Valium vs. Xanax: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Valium (diazepam) and Xanax (alprazolam) are each members of a class of drugs called benzodiazepines. Benzodiazepines are commonly used to treat neural conditions such as anxiety. They work by enhancing the effects of gamma-aminobutyric acid (GABA), which is known to suppress the over-activity of nerves. Overactive nerves are thought to play a key role in anxiety, panic, and other neurological and psychiatric disorders. Both Valium and Xanax can be used to treat anxiety disorders. Xanax is also used in the treatment of panic disorders. Valium may also be used to treat seizure disorders, alcohol withdrawal symptoms, and as a muscle relaxant.

Valium is considered a rapid onset benzodiazepine, while Xanax is considered an intermediate onset benzodiazepine.

What are the main differences between Valium and Xanax?

Valium is known by the generic name diazepam, and it is used to treat anxiety disorders, seizure disorders, muscle tightness, and alcohol withdrawal symptoms. It has a rapid onset of action with an average time to peak concentration of one hour. The half-life of the drug has a range of 20-50 hours which is prolonged even further by an active metabolite, reaching up to a 100-hour half-life.

Xanax is known by the generic name alprazolam, and it is used primarily for anxiety and panic disorders. It has an intermediate onset of action ranging from 1-2 hours. Its half-life is shorter than that of Valium, ranging from 6-20 hours.

Main differences between Valium and Xanax
	Valium	Xanax
Drug class	Benzodiazepine	Benzodiazepine
Brand/generic status	Generic available	Generic available
What is the generic name?	Diazepam	Alprazolam
What form(s) does the drug come in?	Tablet Oral solution (concentrated and unconcentrated) Intravenous solution Rectal gel	Tablet (immediate-release and extended-release) Concentrated oral solution
What is the standard dosage?	2 mg to 10 mg two to four times daily	0.25 mg to 0.5 mg three times daily
How long is the typical treatment?	Short-term	Short-term
Who typically uses the medication?	Anxiety, muscle relaxation, alcohol withdrawal: adults Seizure disorder: infants, children, and adults	Anxiety: Children 7 years old and above, adults Panic: Adults

Conditions treated by Valium and Xanax

Valium and Xanax are each FDA-approved to treat anxiety disorders, and Xanax is also approved to treat panic disorders. Xanax has been used off-label to treat anxiety associated with medical procedures.

Valium is also used to treat the symptoms of acute alcohol withdrawal. It can also be used in combination with other treatments to help relieve skeletal muscle spasms as well as to treat acute active seizures and status epilepticus. Valium has also been used off-label to treat vertigo.

Condition	Valium	Xanax
Anxiety disorder	Yes	Yes
Panic disorder	No	Yes
Alcohol withdrawal symptoms	Yes	No
Seizure disorder	Yes	No
Status Epilepticus	Yes	No
Muscle relaxation	Yes	No
Vertigo	Off-label	No
Pre-procedural anxiety	No	Off-label

Is Valium or Xanax more effective?

Valium and Xanax have been studied extensively in regards to their effects on anxiety disorders. In one instance, Valium was shown to be slightly more effective at managing anxiety, though the difference between the two drugs may not be clinically meaningful. Both medications are known to cause drowsiness and slow reaction time and mobility. Due to its long half-life, the effects of Valium will take longer to wear off, and this would need to be considered when choosing therapy.

Valium rectal gel is the only FDA-approved pre-hospital treatment for severe seizures. One study showed it to be 85% effective at stopping seizures. It also was shown to improve quality of life due in part to more flexibility in activities because patients felt they had more control over their seizures.

Only a healthcare provider can determine what therapy, or combination of therapy, is appropriate for each patient. Providers must take into account many patient-specific factors, such as age, previous treatment, and history of results with other medications.

Coverage and cost comparison of Valium vs. Xanax

Valium is available generically as diazepam and is generally covered by Medicare and most insurance plans. The average retail cost of Valium is about $215 for 30 5mg tablets. With a SingleCare coupon, that price drops as low as $6-$8.

Xanax is available generically as alprazolam and is generally covered by Medicare and most insurance plans. The average retail cost of 60 Xanax 1mg can be over $500, but you can get it for as low as $53 with a SingleCare coupon.

	Valium (diazepam)	Xanax (alprazolam)
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare?	Yes	Yes
Standard dosage	30, 5mg tablets	60, 1mg tablets
Typical Medicare copay	Plan dependent	Plan dependent
SingleCare cost	$6-$58	$53-$73

Common side effects of Valium vs. Xanax

Valium and Xanax have a similar side effect profile which is caused primarily by its depression of the central nervous system (CNS). Both of these medications can cause drowsiness, lightheadedness, and confusion. Both Valium and Xanax can affect the gastrointestinal system and cause nausea and constipation. Valium and Xanax each have the ability to increase the incidence of depression. This effect should be monitored closely in patients.

Valium’s longer elimination half-life means that adverse effects may last longer than Xanax or other benzodiazepines. This should be taken into effect when choosing appropriate therapy.

	Valium		Xanax
Side Effect	Applicable	Frequency	Applicable	Frequency
Drowsiness	Yes	23%	Yes	41%
Dizziness	Yes	1 to 10%	Yes	2%
Confusion	Yes	1 to 10%	Yes	10%
Lightheadedness	Yes	1 to 10%	Yes	21%
Headache	Yes	1 to 10%	Yes	13%
Depression	Yes	1 to 10%	Yes	14%
Constipation	Yes	Not defined	Yes	10%
Nausea	Yes	1 to 10%	Yes	10%
Blurred vision	Yes	Not defined	Yes	6%
Hypotension	Yes	1 to 10%	Yes	5%

This chart is not a complete list of serious side effects or adverse events. Prevalence of adverse events may depend on dose, frequency, and route of administration. Please consult a doctor or pharmacist for additional information and a complete list of side effects.

Source: DailyMed (Valium), DailyMed (Xanax)

Drug interactions of Valium vs. Xanax

All benzodiazepines, including Valium and Xanax, have the ability to worsen the respiratory depression caused by opioids. The concomitant use of Valium or Xanax with opioids such as hydrocodone or morphine may cause severe respiratory depression and sedation leading to coma or death. Patients should be monitored closely if this combination becomes medically necessary, and the combination should be used for the shortest duration possible.

The CNS depression caused by Valium and Xanax can enhance or be enhanced by other medications which also cause CNS depression, such as anticonvulsants, alcohol, and other psychotropic medications. The use of more than one CNS depressive medication should be monitored closely.

Valium and Xanax are both processed by the liver, and certain medications may speed up or slow down their metabolism when taken at the same time. Enzyme inhibitors will increase benzodiazepine levels by slowing metabolism, and some examples include fluoxetine, ketoconazole, and omeprazole. Enzyme inducers, such as carbamazepine, will speed up metabolism.

Drug	Drug Class	Valium	Xanax
Hydrocodone Oxycodone Codeine Morphine	Opioids	Yes	Yes
Alcohol	CNS depressant	Yes	Yes
Fluoxetine Fluvoxamine	SSRI	Yes	Yes
Erythromycin Clarithromycin	Macrolide antibiotics	Yes	Yes
Carbamazepine Phenytoin	Anticonvulsant	Yes	Yes
Itraconazole Ketoconazole	Antifungal	Yes	Yes
Cimetidine	H2 Antagonist	Yes	No
Omeprazole	Proton Pump Inhibitor (PPI)	Yes	No
Phenytoin	Anticonvulsant	Yes	Yes

This may not be a complete list of all drug interactions. Please consult a doctor or pharmacist for a complete list and additional information.

Warnings of Valium and Xanax

Valium and Xanax are prescription drugs that are classified as controlled substances by the DEA. They each have the potential for abuse and addiction, and therefore should be used for as short of a treatment term as possible. Patients with a history of substance abuse should be monitored closely when taking these medications and avoid them if possible.

Taking Valium and Xanax in combination with opioids should be avoided when possible. The combination may lead to severe respiratory depression, coma, or death.

The side effect profile of benzodiazepines leads to an increased risk of falling and causing injury. These drugs should be avoided in the elderly and any patient who may already have a high risk of falls.

Patients with liver disease should be monitored while taking Valium and Xanax as the absorption and effects of the drug are affected by liver function.

Valium and Xanax are both category D drugs in pregnancy. If you are pregnant or planning to become pregnant, work with your physician to find safe and effective treatment alternatives.

Frequently asked questions about Valium vs. Xanax

What is Valium?

Valium (diazepam) is a rapid-acting benzodiazepine used in the treatment of anxiety, seizure disorders, and muscle spasms. It is a controlled substance that requires a medical evaluation by a physician and a prescription to obtain. It has the potential to cause dependence and abuse.

What is Xanax?

Xanax (alprazolam) is an intermediate-acting benzodiazepine used to treat symptoms of anxiety and panic disorders.  It is also a prescription drug and controlled substance which requires a medical evaluation by a physician. It has the potential to cause dependence and abuse.

Are Valium and Xanax the same?

Valium and Xanax are both benzodiazepines, however, Valium has a quicker onset and takes longer to eliminate from the body. While they both treat anxiety disorders effectively, Xanax is also approved in the treatment of panic attacks. Valium is also effective in treating seizure disorders and muscle spasms.

Is Valium or Xanax better?

Valium and Xanax are both effective in treating anxiety disorders. Your physician will help determine which one is best for your individual needs based on your symptoms and other medical factors.

Can I use Valium or Xanax while pregnant?

Both Valium and Xanax are considered pregnancy category D and should not be used in pregnancy. Your physician can suggest safer alternatives for the treatment of your disorder during pregnancy.

Can I use Valium or Xanax with alcohol?

Alcohol, like benzodiazepines, is a CNS depressant. Using alcohol with Valium or Xanax can be dangerous because the CNS depression of each can be potentiated. Alcohol abuse can cause hepatic injury or impairment and affect how Valium and Xanax are metabolized.

How strong is Valium compared to Xanax?

Valium has a more rapid onset than Xanax, therefore its effects will present sooner than those of Xanax. Valium also takes longer to be eliminated from the body, therefore the effects of Valium may last longer than Xanax.

Is Valium or Xanax the best for anxiety disorders?

Valium and Xanax have been shown to be comparable in the treatment of anxiety disorders. Which one is best for a particular patient may depend on treatment history and other factors.