Table of ContentsView AllTable of ContentsUnderstanding Anxiety DisordersWhat Is Ativan?What Is Klonopin?Dosing GuidelinesEfficacyAlternative Treatment OptionsSide EffectsInteractionsFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Understanding Anxiety Disorders
What Is Ativan?
What Is Klonopin?
Dosing Guidelines
Efficacy
Alternative Treatment Options
Side Effects
Interactions
Frequently Asked Questions
Ativan (lorazepam) andKlonopin (clonazepam)are two prescription medications belonging to thebenzodiazepine (BZD)drug class.
Ativan is used to relieveanxietyandinsomnia, while Klonopin is used to control certain types ofseizuresand relievepanic attacks.
Ativan is available as an immediate-release (IR) oral tablet, intravenous (IV) injection, or intramuscular (IM) injection. Klonopin is available only in IR tablet form.
While Ativan and Klonopin belong to the same class and are used for overlapping purposes, they have notable differences regarding active ingredients, potential side effects, varying forms of administration, and dosing regimens.
This article will provide an in-depth analysis of Ativan and Klonopin.
Luis Alvarez / Getty Images
The following provides an overview of anxiety, including information regarding its causes, types, and treatments.
What Is Anxiety?
Anxietyis a feeling of fear, worry, and uneasiness. It can make you sweat, feel restless and tense, and experiencetachycardia (rapid heartbeat).
Occasional anxiety is a normal part of life. It can be a necessary reaction to a stressful situation. Anxiety disorder, however, is when the anxiety does not go away or it worsens over time.
Anxiety disorders are the most prevalent psychiatric disorders, often underrecognized and undertreated in primary care.
Types of Anxiety Disorder
There are several types of anxiety disorders, includinggeneralized anxiety disorder (GAD),panic disorder, andsocial anxiety disorder.
Symptoms & Causes
Common anxiety symptoms include restlessness and bodily tension, pounding or rapid heartbeat, unexplained aches and pains, behavioral changes, dizziness, and shortness of breath.
The exact cause of anxiety is unknown. However, genetics, brain biology and chemistry, stress, and environmental factors may play a role.
Risk Factors
Risk factors for the different types of anxiety disorders can vary.
However, notable risk factors include shyness, traumatic events in early childhood or adulthood, family history, and varying health conditions.
Treatment
BZDs are among the most widely prescribed drug classes in the United States and a standard drug class for managing anxiety disorders.They are psychoactive drugs known for their depressant effect on the central nervous system (CNS).
Anxiety vs. Panic Disorder
An anxiety disorder is different from a panic disorder.
Stress usually triggers anxiety gradually over time, while panic attacks happen unexpectedly and suddenly without a clear trigger. Panic attack symptoms are much more intense and severe than anxiety attack symptoms.
Panic disorder is generally treated with psychotherapy (talk therapy), medication, or a combination of therapy and a prescription medication.
If you have a panic attack, speak with a healthcare provider to prescribe the best treatment for you.
Relevant Statistics
According to diagnostic assessment and population data, an estimated 31.1% of adults in the United States experience any anxiety disorder at some time in their lives.
According to the World Health Organization (WHO), in 2019, 301 million people were living with an anxiety disorder, including 58 million children and adolescents.
Brand-name Ativan, containing the active ingredient lorazepam, belongs to the BZD drug class.
Ativan is FDA-approved to treatinsomniaand the short-term management of anxiety symptoms related to anxiety disorders or everyday life events.
This medication is typically administered to adults and adolescents 12 years and older.
Ativan is also used in adults to treatstatus epilepticus(a seizure or a series of seizures lasting five minutes or longer) and as a pre-anesthetic medication (used beforeanesthesia) to produce sedation (sleepiness or drowsiness) and relief from anxiety associated with surgical procedures.
It is available as a prescription in the tablet and injection form to take two or three times daily with or without food.
Off-Label Uses
Ativan is sometimes used off-label, meaning using a drug for a non-FDA-approved use to treatchemotherapy-induced nausea and vomitingand to control agitation due to alcohol withdrawal.
In addition to Ativan, other name-brand forms of lorazepam available in the market include Loreev XR, an extended-release capsule used for the management of anxiety.
Generic lorazepam comes in an IR tablet or injection form.
How It Works
Ativan increases the brain’s response to a neurotransmitter calledgamma-aminobutyric acid (GABA). It reduces the excitability of nerve signals in the brain and slows them down, leading to relaxation.
Ativan may improve anxiety or insomnia rapidly or over days or within hours of taking the first dose.
How Quickly Does It Work?
Ativan is well absorbed after oral administration and reaches maximum levels within the bloodstream within two hours.
The elimination half-life (the time required for one-half of the drug to be removed from the body) is between 12 and 18 hours. It is expelled from the body primarily through urine.
Ativan takes effect within one to three minutes when administered via IV and 15 to 30 minutes if taken orally.
Brand-name Klonopin, containing the active ingredient clonazepam, belongs to the BZD drug class.
Klonopin is FDA-approved to be used alone or in combination with other medications to control certain types ofseizures.
It also relieves panic attacks that may or may not present alongsideagoraphobia (extreme fear).
Klonopin is generally prescribed to adults and children 10 years and older; however, if deemed necessary, a healthcare provider may prescribe a modified dose for people younger than 10.
Klonopin is administered via IR tablets that are taken between one and three times daily, with or without food.
Klonopin is sometimes prescribed off-label to treat symptoms ofakathisia(restlessness or inability to remain still).
Akathisia is a side effect of treatment withantipsychotic medications(medications for mental illness).
It is also used off-label to treatcatatonic reactions(a condition in which a person does not move and speak, or they speak and move abnormally).
Klonopin is the only brand-name product with the active ingredient clonazepam.
However, generic clonazepam is available as an IR tablet and an orally disintegrating tablet.
As a benzodiazepine, clonazepam works on GABA receptors to reduce abnormal electrical activity in the brain.
Klonopin is rapidly absorbed after oral administration. It reaches maximum levels in the bloodstream within one to four hours. The elimination half-life of Klonopin is 30 to 40 hours.
Klonopin may help control your condition but will not cure it. Additionally, it may take a few weeks or longer for Klonopin to improve symptoms.
The following will outline general dosing guidelines associated with Ativan and Klonopin.
Ativan
Ativan is available in tablets and injectable forms. Ativan tablets are available in 0.5, 1, and 2 milligrams (mg) strengths.
Standard dosing regimens are as follows:
Status epilepticus:
Preanesthetic:
For oral forms of Ativan, standard dosing is as follows:
Klonopin
Klonopin is available as a tablet in strengths of 0.5, 1, and 2 mg.
Seizure disorders:
Panic disorder:
Taking Ativan vs. Klonopin
The following outlines basic safety protocols regarding the active use of Ativan vs. Klonopin.
When taking Ativan orally, swallow the tablets whole (no chewing) with or without food.
Ativan is only for the short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms. It must not be used for more than four months.
Ativan must never be used without individualizing dosage, particularly when taken with other medications causing CNS depression.
Klonopin is typically taken two to three times daily with or without food at around the same time(s) every day.
Your healthcare provider will start you on the lowest dose and gradually increase your dose, not more often than once every three days.
Klonopin may help control your condition but will not cure it.
Do not stop taking Klonopin without talking to your healthcare provider, even if you experience side effects such as unusual changes in behavior.
Sudden discontinuation of Klonopin may result in withdrawal symptoms such as seizures,hallucinations, changes in behavior, sweating, uncontrollable shaking of a body part, stomach or muscle cramps, anxiety, or difficulty falling or staying asleep.
Your healthcare provider will gradually decrease your dose before completely stopping it.
Comparing Efficacy
Experts typically regard Ativan (lorazepam) and Klonopin (clonazepam) as being reliable, safe, and effective for the management of anxiety and repeated seizures.
However, due to the higher potency associated with Klonopin, Ativan is safer and has minimal complications vs. Klonopin regarding the treatment of methamphetamine-induced agitation in children.
Talk therapy may help to ease the agitation and emotional problems associated with the anxiety disorder. Additionally, for the alleviation of anxiety, exercise is a productive additional treatment option.
Alternative medicine therapies can play a role in improving symptoms of clinical anxiety.
These include Ayurvedic medicine, Reiki, healing touch, acupuncture, and meditation-based techniques.
Notably, within the 1990s, popular alternative treatment strategies for anxiety disorders emerged. These included herbal medications, such as Saint-John’s-wort.
Side Effects & Precautions
Ativan and Klonopin are Schedule IV controlled substances that carry FDA-assigned boxed warnings regarding their potential for abuse, misuse, and addiction.
Prolonged use of BZDs, including Ativan and Klonopin, may cause clinically significant physical dependence. Increased doses can cause withdrawal effects.
Use of these drugs with opioids can cause respiratory depression, sedation, coma, and potentially death.
Common Side Effects
Ativan and Klonopin may cause some common side effects that usually do not require any medical treatment and go away.
However, if the symptoms worsen, immediately call your healthcare provider.
Common side effects associated with the use of Ativan and Klonopin include:
Severe Side Effects
Experiencing adverse effects associated with Ativan or Klonopin may require immediate medical attention.
Call for help if you develop any of the following hypersensitivity reactions that include the following symptoms:
Ativan-Specific Side Effects
Ativan may also cause severe side effects such as:
Warning & Precautions
Consult your provider before starting treatment with Ativan or Klonopin if any of the following apply, as it may disqualify you from taking either drug:
Potential for Interaction
So your healthcare provider can design a dosing regimen that will work for you, let them know about all the drugs you take, including over-the-counter (OTC) medications, supplements, and herbs.
Some common drugs that may negatively interact with Ativan and Klonopin if taken simultaneously are as follows:
Summary
These disorders affect mental health and can interfere with daily activities such as job performance, school work, and relationships.
Anxiety disorders include GAD and panic disorders. As per WHO, an estimated 4% of the global population currently experience an anxiety disorder.
Ativan (lorazepam) and Klonopin (clonazepam) are Schedule IV controlled BZDs used to manage anxiety and seizure symptoms.
While seen as generally similar, Ativan and Klonopin carry different active ingredients and have differences in FDA-approved uses, dosing regimens, different modes of administration, and some differences in potential side effects.
However, Ativan and Klonopin both contain boxed warnings that alert to their potential for misuse and addiction.
Speak to your healthcare provider to determine whether either drug is right for you.
Frequently Asked QuestionsStore the orally administered forms of Ativan or Klonopin in a safe, secure location at room temperature (68-77 degrees F). Be sure to keep either drug away from any area susceptible to high levels of heat or moisture, such as a bathroom.Conversely, keep injectable forms of Ativan refrigerated and out of reach of children and pets.BZDs, including Ativan and Klonopin, may cause addiction.The continued use of Ativan or Klonopin for several days to weeks can cause physical dependence. Additionally, the risks of dependence and withdrawal effects increase with longer treatment duration and higher daily doses.Ativan and Klonopin each carry an FDA-designated boxed warning that outlines their potential for physical dependence or addiction.
Store the orally administered forms of Ativan or Klonopin in a safe, secure location at room temperature (68-77 degrees F). Be sure to keep either drug away from any area susceptible to high levels of heat or moisture, such as a bathroom.Conversely, keep injectable forms of Ativan refrigerated and out of reach of children and pets.
Store the orally administered forms of Ativan or Klonopin in a safe, secure location at room temperature (68-77 degrees F). Be sure to keep either drug away from any area susceptible to high levels of heat or moisture, such as a bathroom.
Conversely, keep injectable forms of Ativan refrigerated and out of reach of children and pets.
BZDs, including Ativan and Klonopin, may cause addiction.The continued use of Ativan or Klonopin for several days to weeks can cause physical dependence. Additionally, the risks of dependence and withdrawal effects increase with longer treatment duration and higher daily doses.Ativan and Klonopin each carry an FDA-designated boxed warning that outlines their potential for physical dependence or addiction.
BZDs, including Ativan and Klonopin, may cause addiction.
The continued use of Ativan or Klonopin for several days to weeks can cause physical dependence. Additionally, the risks of dependence and withdrawal effects increase with longer treatment duration and higher daily doses.
Ativan and Klonopin each carry an FDA-designated boxed warning that outlines their potential for physical dependence or addiction.
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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DailyMed.Label: Ativan- lorazepam injection.
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Bandelow B, Michaelis S, Wedekind D.Treatment of anxiety disorders.Dialogues Clin Neurosci.2017;19(2):93-107. doi:10.31887/DCNS.2017.19.2/bbandelow
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Edinoff AN, Nix CA, Hollier J, et al.Benzodiazepines: uses, dangers, and clinical considerations.Neurol Int. 2021;13(4):594-607. doi:10.3390/neurolint13040059
National Institute of Mental Health.Panic disorder: when fear overwhelms.
National Institute of Mental Health.Any anxiety disorder.
World Health Organization.Mental disorders.
Tiglao SM, Meisenheimer ES, Oh RC.Alcohol withdrawal syndrome: outpatient management.Am Fam Physician. 2021;104(3):253-262.
DailyMed.Label: Loreev XR- lorazepam capsule, extended release.
DailyMed.Label: lorazepam tablet.
DailyMed.Label: lorazepam injection.
Griffin CE, Kaye AM, Bueno FR, Kaye AD.Benzodiazepine pharmacology and central nervous system–mediated effects.Ochsner J.2013;13(2):214-223.
National Alliance on Mental Illness.Lorazepam (Ativan).
National Health Service.How and when to take lorazepam.
Lima AR, Soares-Weiser K, Bacaltchuk J, Barnes TR.Benzodiazepines for neuroleptic-induced acute akathisia.Cochrane Database Syst Rev. 2002;1999(1):CD001950. doi:10.1002/14651858.CD001950
Agrawal AK, Das S, Tirthalli J.Clonazepam in catatonia: thinking beyond the boundary of lorazepam: a case report.Indian J Psychol Med. 2023;45(1):97-99. doi:10.1177/02537176221116265
DailyMed.Label: clonazepam tablet.
DailyMed.Label: clonazepam tablet, orally disintegrating.
Farnaghi F, Rahmani R, Hassanian-Moghaddam H, et al.Oral clonazepam versus lorazepam in the treatment of methamphetamine-poisoned children: a pilot clinical trial.BMC Pediatr. 2020;20(1):543. doi:10.1186/s12887-020-02441-x
Bystritsky A, Khalsa SS, Cameron ME, Schiffman J.Current diagnosis and treatment of anxiety disorders. P T. 2013;38(1):30-57.
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