Lorazepam vs. Xanax: Differences, Similarities, and Which is Better
Dr. Gerardo Sison
Approximately one out of every five American adults struggles to deal with feelings of chronic anxiety. Lifestyle changes like getting more exercise or working with a mental health counselor can be helpful tools in managing anxiety, but some patients may also benefit from treatment with prescription drugs like lorazepam or Xanax.
If you are considering using one of these drugs to help manage your mental health or another condition, you may be curious about the differences between lorazepam and Xanax.
Lorazepam and Xanax belong to a class of drugs called benzodiazepines; this class of drugs also includes Klonopin, Valium, and other anti-anxiety medications. Xanax and lorazepam are commonly referred to as tranquilizers, sedative-hypnotics, or anxiolytics due to their effects on the central nervous system. Lorazepam and Xanax are both available in the form of an oral tablet, while lorazepam is also available as an injection.
Both lorazepam and Xanax are best known for their treatment of acute anxiety symptoms, but both drugs also treat other conditions as well. Lorazepam, a generic medication that is also sold under the brand name Ativan, is approved by the U.S. Food and Drug Administration (FDA) for the treatment of anxiety, insomnia, and seizures. Xanax, also sold under the generic name alprazolam, is FDA-approved for the treatment of anxiety disorders, short-term relief of anxiety symptoms, anxiety associated with depression, and panic disorder.
How The Drugs Work
Lorazepam and Xanax treat symptoms of anxiety by affecting the action of a neurotransmitter in the brain known as gamma-aminobutyric acid (GABA).
GABA is an inhibitory neurotransmitter that helps regulate sleep patterns and promote feelings of anxiety and relaxation. Lorazepam and Xanax improve symptoms of anxiety by adhering to GABA receptors in the brain, which increases the levels and activity of GABA in the brain. As levels of GABA rise, the brain and central nervous system begin to slow down, which improves symptoms of anxiety.
The speed at which lorazepam and Xanax take effect and the length of time that they work are two of the major differences between the drugs.
Lorazepam is considered to be a faster acting medication than Xanax. Patients who take lorazepam will typically start to feel the effects of the medication in about 20 to 30 minutes, with the drug reaching its full potency after about 60 to 90 minutes. The effects of lorazepam continue for up to eight hours.
Compared to lorazepam, Xanax starts working slightly more slowly, meaning patients are not likely to notice the effects of the medication until about an hour after taking the pill. Xanax is available in both an immediate-release and extended-release form, with the immediate-release tablet lasting about five hours and the extended release form of the drug lasting up to eleven hours.
A person’s genetics can influence the amount of time that Xanax stays in the body, with studies showing that the drug lasts about 25 percent longer in people of Asian descent compared to those of Caucasian descent, and the drug also lasts longer in older adults.
Because both lorazepam and Xanax last less than a full 24 hours, patients may need to take multiple doses of the medication to manage their symptoms throughout the day.
Side effects for both Xanax and lorazepam can be categorized as common, less common, and serious. Many of the side effects between the medications overlap, as they belong to the same class of drugs.
Side effects commonly associated with both Xanax and lorazepam may include:
- Difficulty with coordination
- Memory impairment
- Decreased libido
- Weight gain
- Weight loss
- Slurred speech
- Skin rash
- Cognitive dysfunction
- Blurred vision
- Increased appetite
- Decreased appetite
Less common side effects associated with Xanax include:
- Muscle twitching
- Increased libido
- Sexual disorder
- Low blood pressure
Less common side effects of Lorazepam include:
Lorazepam and Xanax can both cause serious side effects that are associated with depression of the central nervous system.
Serious side effects of Xanax and lorazepam include:
- Slowed breathing
- Respiratory failure
- Suicidal thoughts
- Psychological and physical dependence
- Serious allergic reaction (possibly requiring the use of antihistamines)
Lorazepam and Xanax are classified as Schedule IV controlled substances by the U.S. Drug Enforcement Administration (DEA) due to their potential to cause physical and psychological dependence even when taken as prescribed.
Symptoms of dependence may include:
- Muscle weakness
- Body aches
It is possible to be allergic to any of the ingredients in lorazepam or Xanax. Symptoms of an allergic reaction include:
- Swelling of lips, tongue, or face
- Trouble breathing or swallowing
- Rash or hives
- Rapid heartbeat
Withdrawal and Overdose
Both lorazepam and Xanax can be habit forming. Patients are more likely to develop a dependence on the drugs when they are used for extended periods of time or in higher doses than prescribed, which is why it is important to take them exactly as prescribed. If use of the medication is stopped abruptly, either drug can cause withdrawal symptoms.
If you have been taking lorazepam or Xanax for more than two weeks, do not stop or reduce your dose of the medication without first consulting with a healthcare provider for instructions on how to safely reduce your dose, commonly through tapering. The longer you have taken the medication, the more likely you are to experience withdrawal.
Common withdrawal symptoms include:
More serious withdrawal symptoms may occur in people who have become severely dependent on their medication. Serious signs of withdrawal include:
- Panic attacks
People who have been using lorazepam or Xanax for longer than the prescribed amount of time, in higher doses than prescribed, or when mixed with alcohol or opioid medications are more likely to suffer from an overdose of the medication.
Signs of an overdose include:
- Extreme drowsiness or sedation
- Respiratory depression
- Slow heartbeat
- Weak or shallow breathing
- Feeling restless
- Muscle weakness
- Loss of balance or coordination
If you believe that you might be experiencing an overdose while taking lorazepam or Xanax, seek medical attention immediately.
Which is Better?
Whether lorazepam or Xanax is better for you will depend in part on which condition is being treated with the medication, how quickly you need your medication to work, and how long you’d like the drug to last. Some patients may find that their bodies handle one medication better than the other, but in general, the side effects of the two medications are similar. Both lorazepam and Xanax are used to treat acute symptoms of anxiety while waiting for long-acting anti-anxiety medications, such as the antidepressants Lexapro and Prozac, to start working.
Seek medical advice from your prescribing doctor to see if lorazepam or Xanax might be right for you or your loved ones. Your doctor will also be able to tell you if you're at a higher risk for drug interactions or benzo dependency.