From the Guidelines
Neither Xanax (alprazolam) nor Ativan (lorazepam) is inherently safer than the other, as both are benzodiazepines with similar safety profiles and risks. Both medications are effective for treating anxiety disorders but carry risks of dependence, withdrawal, and side effects like drowsiness and impaired coordination. The key differences between Xanax and Ativan lie in their pharmacokinetics, with Xanax having a quicker onset but shorter duration of action compared to Ativan 1. Ativan may be slightly preferred in patients with liver problems as it doesn't undergo extensive liver metabolism like Xanax. Some important considerations when choosing between these medications include:
- Age: Elderly patients are significantly more sensitive to the sedative effects of benzodiazepines 1
- Other medications: Benzodiazepines can cause respiratory depression and systemic hypotension, especially when administered in conjunction with other cardiopulmonary depressants, particularly opioids 1
- Medical conditions: Benzodiazepine-induced cardiopulmonary instability is more likely to occur in critically ill patients with baseline respiratory insufficiency and/or cardiovascular instability 1
- Substance use history: Tolerance to benzodiazepines develops with long-term administration 1 Both should be used at the lowest effective dose for the shortest duration possible under medical supervision, as they carry similar risks of tolerance, dependence, and potentially dangerous withdrawal symptoms if stopped abruptly. The choice between these medications should be made by a healthcare provider based on your specific situation and needs, taking into account the potential benefits and risks associated with each medication.
From the Research
Comparison of Xanax and Ativan
- Xanax (alprazolam) and Ativan (lorazepam) are both benzodiazepines used to treat anxiety disorders 2.
- A study published in 1985 suggests that benzodiazepines with a relatively short half-life, such as alprazolam (Xanax) and lorazepam (Ativan), are better hypnotics for the elderly than those with a long half-life 2.
- However, another study published in 2016 advises against using benzodiazepines, including Xanax and Ativan, in older adults due to the risk of serious adverse effects 3.
- In terms of efficacy, a meta-analytic review published in 2018 found that benzodiazepines, including Xanax and Ativan, were more effective than serotonergic antidepressants in treating generalized anxiety disorder 4.
- A study published in 2019 found that combined therapy of benzodiazepines plus antidepressants was more effective than antidepressants alone in improving depression severity, response in depression, and remission in depression in the early phase 5.
Safety Considerations
- The use of benzodiazepines, including Xanax and Ativan, carries risks of dependence and adverse effects, particularly in older adults [(2,3)].
- A study published in 1984 reviewed the metabolism and method of action of benzodiazepines, including Xanax and Ativan, and discussed the potential for addiction and other adverse effects 6.
- The 2019 study found that combined therapy of benzodiazepines plus antidepressants resulted in fewer dropouts due to adverse events than antidepressants alone, but was associated with a greater proportion of participants reporting at least one adverse effect 5.