From the Guidelines
Klonopin (clonazepam) and Xanax (alprazolam) are both benzodiazepines used to treat anxiety disorders, but they differ in important ways, with Klonopin having a slower onset of action and longer duration, making it better for generalized anxiety, while Xanax works more quickly but has a shorter duration, making it more suitable for panic attacks or acute anxiety. The main differences between Klonopin and Xanax are their onset of action, duration, and potential for dependency. Klonopin has a slower onset of action (1-4 hours) and longer duration (20-50 hours), making it better for generalized anxiety with once or twice daily dosing, typically 0.5-2mg per day 1. Xanax works more quickly (within 1 hour) but has a shorter duration (12-15 hours), making it more suitable for panic attacks or acute anxiety, usually dosed at 0.25-0.5mg three times daily. Some key points to consider when choosing between Klonopin and Xanax include:
- Onset of action: Klonopin takes longer to start working, but its effects last longer, while Xanax works quickly, but its effects are shorter-lived
- Duration: Klonopin has a longer duration of action, making it better for generalized anxiety, while Xanax has a shorter duration, making it better for panic attacks or acute anxiety
- Potential for dependency: Klonopin tends to cause less intense sedation and has a lower risk of dependency compared to Xanax, which has stronger sedative effects but higher potential for dependence and withdrawal 1
- Side effects: Both medications can cause side effects like drowsiness, dizziness, and impaired coordination, and neither should be stopped abruptly due to withdrawal risks It's also important to note that both medications should only be used under medical supervision, as they both carry risks of dependence and are controlled substances. Additionally, the choice of medication may depend on the individual patient's response to the first medication, with patients who continue to complain of anxiety or insomnia potentially being prescribed a different medication or a combination of medications 1.
From the Research
Comparison of Clonazepam and Alprazolam
- Clonazepam and Alprazolam are both high-potency benzodiazepines used to treat panic disorder and anxiety [ 2, 3 ].
- A controlled trial found that both Clonazepam and Alprazolam had similar positive effects in treating panic disorder [ 2 ].
- Clonazepam has a relatively long half-life, allowing for less frequent dosing and more continuous control of anxiety, but around 20% of patients experience unacceptable sedative effects or no reduction in anxiety [ 2 ].
Efficacy and Safety
- Both Clonazepam and Alprazolam are effective and safe in the short-term treatment of panic disorder [ 2, 4 ].
- Clonazepam may be a useful alternative to Alprazolam and other short-acting benzodiazepines in the treatment of anxiety disorders, offering the advantage of antipanic efficacy without the relative side effect problems seen with tricyclic antidepressants and monoamine oxidase inhibitors [ 5 ].
- Discontinuation of Alprazolam is particularly difficult and is sometimes associated with serious rebound and withdrawal symptoms [ 2 ].
Treatment Outcomes
- A study found that 78% of patients with panic disorder or agoraphobia with panic attacks responded to Clonazepam treatment [ 3 ].
- Another study found that 82% of patients rated Clonazepam as being "better" than Alprazolam due to decreased dosing frequency and lack of interdose anxiety [ 5 ].
- Available naturalistic data suggest that tolerance to the antipanic or antiphobic effects of Clonazepam and Alprazolam does not occur in panic disorder/agoraphobia [ 4 ].