazepines should be used as a short-term treatment, and when discontinuing, the drug should be slowly tapered to avoid withdrawal symptoms, such as seizures, agitation, confusion, rapid heartbeat, and vertigo.
• Patients with seizure disorders have a higher risk for withdrawal symptoms. 
• In patients with depression, there is a risk of suicide. Patients with depression should also be treated with an antidepressant and should be closely monitored.
• Benzodiazepines should be used with caution in patients with impaired respiratory function, such as those who have COPD and sleep apnea.
• Patients with severe hepatic insufficiency or encephalopathy should take benzodiazepines with caution and use lower doses.

Xanax has some additional warnings:

• Patients with panic disorder often use higher doses of Xanax, so there may be a higher risk of dependence.
• Early morning anxiety or anxiety symptoms between doses have occurred in patients with panic disorder. In these situations, it is recommended that the drug be given in smaller doses, more frequently, adding up to the same total daily dose. 

Ativan and Xanax should not be used during pregnancy. Both drugs are classified as pregnancy category D, meaning there is a risk to the fetus. If you are taking Ativan or Xanax and find out that you are pregnant, consult your healthcare provider immediately. 

Both drugs are on the Beers List (drugs that may be inappropriate in older adults). Older adults have increased sensitivity to benzodiazepines, and there is an increased risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults when Ativan or Xanax is used.

Frequently asked questions about Ativan vs. Xanax

What is Ativan?

Ativan, also known by its generic name, lorazepam, is a benzodiazepine drug used to treat anxiety. 

What is Xanax?

Xanax, also known by its generic name, alprazolam, is a benzodiazepine drug used to treat anxiety and panic disorder.

Is Ativan or Xanax better?

Ativan and Xanax are both effective for anxiety and other psychological conditions and have similar side effects, warnings, and drug interactions. Consult your healthcare provider to see if one of these medications is appropriate for you and your condition. 

Can I use Ativan or Xanax while pregnant?

Ativan or Xanax may cause fetal abnormalities and should not be used during pregnancy. If you are already taking Ativan or Xanax and find out that you are pregnant, contact your healthcare provider for guidance.

Can I use Ativan or Xanax with alcohol?

No. The combination of Ativan or Xanax with alcohol is very dangerous and can lead to respiratory depression, extreme sedation, coma, or even death.

Is Ativan milder than Xanax?

It’s hard to categorize Ativan as milder or not; however, we do know that a dose of Xanax wears off faster than a dose of Ativan. Therefore, Xanax may be dosed more frequently than Ativan. 

Which is better for anxiety, Xanax or Ativan?

Both medications are effective for anxiety. Ask your healthcare provider if one of these drugs is right for you, considering your medical history, health conditions, and other medications you take.

Is Ativan a narcotic?

Ativan is not a narcotic. It is classified as a benzodiazepine. It can be habit-forming and has the potential for abuse and dependence, so it is very important to take it as prescribed.