Klonopin vs. Ativan: Differences, similarities and which is better for you

In this article:

• Main differences
• Conditions treated
• Efficacy
• Cost
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• Main differences
• Conditions treated
• Efficacy
• Cost
• Side effects
• Interactions
• Warnings
• FAQs

Klonopin (clonazepam) and Ativan (lorazepam) are two prescription medications that can treat anxiety disorders. Both medications belong to the same class of drugs known as benzodiazepines, which work by binding to GABA receptors in the brain. GABA (gamma-aminobutyric acid) is a major neurotransmitter in the brain with inhibitory effects that slow down activity in the brain. While both drugs work in similar ways, they have some differences in how they are used.

Both Klonopin and Ativan are considered intermediate-acting benzodiazepines. In other words, their effects may last longer than similar drugs. 

What are the main differences between Klonopin vs. Ativan?

Klonopin is the brand name for clonazepam, which is used to treat panic disorder and seizures. Klonopin stays in the body relatively long, with a half-life of 30 to 40 hours. This means that a person can still feel the lingering effects of Klonopin for some time after it’s taken. Klonopin is available as an oral tablet that is usually taken two to three times per day, depending on the condition being treated.

Ativan is the brand name for lorazepam. It can be used to treat anxiety and insomnia. The injectable form can also be used to treat certain seizures and for anesthesia before procedures. Ativan doesn’t last as long as Klonopin, with a half-life of around 20 hours in the body. Ativan is available as an oral tablet or injection. It is most commonly taken orally, with dosages ranging from 1 mg to 10 mg per day in divided doses depending on the condition being treated. 

	Klonopin	Ativan
Drug class	Benzodiazepine	Benzodiazepine
Brand/generic status	Generic version available	Generic version available
What is the generic name?	Clonazepam	Lorazepam
What form(s) does the drug come in?	Oral tablet	Oral tablet  Injection
What is the standard dosage?	Panic disorder in adults: 0.25 mg twice per day. Dosage may be increased depending on the response to the medication.  Seizures in adults: Up to 1.5 mg daily in three doses. Dosage may be increased depending on the response to the medication.  Seizures in children: Dosage depends on weight.	1 mg to 10 mg per day in divided doses, depending on the indication
How long is the typical treatment?	Short-term	Short-term
Who typically uses the medication?	Panic disorder: Adults 18 years and older Seizures: Adults and children	Adults and children

Conditions treated by Klonopin and Ativan

Klonopin tablets and Ativan injections are FDA-approved to treat seizure disorders. Klonopin can treat various seizures, including akinetic and myoclonic seizures, as well as those resulting from Lennox-Gastaut syndrome. Ativan injections are used to treat a more severe type of seizure called status epilepticus. 

Klonopin tablets are also prescribed to treat recurring panic attacks. On the other hand, Ativan tablets are used to treat various anxiety disorders as well as insomnia caused by anxiety. 

While Ativan is FDA-approved to treat insomnia, some doctors may prescribe Klonopin off-label for sleeping problems. Other off-label uses for Klonopin and Ativan include treating alcohol withdrawal and agitation. 

Condition	Klonopin	Ativan
Seizures	Yes	Yes
Anxiety	Yes	Yes
Panic disorder	Yes	Off-label
Insomnia	Off-label	Yes
Alcohol withdrawal symptoms	Off-label	Off-label

Is Klonopin or Ativan more effective?

In general, Klonopin and Ativan are effective drug treatments. However, because they have been studied for different purposes, their effectiveness can vary depending on the condition being treated.

In a multicenter study, the active ingredients in Klonopin and Ativan were found to be equally effective for treating anxiety disorders. There were no significant differences found between these drugs when looking at improvements in symptoms of anxiety and sleep scores. However, the study found fewer side effects with clonazepam than with lorazepam (26.7% versus 43.9%).

Another study compared the use of clonazepam and lorazepam for status epilepticus, a severe type of seizure. Although lorazepam is approved and more widely used for status epilepticus, clonazepam was found to be a useful alternative. Clonazepam is sometimes used off-label for this purpose. 

Consult your healthcare provider, who can give appropriate medical advice. Depending on your medical and mental health history, one option may be better than the other. 

Coverage and cost comparison of Klonopin vs. Ativan

Medicare and most insurance plans usually cover Generic Klonopin. The average retail cost of Klonopin is around $100 for thirty tablets. With a SingleCare discount card, you can save on generic Klonopin and pay around $3, depending on the pharmacy and quantity prescribed. 

Medicare and most insurance plans usually cover generic Ativan. The average retail cost of Ativan is about $21. With a SingleCare discount card, you can save on generic Ativan and pay around $7. 

	Klonopin	Ativan
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare?	Yes	Yes
Standard dosage	30, 0.5 mg tablets	0.5 mg tablets (supply of 30)
Typical Medicare copay	Depends on your insurance plan	Depends on your insurance plan
SingleCare cost	$3	$7

Common side effects of Klonopin and Ativan

Klonopin and Ativan have similar side effects, mainly affecting the central nervous system (CNS). As CNS depressants, these drugs can cause drowsiness, dizziness, impaired thinking or memory, and unsteadiness or problems with coordination. Both drugs may also cause or worsen depression in some people, especially those with untreated depression.

	Klonopin		Ativan
Side Effect	Applicable?	Frequency	Applicable?	Frequency
Drowsiness	Yes	7%	Yes	15.9%
Depression	Yes	4%	Yes	n/a
Dizziness	Yes	1%	Yes	6.9%
Nervousness	Yes	1%	No	–
Lack of coordination	Yes	1%	Yes	3.4%
Cognitive dysfunction	Yes	1%	Yes	n/a
Weakness	No	–	Yes	4.2%

*Consult your healthcare provider for all possible adverse effects.

Source: DailyMed (Klonopin), DailyMed (Ativan)

Drug interactions of Klonopin vs. Ativan

Klonopin and Ativan can interact with other drugs that cause similar effects. Taking narcotics or opioids with benzodiazepines can increase side effects such as sedation, drowsiness, and, in severe cases, slowed breathing, coma, and death.

Benzodiazepines can interact with other CNS depressant drugs, such as anticonvulsants, antidepressants, antipsychotics, anesthetics, barbiturates, and other sedatives. Using these drugs together can increase side effects such as drowsiness and sedation. 

Because Klonopin and Ativan are processed in the liver, they should be avoided or monitored with other drugs that are processed in the same way. Liver enzyme inhibitors include erythromycin, ketoconazole, and ritonavir, which can increase the level of these benzodiazepines in the body and increase their side effects. Liver enzyme inducers include carbamazepine and phenytoin, which may decrease the level of benzodiazepines in the body and affect how well they work.

Tell your healthcare provider about all medications you take, including prescription drugs, over-the-counter medicines, and dietary supplements, before starting treatment with a benzodiazepine.

Drug	Drug Class	Klonopin	Ativan
Codeine Oxycodone Hydrocodone Morphine Methadone	Opioids	Yes	Yes
Phenytoin Carbamazepine Lamotrigine Valproic acid	Anticonvulsants	Yes	Yes
Phenobarbital Pentobarbital Secobarbital	Barbiturates	Yes	Yes
Haloperidol Olanzapine Risperidone	Antipsychotics	Yes	Yes
Amitriptyline Desipramine Doxepin Nortriptyline	Tricyclic antidepressants	Yes	Yes
Rasagiline Isocarboxazid Phenelzine Selegiline Tranylcypromine	Monoamine oxidase inhibitor (MAOI)	Yes	Yes
Probenecid	Uricosuric	Yes	Yes
Theophylline Aminophylline	Methylxanthine	Yes	Yes
Erythromycin Clarithromycin Telithromycin Rifampin	Antibiotic	Yes	Yes
Ketoconazole Itraconazole	Antifungal agent	Yes	Yes

*This may not be a complete list of all possible drug interactions. Consult a healthcare provider about all medications you may be taking. 

Warnings of Klonopin and Ativan

Taking Benzodiazepines and opioids together should be avoided. Doing so can cause a greater risk of respiratory depression, coma, and death. 

Benzodiazepines are considered Schedule IV controlled substances by the DEA. In other words, they carry a risk of misuse and psychological or physical dependence. Therefore, they are usually recommended for short-term use only.

Klonopin and Ativan should be avoided in older adults or in those who may be at risk for falls. Because both drugs affect the liver, they should also be monitored in those with liver disease. 

Klonopin and Ativan should generally be avoided during pregnancy. Using these medications close to the due date may cause problems like difficulty breathing, extreme sleepiness, weak muscles in newborns, or even withdrawal symptoms such as increased reflexes, irritability, and trouble feeding. 

Consult a healthcare provider regarding steps to take while planning pregnancy. Benzodiazepines should also be avoided or monitored while breastfeeding.

Frequently asked questions about Klonopin vs. Ativan

Are Klonopin and Ativan the same?

Klonopin and Ativan are similar benzodiazepines that work in identical ways. While they both are used for the treatment of anxiety disorders and certain seizures, they have differences in how long they work. Ativan can also be used as a premedication for anesthesia, whereas Klonopin is not usually used for this purpose. Ativan comes as an oral tablet or injection, while Klonopin is available as an oral tablet only. 

Is Klonopin or Ativan better?

Klonopin may be preferred for its longer-lasting effects, depending on the condition being treated. Klonopin may also be preferred for certain seizures. It is approved to treat akinetic and myoclonic seizures, whereas Ativan is approved to treat status epilepticus.

Can I use Klonopin or Ativan while pregnant?

Klonopin and Ativan are not recommended for pregnant women. Taking certain anti-anxiety medications like benzodiazepines while pregnant may increase the risk of sedation and withdrawal symptoms in newborns. Consult a healthcare provider to see if the benefits may outweigh the risks. 

Can I use Klonopin or Ativan with alcohol?

Klonopin and Ativan are not recommended while drinking alcohol. Doing so can increase the risk of drowsiness and sedation. Drinking alcohol with benzodiazepines can also increase the risk of overdose, respiratory depression, coma, and death.