Combining Xanax and Ativan is Not Recommended
You should not take Xanax (alprazolam) and Ativan (lorazepam) 2mg together. Combining two benzodiazepines from the same drug class provides no therapeutic advantage and significantly increases risks of central nervous system depression, respiratory suppression, cognitive impairment, and paradoxical agitation 1.
Why This Combination Should Be Avoided
Same Mechanism, Compounded Risks
Both alprazolam and lorazepam are benzodiazepines that work through identical mechanisms (GABA-A receptor modulation), making their concurrent use pharmacologically redundant 2, 3.
Combining benzodiazepines dramatically increases the risk of respiratory depression, oversedation, falls, cognitive impairment, and potential for tolerance and dependence 1.
The CDC explicitly warns against concurrent use of multiple central nervous system depressants, emphasizing that benzodiazepines potentiate each other's depressant effects 1.
Clinical Guidelines Oppose This Practice
Multiple clinical practice guidelines consistently recommend against using two medications from the same psychotropic class simultaneously, as there is limited evidence supporting such approaches and substantial evidence of increased harm 1.
When benzodiazepines are indicated for anxiety or agitation, guidelines recommend selecting a single agent and titrating to effect, not combining multiple benzodiazepines 1.
Emergency medicine guidelines studying agitation management have compared alprazolam versus lorazepam as alternatives to each other, not as combination therapy, reinforcing they serve the same clinical purpose 1.
When Two Benzodiazepines Might Temporarily Coexist
Transitioning Between Medications Only
The only clinically appropriate scenario where a patient might have both medications is during a brief cross-taper when switching from one benzodiazepine to another 1.
This transition period should be as short as possible (typically days to 1-2 weeks maximum) with clear dose reduction of the first agent as the second is introduced 1.
Abrupt discontinuation of benzodiazepines can cause dangerous withdrawal including seizures, so gradual tapering is essential when stopping one 1.
Comparative Efficacy: Choose One or the Other
Research Shows Equivalence
Direct comparison studies demonstrate that alprazolam and lorazepam have comparable efficacy for treating anxiety and panic disorders when dosed appropriately 2, 3, 4.
Lorazepam at 7mg daily showed equivalent antipanic efficacy to alprazolam 3mg daily, with both being well-tolerated as monotherapy 4.
The drugs differ slightly in pharmacokinetics (alprazolam may have faster onset, lorazepam has intermediate half-life), but both effectively treat the same conditions 5, 3.
Critical Safety Considerations
Increased Adverse Effects
Combining benzodiazepines increases risk of drowsiness, lightheadedness, dizziness, cognitive impairment, and paradoxical agitation (which occurs in approximately 10% of patients on benzodiazepines) 1, 2, 3.
Elderly and debilitated patients face particularly high risks of falls, confusion, and respiratory depression with benzodiazepine combinations 1.
Regular use of multiple benzodiazepines accelerates tolerance development and increases addiction potential 1.
Respiratory Depression Risk
Both medications cause central nervous system and respiratory depression, and concurrent use compounds these life-threatening effects 1.
This risk is especially pronounced when benzodiazepines are combined with opioids or other sedating medications 1.
Recommended Approach
Select a Single Benzodiazepine
Choose either alprazolam OR lorazepam based on clinical indication, not both 1.
For anxiety: Start lorazepam 0.5-1mg four times daily as needed (maximum 4mg/24 hours), or alprazolam at equivalent doses 1.
For elderly patients: Reduce doses to lorazepam 0.25-0.5mg (maximum 2mg/24 hours) 1.
If Currently Taking Both
Consult the prescribing physician immediately to develop a safe consolidation plan 1.
Do not abruptly stop either medication due to withdrawal seizure risk 1.
A gradual taper of one agent while maintaining the other is the safest approach, typically reducing by 25% every 1-2 weeks 1.
Bottom Line
There is no legitimate clinical indication for taking Xanax and Ativan together. This combination provides no additional therapeutic benefit while substantially increasing risks of sedation, respiratory depression, cognitive impairment, falls, and dependence. One benzodiazepine, properly dosed, is sufficient for managing anxiety or agitation 1.