Klonopin vs. Xanax: Similarities & Differences
Medically reviewed by David Snyder, PharmD, BCPP
When an individual presents with a diagnosable case of an anxiety disorder, a healthcare provider will often recommend therapy or a prescription drug regime to help the distressed person feel more confident and comfortable in their day-to-day life.
Therefore, if a prescription medication route is chosen, some commonly prescribed medications for anxiety include Klonopin (clonazepam) and Xanax (alprazolam). Klonopin and Xanax are Food and Drug Administration (FDA)-approved medications that are classified as benzodiazepines.
Benzodiazepines are a class of medications that are used for anxiety, muscle spasms, and/or seizures, depending on the specific medication.
Nonetheless, while these drugs are deemed generally similar, safe, and practical, they carry some notable differences that potential users should be aware of.
This article will offer an in-depth comparison between Klonopin and Xanax, examining their specific uses, active ingredients, dosing guidelines, potential side effects, and more.
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Understanding Anxiety
Feelings of anxiety can cause mental symptoms like persistent fear and dread, in addition to physical symptoms such as sweating and a fast heartbeat.
Moreover, regarding their prevalence, anxiety disorders are the most common mental health condition among adults in the United States, affecting nearly 20% of adults annually.
There are various types of anxiety disorders, including:
Generalized anxiety disorder (GAD), a condition that causes people to worry excessively on most days for at least six months
Panic disorder, a condition that causes panic attacks—sudden periods (attacks) of intense fear and distress
Phobias, fear-based conditions caused by irrational anxiety about objects/places/situations that are not dangerous, such as crowds or social situations (also known as social anxiety)
Not all feelings of anxiety are necessarily linked to a disorder; however, if you feel that anxiety consistently affects your ability to maneuver throughout the day successfully, it may be wise to consult a healthcare provider,
What Is Klonopin?
Klonopin contains the active ingredient clonazepam. It is FDA-approved to:
Treat panic disorder with or without agoraphobia (fearing and avoiding places/situations that may cause panic and feelings of being trapped or helpless) in adults
Prevent certain seizure disorders in adults and children
Some healthcare providers prescribe medications off-label. This means prescribing a drug that is not FDA-approved for a particular use.
Sometimes, healthcare providers prescribe Klonopin off-label for conditions such as:
GAD
Tardive dyskinesia (TD, a movement disorder often associated with certain antipsychotic drugs)
Insomnia (trouble falling asleep and/or staying asleep)
Klonopin is classified by the Drug Enforcement Administration (DEA) as a Schedule IV drug because it carries a risk of abuse and dependence.
How Does Klonopin Work?
The exact way Klonopin works has yet to be understood entirely. However, it is thought to work on a receptor that binds a neurotransmitter (chemical messenger) typically in the central nervous system (CNS) called gamma-aminobutyric acid (GABA), enhancing its activity.
Klonopin causes a slowing down of the CNS, which causes relaxation and sleepiness and can also help prevent seizures.
It is available in brand and generic forms as oral and orally disintegrating tablets (tablets that dissolve in a person's mouth.
What Is Xanax?
Xanax contains the active ingredient alprazolam. It is FDA-approved to:
Treat GAD in adults
Treat panic disorder with or without agoraphobia in adults
Sometimes, healthcare providers prescribe Xanax off-label for conditions such as:
Children with severe anxiety (Xanax is FDA-approved for anxiety in adults, but using it in children would be considered an off-label use)
Insomnia (especially in individuals who also have anxiety or depression)
Like Klonopin, Xanax is classified by the DEA as a Schedule IV drug because it risks abuse and dependence.
How Does Xanax Work?
Like Klonopin, Xanax is thought to work on a receptor that binds a neurotransmitter typically in the CNS called GABA.
Xanax is available in both brand and generic formulations:
Immediate-release tablets (Xanax)
Extended-release (XR) tablets (Xanax XR)
Orally disintegrating tablets
Oral liquid
Black Box Warning
Both Klonopin and Xanax (as well as all benzodiazepines) have a black box warning, the most severe warning required by the US Food and Drug Administration (FDA).
The warning states:
Using a benzodiazepine with an opioid (narcotic pain medicine) can cause severe sedation, slowed breathing, coma, and death. These medications should not be taken together unless there are no alternative options. If they must be taken together, each drug should be prescribed at the lowest dose and for the shortest time - and the individual will be closely monitored.
Benzodiazepines have a risk for abuse and dependence, which can lead to overdose and death. Abuse and misuse often occur with other medicines, alcohol, and/or illegal drugs.
Benzodiazepines can cause your body to depend on the medication. When you stop taking a benzodiazepine, your healthcare professional will provide you with a tapering schedule so you can slowly and safely stop taking the medication and lower the risk of withdrawal reactions, which can be life-threatening.
Dosing Comparison
With benzodiazepines, the healthcare provider will prescribe the lowest effective dose and monitor the individual closely.
When stopping a benzodiazepine, the dosage will be gradually tapered to lower the risk of withdrawal reactions.
Dosage is individualized, and the healthcare provider will determine the best dosage based on various factors. We will provide some general dosing guidelines here.
Klonopin
General dosing guidelines are as follows. However, some individuals may be prescribed one dose at bedtime rather than two daily doses.
For oral dosage forms (tablets or disintegrating tablets):
Seizures:
Adults and children 10 and older: First, 0.5 milligrams (mg) thrice daily. Your healthcare provider may adjust your dose as needed. However, the dose is typically not more than 20 mg per day.
Children up to 10 years old or 66 pounds (lbs) of body weight: The dose is based on body weight and must be determined by your healthcare provider. The dose is usually 0.01 to 0.03 mg per kilogram (kg) of body weight per day, given in two or three divided doses. However, the dose is usually less than 0.05 mg per kilogram of body weight. Your healthcare provider may adjust your dose as needed.
Panic disorder:
Adults: First, 0.25 mg two times per day. Your healthcare provider may adjust your dose as needed. However, the dose is usually not more than 4 mg per day.
Pediatrics: A healthcare provider will determine the use and dose.
Xanax
The recommended starting dose for GAD is 0.25 or 0.5 mg thrice daily.
The healthcare provider may gradually increase the dosage to a maximum recommended total daily dose of 4 mg given in divided doses.
Anxiety:
For oral dosage forms (solution, tablets, or orally disintegrating tablets):
Adults: First, 0.25 to 0.5 mg thrice daily. Your healthcare provider may increase your dose as needed. However, the dose is usually not more than 4 mg per day.
Older adults: First, 0.25 mg two or three times daily. Your healthcare provider may increase your dose as needed.
Pediatrics: A healthcare provider will determine the use and dose.
Panic disorder:
For oral dosage form (ER tablets):
Adults: First, 0.5 to 1 mg taken in the morning once a day. Your healthcare provider may increase your dose as needed. However, the dose is usually not more than 10 mg per day.
Older adults: First, 0.5 mg is taken daily in the morning. Your healthcare provider may increase your dose as needed.
Pediatrics: A healthcare provider will determine the use and dose.
For oral dosage forms (solution, tablets, or orally disintegrating tablets):
Adults: First, 0.5 mg thrice daily. Your healthcare provider may increase your dose as needed. However, the dose is usually not more than 10 mg per day.
Older adults: First, 0.25 mg two or three times daily. Your healthcare provider may increase your dose as needed.
Pediatrics: A healthcare provider will determine the use and dose.
Beers' Criteria
The American Geriatrics Society publishes lists of medications that may be potentially dangerous in older adults. The list is called the Beers' Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adults, and it helps healthcare providers make prescribing decisions.
The updated 2023 guidelines strongly recommend avoiding benzodiazepines in older adults (65 and older). This is because of the risks of these medications, such as abuse, misuse, addiction, severe sedation, impairment, falls, fractures, car crashes, breathing problems, coma, and death.
However, certain benzodiazepines may be appropriate in specific individuals if the healthcare provider weighs the risks and benefits and determines that the benefits outweigh the risks.
If you are 65 and older, talk to your healthcare provider about the benefits and risks before taking a benzodiazepine medicine.
Alternative Treatment Options
In addition to medication (which may also include an antidepressant) for anxiety, you can try other things to help with anxiety symptoms.
Alternative options include:
Take time for yourself to do something you enjoy, such as reading a book or practicing relaxation
Eat healthy, balanced meals and drink enough water to stay hydrated. Avoid or limit alcohol and caffeine (both can worsen anxiety and panic attacks).
Get enough high-quality sleep. Practice good sleep hygiene.
Exercise (consult your healthcare provider before beginning a new exercise program): Guidelines for adults suggest 150 minutes of moderate-intensity physical activity per week (you can break this up into five 30-minute sessions), plus two days of strength-training exercises
Deep breathing
Try to keep a positive attitude.
Find ways to get involved in your community.
Keep a journal to help identify your anxiety triggers.
Side Effects & Safety
In addition to the black box warnings described above, there are some side effects to be aware of when taking a benzodiazepine such as Klonopin or Xanax.
Common Side Effects
Common side effects of both medications include but are not limited to:
Drowsiness
Impaired coordination
Lightheadedness
Dizziness
Lethargy
Confusion
Constipation
Difficulty speaking
Severe Side Effects
Serious side effects and their symptoms can include, but are not limited to, the following:
Anaphylaxis (severe allergic reaction): Get emergency medical help if you have urticaria (hives), difficulty breathing, or swelling of the face, lips, tongue, or throat
Abuse and dependence
Respiratory depression (slow and ineffective breathing)
Withdrawal reactions if the medication is stopped abruptly and not tapered gradually
Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening, or you think you have a medical emergency.
Who Should Avoid Klonopin or Xanax?
You should not take Klonopin if you:
Are allergic to clonazepam, any benzodiazepine, or any of the inactive ingredients in Klonopin
Have severe liver problems
Have acute narrow-angle glaucoma (a type of glaucoma that starts suddenly and can cause sudden and permanent vision loss)
You should not take Xanax if you:
Are allergic to alprazolam, any benzodiazepine, or any of the inactive ingredients in Xanax
Take certain antifungal medications, such as Nizoral (ketoconazole) or Sporanox (itraconazole)
Interactions: Klonopin vs. Xanax
Tell your healthcare provider about all of the medicines you take, including:
Prescription drugs
Over-the-counter (OTC) medicines
Vitamins
Supplements
While taking Klonopin or Xanax, do not start any new medications without approval from your healthcare provider.
Some interactions that apply to both Klonopin and Xanax include:
Alcohol
Opioid pain medications such as Percocet or OxyContin
Medications used for sleep, such as Ambien (zolpidem)
Monoamine oxidase inhibitors (MAOIs), such as selegiline
Muscle relaxants, such as Skelaxin (metaxalone) or Flexeril (cyclobenzaprine)
Tricyclic antidepressants, such as Elavil (amitriptyline) or Pamelor (nortriptyline)
Anticonvulsant medications, such as Dilantin (phenytoin) or phenobarbital
Antifungals, such as Nizoral (ketoconazole) or Sporanox (itraconazole)
This is not a full list of drug interactions. Other drug interactions may occur with Klonopin or Xanax. Consult your healthcare provider for more information about drug interactions and how they may affect you.
Summary
Klonopin (clonazepam) and Xanax (alprazolam) are two FDA-approved medications for treating adult anxiety disorders.
Klonopin can also be used to prevent seizures in adults and children. Both drugs are benzodiazepines and controlled substances. Therefore, these benzodiazepines have the potential for abuse and dependence and, thus, are not always safe for everyone.
Consult your healthcare provider for more information about these medications.
Frequently Asked Questions
How do I store Klonopin vs. Xanax?
Store Klonopin or Xanax at room temperature (between 68 and 77 degrees F), away from direct light, heat, and moisture. Do not store it in the bathroom.
Because these medications have a high risk of misuse (which can cause addiction, overdose, and death), store your medicine where no one can get to it and keep track of your pills so you know if any are missing.
Where can I go for more information on treating anxiety?
You can talk to your healthcare provider and ask for a referral to a mental health professional. If you are in immediate danger, you should call 911.
If you are in suicidal crisis or emotional distress, call or text 988 for the Suicide & Crisis Lifeline. You can also find other resources at the National Institute of Mental Health or Anxiety & Depression Association of America.
Read the original article on Verywell Health.
