Alprazolam vs. Diazepam (Differences between Side Effects and Uses)

  • Medical Reviewer: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Alprazolam vs. diazepam quick comparison

What is alprazolam? What is diazepam? How do they work?

Alprazolam (Xanax XR, Niravam) is an anti-anxiety medication in the benzodiazepine family. It is used to treat anxiety disorders and panic attacks. Alprazolam and other benzodiazepines act by enhancing the effects of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter (a chemical that nerve cells use to communicate with each other) that inhibits activity in the brain. It is believed that excessive activity in the brain may cause anxiety or other psychiatric disorders.

Diazepam (Valium is an oral benzodiazepine medication used to treat anxiety. Diazepamt also is used to treat agitation, tremors, delirium, seizures, and hallucinations resulting from alcohol withdrawal.

What are the uses for alprazolam vs. diazepam?

Alprazolam (Valium) uses

Alprazolam (Xanax) is used for the treatment of anxiety disorders and panic attacks

Diazepam uses

  • Diazepam is used for the treatment of disorders with anxiety.
  • Diazepam also is used for the treatment of agitation, tremors, delirium, seizures, and hallucinations resulting from alcohol withdrawal.
  • It is used for the treatment of seizures, relief of muscle spasms in some neurological diseases, and for sedation during surgery.

What are the side effects of alprazolam vs. diazepam?

Alprazolam side effects

Alprazolam is used for the treatment of anxiety disorders and panic attacks. Anxiety disorders are characterized by:

Panic attacks occur either unexpectedly or in certain situations (for example, driving), and can require higher dosages of alprazolam.

Diazepam side effects

The most common side effects of diazepam are:

Other important side effects include:

Possible serious side effects:

Are alprazolam and diazepam addictive?

Both alprazolam and diazepam can lead to addiction (dependency), especially when higher dosages are used over prolonged periods of time. In patients addicted to diazepam or after prolonged use, abrupt discontinuation may cause symptoms of withdrawal such as:

  • Insomnia
  • Headaches
  • Nausea
  • Vomiting
  • Lightheadedness
  • Sweating
  • Anxiety
  • Fatigue
  • Seizures can occur in more severe cases of withdrawal. Therefore, after extended use, diazepam should be slowly tapered under a doctor's supervision rather than abruptly stopped.
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What is the dosage for alprazolam vs. diazpam?

Alprazolam dosage

  • The starting dose for treating anxiety is 0.25-0.5 mg 3 to 4 times daily using immediate release tablets. The dose may be increased every 3-4 days to a maximum dose of 4 mg daily.
  • The starting dose for treating panic attacks is 0.5 mg 3 times daily. Doses can be increased every 3-4 days but by no more than 1 mg daily.
  • The effective dose for preventing panic attacks may be as high as 10 mg daily for some patients. The starting dose when using extended release tablets to treat panic disorder is 0.5 mg once daily and the average dose is 3-6 mg once daily.
  • Alprazolam may be taken with or without food.

Diazepam dosage

  • Diazepam may be taken with or without food.
  • Diazepam is disposed of by the liver and excreted mainly by the kidney. Dosages of diazepam may need to be lowered in patients with abnormal kidney function.
  • The usual oral diazepam dose for anxiety or seizures is 2-10 mg given 2-4 times daily.
  • The usual rectal dose is 0.2-0.5 mg/kg and depends on the age of the patient.

What drugs interact with alprazolam vs. diazepam?

Alprazolam drug interactions

Diazepam drug interactions

Alcohol or medications that cause sedation may add to the sedative effects of diazepam. Patients taking benzodiazepines should avoid such combinations.

The following drugs may prolong the effects of diazepam by inhibiting liver enzymes that eliminate diazepam so dosages may need to be decreased when these drugs are used with diazepam.

Carbamazepine (Tegretol), rifampin (Rifadin), and St. John's Wort decrease levels of diazepam by increasing the elimination of diazepam by liver enzymes.

Are alprazolam and diazepam safe to take if I'm pregnant or breastfeeding?

  • Benzodiazepines like alprazolam and diazepam can cause fetal abnormalities and should not be used during pregnancy.
  • Both alprazolam and diazepam are excreted in breast milk, and can affect nursing infants. Therefore, diazepam should not be used by women who are nursing.

REFERENCES: FDA Prescribing Information.

Summary

Alprazolam (Valium) and diazepam (Xanax) are medications that belong a drug class called benzodiazepines. Benzodiazepines cause mild to severe depression of the nerves within the brain, and sedation. Both alprazolam and diazepam are prescribed to treat anxiety disorders and panic attacks.

Diazepam also is used to treat seizures, relief of muscle spasms in some neurological diseases, sedation during surgery, and symptoms of alcohol withdrawal like:


The common side effects between alprazolam and diazepam are drowsiness and fatigue.

Other side effects of alprazolam include:
Other side effects of diazepam include:
Dosage of alprazolam and diazepam depend upon the patient's health and any other medical problems they may have. Both drugs have important side effects that should be reviewed before taking these medications. Alprazolam and diazepam may cause birth defects, and both drugs are secreted in breast milk; therefore, neither drug is recommended if you are pregnant or breastfeeding.

REFERENCE: FDA Prescribing Information.

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Reviewed on 9/26/2017
References
REFERENCES: FDA Prescribing Information.

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