Two options to treat anxiety


  1. Valium and Xanax are both classified as benzodiazepines, or minor tranquilizers.
  2. Neither drug is recommended for women who are pregnant or breast-feeding.
  3. Drug dependency and drug withdrawal are serious concerns for people taking either drug.

Many of us feel symptoms of anxiety from time to time. For most people, these moments of nervousness don’t come along very often. For others, anxiety, and all its uncomfortable symptoms is a daily occurrence.

According to the National Institute of Mental Health, every 12 months more than 18 percent of people in the United States experience symptoms of an anxiety disorder. This ongoing anxiety can affect a person’s ability to function at home, school, and work.

Treating anxiety often involves cognitive-behavioral therapy and antidepressant medications. Benzodiazepines are another class of medications used to help curb anxiety. Two commonly prescribed benzodiazepines are Valium and Xanax. Read on to learn how these two medications compare.

Similarities and differences

Valium, known generically as diazepam, and Xanax, known generically as alprazolam, are both benzodiazepines. Benzodiazepines are categorized as minor tranquilizers. They work by helping boost the activity of gamma-aminobutyric acid (GABA). GABA is a neurotransmitter, a chemical messenger that transmits signals throughout your body. If your body doesn’t have enough GABA, you may experience anxiety or have an anxiety disorder.

Although they’re in the same drug class, there are unique differences between diazepam and alprazolam.

takes effect quicklyslower to take effect
metabolizes quickly, so it doesn’t stay active as longlonger-acting
available in tablet and liquid formavailable as a tablet, liquid, or gel
approved for panic disordernot approved for panic disorder
safety not established for childrenmay be used to treat children
may be used to treat depression accompanying anxiety, according to American Family Physician  

Why they’re prescribed

Diazepam may be prescribed to treat:

  • anxiety disorders
  • acute alcohol withdrawal
  • skeletal muscle spasm
  • seizure disorders
  • chronic sleep disorder

Alprazolam may be prescribed to treat:

  • anxiety disorders
  • generalized anxiety disorder, with or without agoraphobia (fear of crowds or certain places)
  • anxiety associated with depression
  • panic disorder

Common side effects

Common side effects of each drug include:

  • drowsiness
  • impaired memory
  • impaired motor coordination or balance
  • lightheadedness

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.

See a drug comparison of Xanax and lorazepam »


You should not take diazepam or alprazolam if you have:

  • a history of drug dependence
  • myasthenia gravis
  • severe respiratory insufficiency
  • severe hepatic insufficiency, or liver failure
  • acute narrow-angle glaucoma
  • multiple sclerosis (this is specific for alprazolam use)
  • history of allergic reaction to either drug

Drug interactions

Medications that also affect your central nervous system can combine with benzodiazepines to become dangerous. They can affect your respiratory system. Several groups that interact include:

  • other benzodiazepines or sedatives (sleeping pills, drugs for anxiety)
  • pain drugs, including hydrocodone, oxycodone, methadone, codeine, and tramadol
  • alcohol
  • antidepressants, mood stabilizers, antipsychotics
  • antihistamines
  • antiseizure medications
  • tranquilizers and muscle relaxants

Some of the other drug interactions include:

These are not all of the drug interactions with diazepam or alprazolam. Always tell your doctor and pharmacist about all drugs and supplements you are currently taking before you start taking any new drug.

Dietary interaction

If you take diazepam, you should avoid large amounts or daily consumption of grapefruit or grapefruit juice. Grapefruit blocks the enzyme CYP3A4, which is an important enzyme in breaking down certain medication. Consuming large amounts of grapefruit can cause high and even toxic levels of diazepam.

Women who are pregnant or nursing

Women who are pregnant or nursing should not take these drugs, especially during the first trimester of pregnancy. During this period, the fetus is more likely to be harmed by the medication.

Most benzodiazepines fall into pregnancy categories D or X. This means there’s evidence these drugs may harm the baby. Babies born to mothers who have recently taken one of these drugs may experience withdrawal symptoms and need treatment.

The drugs may pass from mother to child through breast milk. To avoid negative effects in a nursing child, do not breast-feed while taking these drugs.

Older adults

Older adults metabolize these drugs more slowly and are more likely to have adverse reactions to them. Side effects, such as drowsiness and lightheadedness, can make older adults more prone to falls and hip fractures.

Older adults who take benzodiazepines for more than three months may have a greater risk of developing Alzheimer’s disease, according to a study from the journal BMJ. Longer-acting benzodiazepines, such as diazepam, were more likely to cause cognitive problems. Authors of the study note that participants used benzodiazepines to treat anxiety and sleep disturbances. Since these symptoms can be early signs of Alzheimer’s, the disease may have already been present.

Dependence and withdrawal

The most serious concerns about using benzodiazepines are dependence and withdrawal. You can become dependent on these drugs after a few days or weeks. People who use these drugs may build a tolerance over time and the risk increases the longer you use them. You could require more of the drug to reach effective levels.

The risk of dependence and withdrawal also increases as you age. The drugs may have a longer action in older adults and take longer to leave the body.

Withdrawal symptoms may include:

  • anxiety
  • irritability
  • tremors
  • insomnia
  • seizures
  • vomiting
  • diarrhea

You should never stop taking these drugs abruptly. Instead, seek your doctor’s advice on the best way to taper off the medication slowly.

Before benzodiazepines, barbiturates were the main option for people struggling with acute anxiety. These drugs are dangerous because the difference between an effective dose and a lethal dose is rather small.

Which do you choose?

Diazepam and alprazolam are effective in treating several conditions, including acute anxiety. Though they’re similar, there are differences between the two medications. Discuss your symptoms with your doctor to determine which medication may be the best choice for you.