Is Midazolam (Dormicum) more addictive than Alprazolam (Xanax)?

From the Guidelines

Dormicum and Xanax have similar addiction potential, but their characteristics influence their use and abuse liability. When considering the potential for addiction, it's crucial to understand that both Dormicum (midazolam) and Xanax (alprazolam) are benzodiazepines, which carry a significant risk for dependence and addiction 1. The key difference lies in their pharmacokinetics and the context in which they are prescribed. Dormicum has a faster onset and shorter duration of action compared to Xanax, which can potentially increase its abuse liability due to the rapid, intense effects that some users find desirable. On the other hand, Xanax is more commonly prescribed for longer-term use, which increases the risk of developing dependence over time.

Some key points to consider about these medications include:

• Both are benzodiazepines with a high potential for dependence and addiction.
• Dormicum's faster onset and shorter duration may increase its abuse liability.
• Xanax's longer-term prescription increases the risk of dependence.
• Both medications should only be used short-term (generally 2-4 weeks maximum) under close medical supervision.
• The addiction potential stems from their mechanism of action on GABA receptors in the brain, leading to tolerance and requiring higher doses over time.

Given the information from the study on medicines associated with dependence or withdrawal 1, it's clear that benzodiazepines, including both Dormicum and Xanax, carry significant risks. Therefore, it is recommended that both medications be used with caution, under strict medical supervision, and for the shortest duration necessary to minimize the risk of addiction and dependence.

From the FDA Drug Label

Midazolam was actively self-administered in primate models used to assess the positive reinforcing effects of psychoactive drugs. Available data concerning the drug abuse and dependence potential of midazolam suggest that its abuse potential is at least equivalent to that of diazepam Withdrawal symptoms, similar in character to those noted with barbiturates and alcohol (convulsions, hallucinations, tremor, abdominal and muscle cramps, vomiting and sweating), have occurred following abrupt discontinuation of benzodiazepines, including midazolam.

Addiction Comparison: The FDA drug label does not directly compare the addiction potential of Dormicum (midazolam) to Xanax (alprazolam). However, it does mention that midazolam's abuse potential is at least equivalent to that of diazepam, which is another benzodiazepine like Xanax.

• Key Points:
  • Midazolam has a similar abuse potential to diazepam.
  • No direct comparison to Xanax is made in the label.
  • Benzodiazepines, including midazolam, can cause physical dependence and withdrawal symptoms. Based on the available information from the drug label 2, no conclusion can be drawn about whether Dormicum is more addictive than Xanax.

From the Research

Addiction Potential of Benzodiazepines

• The addiction potential of benzodiazepines, including Dormicum (midazolam) and Xanax (alprazolam), has been studied in various research papers 3, 4, 5.
• According to a study published in 1991, alprazolam and diazepam have potential for addictive use, with alprazolam having a shorter half-life and potentially leading to more withdrawal symptoms than diazepam 3.
• Another study from 1990 found that benzodiazepines have a reduced addiction potential compared to barbiturates, but qualitative differences in addiction potential between individual benzodiazepines are not well established 4.
• A 1990 review of benzodiazepines noted that they produce tolerance and dependence in short and long-term administration, and the development of abuse and addiction is strongly substantiated 5.

Comparison of Dormicum and Xanax

• There is limited direct comparison between Dormicum (midazolam) and Xanax (alprazolam) in terms of addiction potential.
• However, a study from 1991 suggests that alprazolam (Xanax) may have a more severe withdrawal syndrome and may occur after a shorter period of use compared to diazepam 3.
• It is not clear if Dormicum (midazolam) has a similar or different addiction potential compared to Xanax (alprazolam), as there is no direct comparison in the provided studies.

Treatment of Anxiety Disorders

• Benzodiazepines, including Xanax (alprazolam), are still commonly prescribed for anxiety and related disorders, despite concerns about dependence and side effects 6.
• A 2022 review of anxiety disorders notes that first-line treatments include pharmacotherapy (such as selective serotonin reuptake inhibitors) and psychotherapy, but does not specifically discuss the use of benzodiazepines like Xanax or Dormicum 7.