Xanax vs. Valium

  • Medical Editor: 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.

What are the differences between Xanax and Valium?

What are Xanax and Valium?

Xanax (alprazolam) and Valium (diazepam) are anti-anxiety medications in the benzodiazepine family, the same family that includes clonazepam (Klonopin), lorazepam (Ativan), flurazepam (Dalmane), and others. Xanax, Valium 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.

What are the side effects of Xanax and Valium?

Xanax

The most common side effects of Xanax taken at lower doses are:

Other side effects include:

  • Memory problems
  • Speech problems
  • Constipation
  • Changes in weight
  • Addiction (dependency)

Addiction is more likely to occur at high doses given over prolonged periods of time. Abrupt discontinuation of alprazolam after prolonged use can lead to symptoms of withdrawal such as:

Seizures can occur in more severe cases of withdrawal. Consequently, patients on alprazolam for extended periods of time should slowly taper the medication under a doctor's supervision rather than abruptly stopping the medication.

Valium

The most common side effects of diazepam are:

Other important side effects include:

  • Paradoxical reactions with excitability
  • Muscle spasm
  • Lack of sleep
  • Rage
  • Confusion
  • Speech problems
  • Double vision

Possible serious side effects:

What is the dosage of Xanax vs. Valium?

Xanax

  • 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.

Valium

  • 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 Xanax and Valium?

Xanax

  • Ketoconazole (Nizoral), itraconazole (Sporanox), nefazodone (Serzone), cimetidine (Tagamet), and fluvoxamine (Luvox) increase concentrations in the blood of alprazolam and therefore may increase the side effects of alprazolam.
  • Alprazolam interacts with alcohol and medications (for example, barbiturates, and narcotics) that suppress activity in the brain by suppressing activity more and causing sedation.
  • Carbamazepine and rifampin reduce the effect of alprazolam by increasing metabolism and elimination of alprazolam in the liver.

Valium

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:

  • cimetidine (Tagamet)
  • ketoconazole (Nizoral)
  • itraconazole (Sporanox)
  • omeprazole (Prilosec, Rapinex)
  • erythromycin
  • clarithromycin (Biaxin)
  • darunavir (Prezista)
  • fluvoxamine (Luvox)
  • fluoxetine (Prozac)

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 Xanax and Valium safe to use while pregnant or breastfeeding?

Xanax

  • Benzodiazepines, such as alprazolam, can cause fetal abnormalities and should not be used in pregnancy.
  • Alprazolam is excreted in breast milk and can affect nursing infants. Therefore, it should not be used by women who are nursing.

Valium

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

Summary

Xanax (alprazolam) and Valium (diazepam) benzodiazepines used to treat anxiety and panic attacks. Valium is also used for the treatment of agitation, tremors, delirium, seizures, and hallucinations resulting from alcohol withdrawal. It is also used for the treatment of seizures, relief of muscle spasms in some neurological diseases, and for sedation during surgery. Side effects of both include drowsiness, fatigue, and speech problems.

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Medically Reviewed on 11/3/2017
References
SOURCE:

The website of the National Cancer Institute (https://www.cancer.gov)

Last updated Oct. 6, 2017
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