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Clonazepam vs. Xanax: A Side-by-Side Review

Clonazepam and Alprazolam

Klonopin (clonazepam) and Xanax (alprazolam) are both central nervous system depressants that are used to treat anxiety disorders, such as panic attacks. The differences between the two medications are clonazepam has a longer duration of action, while alprazolam lasts only a few hours. Also, clonazepam is used to treat other conditions, like seizure disorders and multiple sclerosis.

Treating anxiety disorders is common in the United States. According to National Institute of Mental Health, approximately 40 million American adults are affected by anxiety disorders each year.

Emotional symptoms include feelings of fear, apprehension, and irritability. Among the physical symptoms are:

  • pounding heartbeat
  • shortness of breath
  • stomach and digestive problems
  • headaches
  • tremors and twitching
  • numbness or tingling of the hands and feet
  • sleep problems and fatigue

Treating anxiety disorder usually requires a combination of methods, one of which is medication therapy. To treat your anxiety, your doctor may recommend clonazepam or alprazolam. But how do the two compare?

How They Stack Up

As mentioned earlier, clonazepam is sold under the brand name Klonopin and the brand name for alprazolam is Xanax. Both are central nervous system (CNS) depressants and are classified as benzodiazepines. Benzodiazepines affect gamma-aminobutyric acid (GABA), a key neurotransmitter in the brain. This causes nerve impulses throughout your body to slow down, leading to a sedating, calming effect. These powerful drugs are available only with a doctor’s prescription.

Who They’re Designed For

Both drugs are used for the treatment of anxiety disorders, including panic attacks. There are two major differences between these two drugs: clonazepam can be prescribed to treat seizure disorders (like tremors, seizures, and spasticity) and other conditions, including multiple sclerosis (MS), epilepsy, and Tourette syndrome. The other difference is that alprazolam will affect you for a few hours, while clonazepam has a longer duration of action.

Forms and Dosing

Clonazepam tablets can be taken one to three times a day and are available in the following strengths:

  • 0.25 mg
  • 0.5 mg
  • 1 mg
  • 2 mg

Clonazepam is also available as a disintegrating tablet, or wafer, in these strengths:

  • 0.125 mg
  • 0.25 mg
  • 0.5 mg
  • 1 mg
  • 2 mg

Alprazolam is available in tablet form in these strengths:

  • 0.25 mg
  • 0.5 mg
  • 1 mg
  • 2 mg

Alprazolam is available in an extended release tablet in these strengths: 

  • 0.5 mg
  • 1 mg
  • 2 mg
  • 3 mg

Alprazolam is also available as a 1 mg/mL oral solution.

You may need to take alprazolam several times a day. However, the extended-release version only needs to be taken once a day.

For either medication, your doctor will probably start you off with the lowest possible dose. If necessary, the dose can be raised in small increments. Both drugs may begin working within hours or days of the first dose.

What They Cost

How much you’ll pay for a prescription drug can vary depending on where you live, your pharmacy, and your health insurance plan. Generally speaking, generic versions are significantly less expensive than brand name versions.

Side Effects

There are a lot of potential side effects of benzodiazepines, but you’re unlikely to have more than a few. For most people, the side effects are mild and tolerable. They usually occur early on and subside as the body gets used to the drug. The most common side effects are light-headedness and drowsiness.

However, these drugs can impair your ability to drive. If you feel lightheaded or sleepy, don’t drive or operate dangerous equipment. This effect may persist until the next day; studies have shown increased risk of car accidents in people who take benzodiazepines.

Benzodiazepines can also cause:

  • dry mouth
  • vision problems
  • slowed breathing
  • vertigo
  • tremors
  • nausea, vomiting, loss of appetite
  • constipation, diarrhea

At higher doses, or with long-term use, benzodiazepines can cause:

  • extreme drowsiness
  • euphoria
  • slurred speech
  • problems with motor coordination
  • muscle weakness
  • impaired thinking and memory
  • confusion and disorientation

If you’re experiencing light-headedness or drowsiness, avoid driving or engaging in other activities that could be dangerous. Discuss unusual side effects with your doctor or pharmacist.

Warnings and Interactions

All medications have some risk, and benzodiazepines are no exception. It’s possible to have an allergic reaction to these medications. An obvious symptom of an allergic reaction is hives, itching, or skin rash. If you develop swelling of the face, tongue, or throat, or if you have trouble breathing, seek medical attention immediately or call 911.

The effectiveness and safety of alprazolam has not been established in children. The effects may be more powerful or longer lasting, in older people.

Tolerance and Withdrawal

Even though benzodiazepines can be very helpful, they are habit-forming drugs. If you take them daily for several weeks or longer, you may develop a tolerance to them. This means that your body adjusts to them and you may need a gradual dose increase for the same effect. This also means that you will experience withdrawal — physical or psychological symptoms — if you suddenly stop taking them.

Symptoms of withdrawal include:

  • rapid heart rate
  • insomnia, agitation
  • increasing anxiety

For this reason, talk to your doctor if you want to try to reduce your dose or discontinue the medication. Your doctor can work with you to help you slowly taper off the medication.   

Potential Interactions

Both clonazepam and alprazolam are CNS depressants. Taking additional CNS depressants can intensify that effect. Some other CNS depressants include:

  • sedatives and sleeping pills
  • tranquilizers and mood stabilizers
  • muscle relaxants
  • seizure medications
  • prescription pain medications
  • alcohol
  • marijuana
  • antihistamines

Mixing these substances is very dangerous and can cause loss of consciousness. This can be fatal.

Tell your doctor and pharmacist about all the medications and supplements you take and ask about potentially dangerous interactions.

Pregnancy and Breastfeeding

When taken during pregnancy, clonazepam and alprazolam may cause harm to your developing baby. Your baby could also develop a tolerance to the medication when born and require treatment. Both medications can also pass into your breast milk and may cause drowsiness, slowed heartbeat, and breathing problems in nursing infants.

You asked, we answered

  • Are either clonazepam or alprazolam habit-forming?
  • Clonazepam and alprazolam can be addictive. If you take them daily for several weeks or longer, you may also develop a tolerance to them. A tolerance means that you need more of the drug to get the same effect. You may also experience withdrawal if you suddenly stop taking either drug. Withdrawal can increase your heart rate and your anxiety. It can also cause sleeplessness and agitation. It is extremely important that you follow your doctor’s instructions for taking and stopping these drugs to help avoid both addiction and withdrawal.

    - Healthline Medical Team

Which Is Best?

If you’re being treated for an anxiety disorder, ask your doctor to discuss the pros and cons of each medication. It’s hard to determine in advance which medication will be most effective for you. Your doctor will recommend one based on your symptoms and medical history. If the first choice doesn’t work, you can move on to the next.

Alprazolam is not an effective treatment for tremor, seizures, or spasticity. If you have MS, epilepsy, or another illness that causes these symptoms, clonazepam may be a treatment option.

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