- Lorazepam and alprazolam (Xanax) are both prescribed for short-term use.
- Lorazepam is approved for people who are at least 12 years old. Xanax is FDA approved for adults over 18.
- Deadly drug interactions are possible with both medications if you drink alcohol, or take antidepressants, anti-seizure medications, or sleeping pills.
We all experience anxiety from time to time. However, if you have severe anxiety, or anxiety that interferes with your quality of life or social relationships, there are some medications that can help you manage your symptoms. Two of them are lorazepam (Ativan), and alprazolam (Xanax).
While both of these drugs are frequently prescribed for anxiety, they are also prescribed for a variety of other uses.
Lorazepam and Xanax are benzodiazepine drugs that slow your central nervous system (CNS) and provide a tranquilizing effect. This calming result can help you manage anxiety and nervousness. Both of these drugs are powerful medications designed for short-term use.
Why they’re prescribed
You may be prescribed either of these medications if you have short-term anxiety disorder or anxiety associated with depression. In addition to treating anxiety, both medications are prescribed for off-label drug use.
Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that has not been approved. However, a doctor can still use the drug for that purpose.
This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care.
Lorazepam is approved for adolescents age 12 and up, as well as adults. Other clinical uses include:
- recurring seizures
- pre-surgery sedation
- alcohol withdrawal
- chemotherapy-induced vomiting
- status epilepticus, or severe seizures
Xanax is also FDA-approved for treatment of panic disorder and panic attacks, with or without agoraphobia (fear of certain places or situations, such as crowds). It’s approved for adults aged 18 and older. Other clinical uses include:
- irritable bowel syndrome
- extreme premenstrual syndrome
- essential tremor
- ringing in the ears
Forms and dosing
Lorazepam tablets are available in 0.5 milligrams (mg), 1 mg, and 2 mg strengths. The starting dose for anxiety disorders is usually 0.5 to 1 mg, up to three times a day for adults.
It’s also available as an injectable drug in 2 milligrams per milliliter (mg/mL) and 4 mg/mL solutions. When prescribed for anxiety, the effects are usually felt within the first one to three days.
Alprazolam tablets are available in .25 mg, 0.5 mg, 1 mg, and 2 mg strengths. Extended-release tablets are available in 0.5 mg, 1 mg, 2 mg, and 3 mg strengths.
It also comes in a 1 mg/mL and 2 mg/mL liquid form. When used for anxiety, the usual starting dose is between 0.25 and 0.5 mg up to three times a day. Most people feel the effects within a few days.
Both drugs require a prescription. Forms and dosage vary, depending on the reason for its use. You’ll usually start with the lowest possible dose. If necessary, it can be slowly increased.
The most common side effects of these medications are drowsiness and dizziness. This can impair your ability to drive. Studies have shown increased risk of car accidents in people who take benzodiazepines.
If you feel lightheaded or sleepy, don’t drive or operate dangerous equipment. This effect may pass within a few hours, or persist until the next day.
Alprazolam can cause memory impairment, dry mouth, or low blood pressure. It can also increase the risk of mania, or excitability and difficulty sleeping, in people who have bipolar disorder.
Lorazepam may cause headache, nausea, dry mouth, heartburn, low blood pressure, blurred vision, and confusion.
Allergic reactions are possible. If you have difficulty breathing, seek immediate medical help. These drugs may also be more powerful and longer lasting in older adults. Close monitoring is required, and all side effects should be reported to your doctor.
Physical and psychological dependence
Benzodiazepines can be physically and psychologically habit-forming. This is more likely at higher doses and in patients with a history of substance abuse. Benzodiazepines are intended for short-term use only.
The risk of dependence, or developing a tolerance to these medications, increases the longer you use them. The risk also increases as you age. The drugs may have a longer action in older adults.
Withdrawal symptoms can occur if you stop taking these medications abruptly. Symptoms of withdrawal may include:
If you want to stop taking either medication, your doctor can help you taper off slowly.
Potential drug interactions
These medications depress your CNS. Taking them with other CNS depressants can increase those effects and slow your respiratory system. It can be a deadly combination. Possible drug interactions may include:
- other benzodiazepines
- pain drugs, such as hydrocodone, oxycodone, methadone, codeine, and tramadol
- antidepressants, mood stabilizers, antipsychotics
- antiseizure medications
- sedatives, tranquilizers, sleeping pills
Antihistamines, marijuana, and tobacco can increase the sedative effects of these medications.
If you’re taking lorazepam, some medications can affect its potency. These include:
- doxylamine, an antihistamine
- probenecid, which is used to treat gout
- olanzapine, which is prescribed for schizophrenia and bipolar disorder
- hydroxyzine, an antihistamine
- valproic acid, for seizures
The strength of alprazolam may be impacted by:
- some antibiotics, including erythromycin
- some medications that treat ulcers and gastrointestinal problems
- disulfiram, which is used to treat alcoholism
- fluvoxamine, for obsessive compulsive disorder
- ritonavir and other protease inhibitors, which are used to treat HIV
- levodopa, which is used to treat Parkinson’s disease
- medications used to treat tuberculosis
- some antifungals, including ketoconazole and itraconazole
- theophylline, which is used for asthma and other lung conditions
These are just some of the potential interactions. It’s important to tell your doctor and pharmacist about all the medications that you currently take. Always read the package labels and follow directions carefully.
Pregnancy and breast-feeding
If you’re pregnant, these medications can affect your unborn child. If you’re taking them in the final weeks of pregnancy, your newborn baby may be born with symptoms of withdrawal.
These medications can also pass to your baby through your breast milk.
Each of these medications is effective in treating anxiety for a short time. Your doctor will help you decide which one may be best for you. It’s not always clear why one medication works better for some people than for others.
If your first choice isn’t working out, your doctor can change the dose or try other medications in the benzodiazepine class that may help.