Ativan (Lorazepam) vs. Xanax (Alprazolam) – How Do They Differ?

Ativan (lorazepam) and Xanax (alprazolam) both belong to the benzodiazepine family of medications, which are frequently prescribed to address anxiety. Although they treat similar conditions, there are notable distinctions between these two drugs in terms of how they work, what they’re approved for, and their common side effects.

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Ativan vs. Xanax: Comparison Chart

Ativan and Xanax share some similarities but also have key differences. Their FDA-approved uses vary slightly, and they come in different forms. In addition, they can produce somewhat different side effects, and one may act faster or last longer than the other.

	Ativan	Xanax
Generic Name	Lorazepam	Alprazolam
Drug Class	Benzodiazepine	Benzodiazepine
Drug Schedule	Schedule IV	Schedule IV
Dosage Examples	0.5 mg, 1 mg, 2 mg tablets	0.25 mg, 0.5 mg, 1 mg, 2 mg tablets
Formulations	Oral tablets, liquid solution, injectable	Oral tablets (extended- or immediate-release)
Usage	FDA-approved for multiple anxiety disorders, including anxiety related to depression	FDA-approved for generalized anxiety disorder (GAD) and panic disorder (PD)
Side Effects	Commonly: sedation, dizziness, weakness, unsteady movements	Commonly: coordination problems, low blood pressure, slurred speech, increased libido
Potential for Abuse	Potential for limited physical or psychological dependence	Potential for limited physical or psychological dependence
Onset of Action	Around two hours	About 30 minutes to two hours
Duration of Action	Approximately eight hours	Around four to six hours
Half-Life	About 11.2 hours	About 12 hours

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Which Benzodiazepine Is More Potent?

Both Ativan and Xanax can be effective against anxiety, but their duration and onset differ. Xanax typically begins working a bit faster, yet it also wears off more quickly. It is available in immediate-release and extended-release formulations, which can slightly raise its potential for misuse or dependence.

In contrast, Ativan’s immediate-release forms (tablets, oral solution, and IV) take effect more gradually, and a single dose lasts longer in the body. This characteristic is generally linked with a somewhat lower risk of misuse compared to Xanax. Nevertheless, because tolerance may develop when either is used regularly, increasing doses might be needed over time.

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Fastest-Acting Benzo

Xanax is considered the fastest-acting benzodiazepine, kicking in earlier than many other meds in its category. This can be beneficial for sudden or acute instances of anxiety, like panic attacks. However, the quick onset also means the medication leaves the body sooner.

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Best Benzo for Anxiety

Both Xanax and Ativan carry FDA approval for treating certain types of anxiety. Deciding which option is best can depend on your individual situation:

• Xanax: May be most beneficial for rapid relief in urgent situations, such as an unexpected panic attack or pre-procedure anxiety.
• Ativan: Offers a longer-lasting effect with a more gradual onset, making it potentially useful if you need consistent, longer-lasting relief without frequent dosing. It can also reduce the chances of memory-related side effects if you need to stay alert (such as during a performance or important event).

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Best Benzo for Panic Disorder

Xanax has official FDA approval for panic disorder, largely due to its quick onset. Still, Ativan can be prescribed off-label for similar purposes based on a doctor’s discretion. Always consult your healthcare provider to see which medication — if any — is recommended for your specific situation.

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Best Benzo for Sleep

While Ativan and Xanax can induce drowsiness, they are typically not the first choice for insomnia because they carry the potential for misuse and dependence. Using benzodiazepines consistently can lead to tolerance (needing higher doses to achieve the same benefit) and a reliance on these medications for sleep.

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Best Benzo for Alcohol Withdrawal

Because alcohol acts as a depressant, benzodiazepines can help manage alcohol withdrawal symptoms by lowering the risk of seizures and easing withdrawal. Longer-acting benzodiazepines — such as Ativan (lorazepam), Librium (chlordiazepoxide), or Valium (diazepam) — generally have a slightly reduced misuse risk compared to shorter-acting options like Xanax.

Their longer half-lives also reduce how frequently doses must be taken, decreasing the chances for reinforcing drug-seeking behaviors that can arise with more frequent, short-acting dosing.

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Which Benzo Has More Abuse Potential?

Both Ativan and Xanax are Schedule IV substances, indicating they have some abuse potential. Medications that act quicker (like Xanax) often have a stronger association with misuse because you can more easily link the act of taking the drug with the resulting effects. Although there are no precise statistics comparing addiction rates for Ativan versus Xanax, Xanax’s faster onset could mean a slightly higher risk of dependence.

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Insurance Coverage and Cost Comparison for Ativan vs. Xanax

Ativan and Xanax are both available in generic forms and are typically covered by most insurance plans. If you must pay out of pocket, the average cost for a Xanax 0.25 mg tablet may be around $5.83, whereas Ativan may be around $83.28 for a 1 mg tablet. These prices can vary based on the pharmacy, geographic region, and available discounts.

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How to Decide on the Right Benzo For You

It’s always important to consult your healthcare provider to determine the most suitable medication for you. Factors include:

• How quickly you need relief
• How long the drug’s effects should last
• Potential interactions with other prescriptions you are taking
• Side effects you may be especially prone to

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Switching From Ativan to Xanax

If Ativan is not adequately managing your symptoms, your doctor may recommend transitioning to Xanax. They may also recommend switching if you experience problematic side effects like excessive drowsiness or memory troubles. However, do not abruptly discontinue Ativan if you have been taking it routinely, as this can cause withdrawal.

In approximate terms, 1 mg of Ativan is equivalent to about 0.5 mg of Xanax. This comparison is simply a guideline, and your doctor will consider numerous factors, such as your age, genetics, liver and kidney health, and other medications you might be on.

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Switching From Xanax to Ativan

If you find you need multiple doses of Xanax throughout the day, switching to Ativan may be beneficial. Because each Ativan dose remains active for a longer period, it may provide sustained relief.

Like Ativan, suddenly stopping Xanax can result in withdrawal symptoms. Always seek professional advice from your doctor if you want to change or discontinue your medications.

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Withdrawal Risks

If you stop taking these medications too quickly, withdrawal symptoms can occur.

Ativan Withdrawal Symptoms:

• Trouble sleeping
• Hallucinations
• Headaches
• Seizures
• Muscle or stomach cramps
• Shaking or tremors
• Unusual behaviors

Xanax Withdrawal Symptoms:

• Difficulty focusing
• Insomnia
• Low mood or hopelessness
• Irritability
• Hallucinations
• Loss of appetite
• Nausea or vomiting
• Seizures or tremors
• Muscle or stomach pain
• Suicidal thoughts
• Sweating
• Uncharacteristic behaviors

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Getting Help for Benzodiazepine Addiction

The Recovery Village Salem provides comprehensive addiction treatment services for individuals throughout Oregon and surrounding areas. Our center offers a safe and supportive environment where you can begin your recovery journey. We provide a continuum of care, from medical detox to inpatient treatment, partial hospitalization programs (PHPs), outpatient services, and aftercare planning. We also offer online therapy options to help those who need more flexible schedules.

If you or a loved one is struggling with benzodiazepine misuse, contact The Recovery Village Salem to learn more about our specialized programs. Our expert team is here to help you begin a healthier, substance-free life.