Ativan vs. Klonopin: Similarities & Differences
Medically reviewed by Femi Aremu, PharmD
Ativan (lorazepam) and Klonopin (clonazepam) are two prescription medications belonging to the benzodiazepine (BZD) drug class.
Ativan is used to relieve anxiety and insomnia, while Klonopin is used to control certain types of seizures and relieve panic 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.
As designated by the Drug Enforcement Administration (DEA), these BZDs are labeled as Schedule IV controlled drugs and come with a black box warning. This warning is assigned by the Food and Drug Administration (FDA) regarding the potential for physical dependence and misuse.
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.
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Understanding Anxiety Disorders
The following provides an overview of anxiety, including information regarding its causes, types, and treatments.
What Is Anxiety?
Anxiety is a feeling of fear, worry, and uneasiness. It can make you sweat, feel restless and tense, and experience tachycardia (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, including generalized anxiety disorder (GAD), panic disorder, and social 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
Anxiety disorders are treated by psychological therapies, prescription medications, such as selective serotonin reuptake inhibitors (SSRIs), antidepressants, or a combination of therapy and pharmaceuticals.
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.
What Is Ativan?
Brand-name Ativan, containing the active ingredient lorazepam, belongs to the BZD drug class.
Ativan is FDA-approved to treat insomnia and 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 treat status epilepticus (a seizure or a series of seizures lasting five minutes or longer) and as a pre-anesthetic medication (used before anesthesia) 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 treat chemotherapy-induced nausea and vomiting and to control agitation due to alcohol withdrawal.
Brand-Name & Generic Variations
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 called gamma-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.
What Is Klonopin?
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 of seizures.
It also relieves panic attacks that may or may not present alongside agoraphobia (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.
Off-Label Uses
Klonopin is sometimes prescribed off-label to treat symptoms of akathisia (restlessness or inability to remain still).
Akathisia is a side effect of treatment with antipsychotic medications (medications for mental illness).
It is also used off-label to treat catatonic reactions (a condition in which a person does not move and speak, or they speak and move abnormally).
Brand-Name & Generic Variations
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.
How It Works
As a benzodiazepine, clonazepam works on GABA receptors to reduce abnormal electrical activity in the brain.
How Quickly Does It Work?
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.
Dosing Guidelines
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:
The usual recommended dose of Ativan IV injection is 4 mg, given slowly (2 mg/minute) in adults.
Preanesthetic:
For sedation and relief of anxiety, the usual recommended initial dose for IV injection is 2 mg in adults.
For oral forms of Ativan, standard dosing is as follows:
For anxiety: An initial dose of 2 to 3 mg daily in two or three separate doses
For insomnia due to anxiety: A single daily dose between 2 to 4 mg, which is usually given at bedtime
For elderly or debilitated people: An initial dose of 1 to 2 mg daily administered in divided doses
Klonopin
Klonopin is available as a tablet in strengths of 0.5, 1, and 2 mg.
Standard dosing regimens are as follows:
Seizure disorders:
Adults: The initial dose for adults with seizure disorders should not be more than 1.5 mg daily divided into three doses.
Pediatrics: The initial dose for infants and children (up to 10 years old or 66 pounds) should be between 0.01 and 0.03 mg per kilogram (kg) of body weight (mg/kg) daily and with a maximum of 0.05 mg/kg daily given in two or three divided doses.
Older adults: Start on the lowest dose and increase gradually as required.
Panic disorder:
Adults: The initial dose for adults with panic disorder is 0.25 mg twice daily. An increase to the target dose for most people of 1 mg/day may be made after three days. The maximum dose can be gradually increased to 4 mg/day.
Pediatrics: It's not for use in people younger than 18 years old since its safety and efficacy have not been studied for panic disorders in this age group.
Older adults: Start with a minimum dose and increase gradually as needed.
Taking Ativan vs. Klonopin
The following outlines basic safety protocols regarding the active use of Ativan vs. Klonopin.
Ativan
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
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, when compared, a study that reviewed agitation caused by the accidental ingestion of methamphetamine in children showed that both drugs are equally effective at similar doses.
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.
Alternative Treatment Options
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 black box 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:
Changes in appetite
Blurred vision
Changes in sex drive or ability
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:
Rash
Itching
Swelling of the face, eyes, and mouth
Wheezing
Shortness of breath
Ativan-Specific Side Effects
Ativan may also cause severe side effects such as:
Persistent tremors or inability to remain still
Jaundice (yellowing of the skin or eyes caused by a high bilirubin count)
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:
Currently pregnant, plan to become pregnant
Currently breastfeeding
A history of epilepsy
Diagnosed acute narrow-angle glaucoma or untreated open-angle glaucoma
A history of sleep apnea, COPD (chronic obstructive pulmonary disease), or asthma
A history of liver disease
Diagnosed phenylketonuria (PKU) disease
A history of alcohol and drug use
A history of suicidal thoughts
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:
Antihistamines, such as Benadryl (diphenhydramine)
Narcotic pain medications, such as OxyContin (oxycodone) and Vicodin (hydrocodone)
Opioid cough medications, such as codeine cough syrup
Sleep-aid medications, such as Ambien (zolpidem)
Other anti-anxiety medications, such as Xanax (alprazolam) or Valium (diazepam)
Anticonvulsant medications, such as Tegretol (carbamazepine) or Dilantin (phenytoin)
Summary
Anxiety is a feeling of fear, worry, and restlessness. The wide variety of anxiety disorders differs by symptoms, trigger factors, and how they cause behavioral disturbances.
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 black box 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 Questions
How do I store Ativan or Klonopin?
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.
Does either Ativan or Klonopin carry the potential to become addictive?
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 black-box warning that outlines their potential for physical dependence or addiction.
Read the original article on Verywell Health.
