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Ativan vs Valium
Introduction
For patients dealing with anxiety disorders or symptoms of acute stress, certain medications that influence the level of chemicals in the brain related to nervous system function can offer significant relief. Ativan and Valium are two such drugs often prescribed for these conditions. Both belong to a class of medications called benzodiazepines which enhance the effect of GABA, a neurotransmitter in the brain known for its calming effect.
Ativan (lorazepam) tends to have a shorter duration of action compared to Valium (diazepam), hence it is more frequently used for short-term or immediate symptom relief including preoperative sedation. On the other hand, Valium has longer-lasting effects and active metabolites which make it suitable for situations requiring sustained anxiety control over prolonged periods.
Ativan vs Valium Side By Side
| Attribute | Ativan | Valium |
|---|---|---|
| Brand Name | Ativan | Valium |
| Contraindications | Should not be taken with or shortly after monoamine oxidase inhibitors (MAOIs). | Should not be taken with or shortly after monoamine oxidase inhibitors (MAOIs). |
| Cost | Brand name: around $220 for 60 tablets (1 mg). Generic: between $10 and $50 for 60 tablets (1mg) | Brand name: approximately $230 for 60 tablets (5 mg). Generic: around $10 - $40 for a similar quantity and strength. |
| Generic Name | Lorazepam | Diazepam |
| Most Serious Side Effect | Severe drowsiness or lightheadedness, unusual changes in mood or behavior, sudden restless feeling or excitement, muscle weakness, drooping eyelids, trouble swallowing, vision changes, dark urine, and jaundice. | Signs of an allergic reaction, extreme drowsiness, mood swings and mental changes, memory problems, agitation and increased anxiety, new or worsening depression, suicidal thoughts or actions, a seizure. |
| Severe Drug Interactions | Not specified in the text, but typically includes interactions with alcohol, opioids, other sedatives, and any drugs that significantly increase sedation or respiratory depression. | Not specified in the text, but typically includes interactions with alcohol, opioids, other central nervous system depressants, and any drugs that significantly increase sedation or respiratory depression. |
| Typical Dose | 1-10 mg/day, with a common effective dose being 2-3 mg/day. | 2–10 mg/day, taken two to four times daily, with a maximum recommended dose being 30 mg/day. |
What is Ativan?
Lorazepam (the generic name for Ativan) and Diazepam (generic name for Valium) are both benzodiazepines, a class of medication known for their sedative properties. Lorazepam was first approved by the FDA in 1977 while Diazepam gained approval earlier in 1963. Both drugs increase levels of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits activity within the nervous system, thus providing calming effects on the brain and nerves. They are prescribed for treating similar conditions including anxiety disorders, alcohol withdrawal symptoms, and seizures. However, there's a difference between these two: Ativan has more selective action with quicker onset but shorter duration compared to Valium which has longer half-life allowing it to stay in the body longer. This results in less frequent dosing with Valium than Ativan but also potentially more prolonged side effects.
What conditions is Ativan approved to treat?
Ativan and Valium are both approved for the management of several conditions:
- Anxiety disorders and symptoms associated with anxiety
- Acute alcohol withdrawal (ease symptoms)
- Preoperative sedation, anxiolysis, or amnesia (memory loss) prior to certain surgical procedures
- As adjunctive therapy for seizures in some instances
How does Ativan help with these illnesses?
Ativan and Valium are both benzodiazepines that enhance the effect of gamma-aminobutyric acid (GABA), a neurotransmitter in the brain which inhibits activity in the nervous system. This action results in sedative, sleep-inducing, anxiolytic, anticonvulsant, muscle relaxant and amnesic effects. They accomplish this by binding to specific sites on GABA receptors in the brain; when these drugs bind to their targets, they increase the efficiency of GABA's natural calming actions.
Both Ativan and Valium help manage anxiety disorders or short-term symptoms of anxiety. However, while Ativan is often administered for its fast-acting relief of acute symptoms, it's also used as premedication for anesthesia due to its high potency and quick onset. On the other hand, Valium stays active longer within the body so it can be used for a broader range of conditions including alcohol withdrawal symptoms or muscle spasms. Its long half-life allows less frequent dosing but may also contribute to cumulative effects over time.
What is Valium?
Valium, a brand name for diazepam, is a benzodiazepine that enhances the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABAa receptor, resulting in sedative, sleep-inducing, antianxiety, anticonvulsant, and muscle relaxant properties. Diazepam was first approved by the FDA in 1963. Unlike Ativan, Valium is not just an antianxiety medication, it also has anticonvulsant properties. Its wide spectrum of action means that its side-effect profile may be different from that of Ativan, particularly in that it may cause drowsiness and a feeling of relaxation. The effects of diazepam can be beneficial for the treatment of anxiety, insomnia, and symptoms of acute alcohol withdrawal. It is also used as an adjunctive treatment for muscle spasms and certain types of seizures, especially in patients who do not respond well to typical antiseizure drugs.
What conditions is Valium approved to treat?
Valium is a well-recognized and FDA-approved medication for the treatment of various medical conditions, which include:
- Anxiety disorders
- Alcohol withdrawal symptoms
- Muscle spasms
- Seizures in conjunction with other medications
How does Valium help with these illnesses?
Gamma-aminobutyric acid (GABA) is a neurotransmitter that plays key roles in regulating relaxation and reducing neuronal excitability throughout the nervous system. The sedative effects of GABA are crucial for managing conditions like anxiety, seizures, muscle spasms, and insomnia. Valium works by enhancing the effects of GABA in the brain, thus providing calming and sleep-inducing effects to reduce symptoms related to these health issues. Its action on several other receptors also contributes to its effectiveness as a potent anxiolytic medication. Unlike Ativan, Valium has not only an immediate onset but also a longer duration of effect which can be beneficial in managing prolonged episodes of anxiety or preventing recurrent seizures. Therefore it may sometimes be prescribed when patients do not respond well to shorter acting benzodiazepines like Ativan or require long-term management for their condition.
How effective are both Ativan and Valium?
Both lorazepam (Ativan) and diazepam (Valium) are proven medications in the benzodiazepine class, renowned for their effectiveness in treating anxiety disorders, insomnia, seizures, and symptoms of alcohol withdrawal. They both received FDA approval decades ago - diazepam in 1963 and lorazepam not long after in 1977. As they work on similar neurotransmitters by enhancing GABA activity to reduce neuronal excitability, decision between them often comes down to individual patient factors.
A direct comparison study conducted in 1990 revealed that both drugs were equally effective at relieving symptoms of acute panic attacks. However, it was noted that patients receiving lorazepam reported a quicker onset of symptom relief than those taking diazepam.
In terms of side effects and safety profiles, a review published in 2009 indicated that both drugs have a low risk profile when used short-term but can be associated with dependency if taken over longer periods. It's worth mentioning though that due to its shorter half-life compared to diazepam (10-20 hours as opposed to 20-70 hours), there might be an increased potential for withdrawal symptoms with abrupt discontinuation of Ativan.
As per clinical usage trends identified from various reports over these years show Valium is commonly employed as first-line treatment for alcohol withdrawal syndrome while Ativan is widely preferred choice for managing acute anxiety episodes or inducing sedation before medical procedures because it has fewer active metabolites which allows more predictable pharmacokinetics.
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At what dose is Ativan typically prescribed?
Oral dosages of Ativan range from 1-10 mg/day, but studies have shown that for most people, 2-3 mg/day is adequate for treating anxiety. For children and adolescents, the doctor may start them on a lower dose. In either population, dosage can be increased after a few weeks if there is no response. However, it's important to remember that the maximum dosage should not exceed 10 mg/day in any case. Similarly with Valium (diazepam), initial oral doses range from 2–10mg, taken two to four times daily. This may be increased as needed and tolerated by your physician's discretion but generally should not exceed more than 40mg per day.
At what dose is Valium typically prescribed?
Valium therapy typically commences at a dosage of 2–10 mg/day, taken two to four times daily. The dose can then be escalated based on individual patient response and tolerance, with the maximum recommended dose being 30 mg/day, divided into multiple doses throughout the day. If after several weeks there is no significant improvement in symptoms or if the condition worsens, your doctor may decide to adjust your Valium dosage accordingly. As always, it's important that you follow your physician's instructions closely when taking this medication due to its potential for dependency and withdrawal effects.
What are the most common side effects for Ativan?
Common side effects of Ativan and Valium can include:
- Drowsiness, fatigue, lethargy
- Dizziness
- Weakness
- Unsteadiness
- Disorientation, depression, nausea
- Blurred vision
- Sleep disturbances
- Changes in sexual drive or performance
- Constipation or diarrhea
- Dry mouth or increased salivation It's important to note that these medications may also cause paradoxical reactions like restlessness, agitation, irritability, aggression or hallucinations. As with any medication it's crucial to discuss all possible side effects with your healthcare provider before commencing treatment.
Are there any potential serious side effects for Ativan?
While Ativan and Valium are both benzodiazepines used to treat anxiety, they can potentially have serious side effects. For Ativan, these may include:
- Severe drowsiness or lightheadedness
- Unusual changes in mood or behavior (such as hallucinations, thoughts of suicide)
- Sudden restless feeling or excitement
- Muscle weakness, drooping eyelids, trouble swallowing
- Vision changes (such as blurred vision)
- Dark urine and jaundice(yellowing of the skin or eyes)
For Valium the potential serious side effects could be:
- Slow heartbeats
- Agitation, aggression, hostile behavior
- New or worsening seizures
- Trouble sleeping
- Shallow breathing -Signs of an allergic reaction: hives; difficulty breathing; swelling of your face,lips,tongue ,or throat
If you experience any of these symptoms while taking either medication it is important that you seek medical attention immediately.
What are the most common side effects for Valium?
Common side effects associated with Valium can include:
- Dry mouth, sore throat
- Blurred vision
- Nausea, stomach upset, constipation
- Sleep disturbances (including insomnia and vivid dreams)
- Feeling restless or anxious
- Confusion, forgetfulness
- Slow heartbeat
- Skin rash or itching
- Incoordination or unsteadiness
- Headache, dizziness
-Muscle weakness
These side effects are usually mild and short-lived. However, if they persist or become bothersome you should consult your healthcare provider.
Are there any potential serious side effects for Valium?
Valium is generally safe for use under a doctor's supervision, but it can sometimes cause serious side effects. These may include:
- Signs of an allergic reaction such as hives, difficulty breathing or swallowing, swelling in your face or throat
- Extreme drowsiness that could lead to accidents or falls
- Mood swings and mental changes (such as hallucinations)
- Memory problems
- Agitation and increased anxiety
- New or worsening depression
- Suicidal thoughts or actions
- A seizure (convulsions) even if you've never had one before And lastly, -Signs of a paradoxical reaction - this includes restlessness, agitation, aggression, irritability, nightmares.
If you experience any of these symptoms while taking Valium, contact your healthcare provider immediately.
Contraindications for Ativan and Valium?
Both Ativan and Valium, like most benzodiazepines, have the potential to increase feelings of depression in certain individuals. If you notice your symptoms worsening or an increase in suicidal thoughts or behaviors after taking either medication, please seek medical attention immediately.
Neither Ativan nor Valium should be taken if you are using or have recently discontinued monoamine oxidase inhibitors (MAOIs). Always inform your physician about any medications you're currently on; MAOIs will require a period of about two weeks to clear from your system before it is safe to initiate treatment with Ativan or Valium to avoid potentially dangerous interactions.
How much do Ativan and Valium cost?
For the brand name versions of these drugs:
- The price of 60 tablets of Ativan (1 mg) averages around $220, which works out to about $3.67/day at a typical dosage.
- The price for 60 tablets of Valium (5 mg) is approximately $230, working out to roughly $3.83/day.
Thus, if you are in the higher dosage range for Ativan (i.e., up to 6mg per day), then brand-name Valium may be less expensive on a per-day treatment basis depending on your exact dose. It's important to remember that while cost is significant, it should not be the primary factor when determining which drug is right for you.
As with many medications, generic versions offer cost savings:
- Lorazepam (the generic form of Ativan) typically costs between $10 and $50 for a supply of 60 tablets (1mg each), resulting in an approximate daily cost ranging from as low as $0.17 up to about $0.80.
- Diazepam (generic Valium) often ranges from around $10 - $40 for a similar quantity and strength, translating into a daily expenditure that starts at about $.15 and doesn't usually exceed more than $.70.
Again, these prices can vary based on factors such as your location or pharmacy choice but generally illustrate how generics can provide substantial savings over their branded counterparts.
Popularity of Ativan and Valium
Lorazepam, available under the brand name Ativan, was estimated to have been prescribed to about 14.7 million people in the US in 2019. Lorazepam accounted for just over 10% of all benzodiazepine prescriptions in the US that year. It is often used for treating anxiety disorders and is classified as a short-to-intermediate-acting benzodiazepine.
Diazepam, which is known by its brand name Valium, was prescribed to approximately 13.5 million people in the USA during 2019. Diazepam accounts for nearly 10% of all benzodiazepine prescriptions across the country and has held a generally steady prevalence over recent years. This drug belongs to long-acting benzodiazepines and it's commonly used not only for managing anxiety but also muscle spasms and seizures due to its anticonvulsant properties.
Conclusion
Both Ativan (lorazepam) and Valium (diazepam) have long-standing records of usage in patients with anxiety disorders, insomnia, seizures, and alcohol withdrawal. They are backed by numerous clinical studies indicating that they are more effective than placebo treatments. Both belong to the benzodiazepine class of drugs which work by enhancing the activity of a neurotransmitter called GABA in the brain leading to sedative effects.
In terms of their mechanisms of action, lorazepam has a shorter half-life compared to diazepam meaning it leaves your system quicker. This could make it less suitable for conditions requiring continuous control over symptoms but potentially beneficial when rapid clearance from the body is desirable.
Ativan is often considered as a first-line treatment option for acute anxiety episodes or panic attacks due to its faster onset while Valium might be preferred for longer-term management or use during alcohol withdrawal because of its prolonged duration of effect.
Both drugs are available in generic form providing cost savings options especially for patients who must pay out-of-pocket expenses. The adjustment period may vary depending on individual patient response but usually becomes noticeable after an hour post-ingestion.
The side effect profile is similar between these two medications; however, due to longer half-life Diazepam can lead to 'hangover' effects such as daytime sleepiness and cognitive impairment more frequently than Lorazepam. For both drugs, close monitoring is important due to risk associated with dependency and tolerance development.
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Refrences
- Burrows, G. D., Norman, T. R., Judd, F. K., & Marriott, P. F. (1990, January). Short-acting versus long-acting benzodiazepines: Discontinuation effects in panic disorders. Journal of Psychiatric Research. Elsevier BV.http://doi.org/10.1016/0022-3956(90)90037-q
- Furukawa, T., Nikaido, Y., Shimoyama, S., Masuyama, N., Notoya, A., & Ueno, S. (2021, November 26). Impaired Cognitive Function and Hippocampal Changes Following Chronic Diazepam Treatment in Middle-Aged Mice. Frontiers in Aging Neuroscience. Frontiers Media SA.http://doi.org/10.3389/fnagi.2021.777404
- DONALDSON, D., & RONALD, A. K. (1975, December). A Review Of The Effects Of Diazepam On Cognitive And Psychomotor Performance. The Journal Of Nervous And Mental Disease. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/00005053-197512000-00004
- Lader, M. (1984, January). Short-term versus long-term benzodiazepine therapy. Current Medical Research and Opinion. Informa Healthcare.http://doi.org/10.1185/03007998409109550
- Keane, P. E. (1992, June). Pharmacological, toxicological and neurochemical effects of Δ2(E)-valproate in animals. Pharmaceutisch Weekblad Scientific Edition. Springer Science and Business Media LLC.http://doi.org/10.1007/bf01962706