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

In this article:

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost
• Side effects
• Interactions
• Warnings
• FAQs

Valium (diazepam) and Xanax (alprazolam) are each members of a class of controlled substance 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 and alcohol withdrawal symptoms or as a muscle relaxant and procedural sedative.

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

Main differences between Valium and Xanax
	Valium	Xanax
Drug class	Benzodiazepine	Benzodiazepine
Brand/generic status	Generic available	Generic available
What is the generic name? What is the brand name?	Diazepam Valium	Alprazolam Xanax
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, procedural sedation: infants, children, and adults	Anxiety: Children 7 years old and above, adults Panic: Adults

What are the main differences between Valium and Xanax?

Valium is known by the generic name diazepam and is used to treat anxiety disorders, seizure disorders, muscle tightness, and alcohol withdrawal symptoms or to provide procedural sedation. 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 in some individuals.

Xanax, also known by the generic name alprazolam, 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 Valium, ranging from 6-20 hours. The effects of Valium will linger for a longer period than those of Xanax, and this should be considered when deciding which one is right for the person being treated.

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. It is approved as a sedative for medical procedures. 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
Procedural sedative	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 regard 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 retail cost of Valium can be as much as $345 for thirty 5 mg tablets. With a SingleCare coupon, that price drops as low as $3-$11.

Xanax is available generically as alprazolam and is generally covered by Medicare and most insurance plans. The average retail cost of Xanax is about $520 for sixty 1 mg tablets, but you can get it for as low as $7 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	$3-$11	$7-$29

Common side effects of Valium vs. Xanax

Valium and Xanax have a similar side effect profile, which is primarily because they depress 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 can 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, can 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 that also cause CNS depression, such as anticonvulsants, alcohol, and other psychotropic medications. Patients who take more than one CNS depressive medication should be under close medical supervision and monitored for potential side effects such as extreme drowsiness or confusion.

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 and cause the effects of the benzodiazepine drug class to wear off sooner than expected.

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

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 medications that are classified as controlled substances by the DEA. They each carry the risk of dependence, 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 using 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 potential side effects of benzodiazepines lead 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

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. Xanax has a short half-life and is eliminated more quickly from your body. While they both treat anxiety disorders effectively, Xanax is also approved for the treatment of panic attacks. Valium is 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 anxiety 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, so its effects will present sooner than those of Xanax. Valium also takes longer to be eliminated from the body, so its effects may last longer than those of 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, symptom severity, reasons for use, and other factors.