Xanax vs. Valium

• Xanax (alprazolam) and Valium (diazepam) benzodiazepines used to treat anxiety and panic attacks.
• A difference is that 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 Xanax and Valium that are similar include drowsiness, fatigue, and speech problems.
• Side effects of Xanax that are different from Valium include memory problems, constipation, and changes in weight.
• Side effects of Valium that are different from Xanax include diarrhea, rash, euphoria, loss of balance, muscle spasm, lack of sleep, rage, confusion, and double vision.
• Xanax and Valium may interact with alcohol, medications that can make you sleepy (for example, barbiturates, and narcotics), ketoconazole, itraconazole, cimetidine, fluvoxamine, carbamazepine, and rifampin.
• Xanax may also interact with nefazodone.
• Valium may also interact with cimetidine, omeprazole, erythromycin, clarithromycin, darunavir, fluoxetine, and St. John's wort.
• Xanax and Valium 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, and fatigue.

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.

Xanax

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

• Drowsiness
• Fatigue

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:

• Insomnia
• Headaches
• Nausea
• Vomiting
• Lightheadedness
• Sweating
• Anxiety
• Fatigue

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:

• Drowsiness
• Fatigue
• Diarrhea
• Rash
• Euphoria
• Ataxia (loss of balance)

Other important side effects include:

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

Possible serious side effects:

• Respiratory depression
• Neutropenia
• Depression

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.

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.

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.