Valium vs. Xanax: Which Is Better for Anxiety?
Medically reviewed by Lindsay Cook, PharmD
Valium (diazepam) and Xanax (alprazolam) are benzodiazepine medications that work by enhancing the effects of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter made in the brain.
Both medications can reduce anxiety symptoms. Clinical trials show that Xanax is as effective as Valium, and sometimes more effective, in alleviating anxiety symptoms.
Apart from treating anxiety, Xanax is also used to manage panic disorders, while Valium is prescribed for muscle spasms, alcohol withdrawal, and seizure disorders.
However, long-term use of these drugs is typically avoided due to the potential for dependence, with Xanax posing a higher risk.
This article will discuss the similarities and differences between Valium and Xanax.
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Boxed Warnings
The Food and Drug Administration (FDA) requires both Xanax and Valium labels to carry boxed warnings, which are the agency's highest safety warnings for a medication.
Before starting either medication, it's important to understand the potential safety considerations, which include the following:
Taking Xanax or Valium with alcohol, opioids, or other substances that make you drowsy (including street drugs) can cause severe drowsiness, slowed breathing, coma, or death.
There is a potential for abuse, misuse, and addiction with Xanax or Valium. Do not increase your dose, take it more frequently, or use it for longer than prescribed. Keep the pills in a safe place to prevent others from taking them.
Do not suddenly stop taking either Xanax or Valium. Doing so can result in severe and even life-threatening withdrawal symptoms such as seizures, sudden and significant changes in mood, depression, hallucinations, hyperactivity, delusions, and suicidal thoughts or actions. Seek immediate medical assistance if you experience any of these symptoms.
Uses of Valium vs. Xanax
Xanax is a prescription medication used to treat anxiety disorders, panic disorders with or without agoraphobia (anxiety causing a fear of being trapped, experiencing a panic attack in public, or being unable to get help if something goes wrong) and for the short-term relief of anxiety symptoms.
Valium is a prescribed for the following reasons:
To treat anxiety disorders/short-term relief of the symptoms of anxiety
To relieve the symptoms of alcohol withdrawal
Along with other medicines, for the relief of muscle spasms
Along with other medicines, to treat seizure disorders
Xanax and Valium work by binding to receptors in the central nervous system. This binding increases the inhibitory effects of GABA, a neurotransmitter involved in anxiety.
How Long Do Valium and Xanax Take to Work?
After taking it orally (by mouth), Valium concentration peaks in your blood within one to 2.5 hours. It starts working within 15 to 60 minutes, but it may take a week or two to feel the full effects. In addition, Valium is long-lasting, with a duration of action of more than 12 hours.
Xanax peaks in your blood within one to two hours after an oral dose. You may start to feel its effects within 30 minutes, and it can last for about six hours. Symptom relief can be expected as early as within the first week.
Which Is More Effective?
Studies show Xanax was at least as effective as Valium, and some even show it more effective in treating anxiety symptoms.
Specifically, in six studies that used a randomized, double-blind, placebo-controlled design, three studies found Xanax and Valium to work as well as each other.
One study found no difference between active drugs and placebo due to the small number of participants. Two studies found Xanax to be more effective than Valium.
It is important to work closely with your healthcare provider to determine the most suitable treatment for you.
When selecting an appropriate medication, your provider will consider a range of factors, including:
Potential side effects
Cost
Your medical history
Other psychiatric conditions you may have
Potential drug interactions
Pharmacokinetic parameters, which include drug absorption, distribution, metabolism, and elimination
Your age
Strength of evidence supporting the use of the medication
Side Effects
Valium and Xanax are both benzodiazepines and have similar side effects. However, because Valium has a longer half-life than Xanax, its side effects may last longer.
You may experience the following while taking either of these medications:
Confusion
Blurred vision
Dizziness
Drowsiness (less frequency with alprazolam than with diazepam)
Dry mouth
Elevated liver enzymes
Excessive drooling
Inability to empty the bladder completely
Irritability
Libido changes
Menstrual irregularities
Rash
Slowed or slurred speech
Tiredness
Severe reactions while taking either Valium or Xanax include:
Dependency or substance abuse: This occurs when you build up a tolerance to a drug over time and can result in feeling the need to use the drug in order to function.
Low blood pressure (hypotension)
Seizures
Slow or labored breathing
Increased depression
Addiction Risk
Both Xanax and Valium have the potential to cause dependence, abuse, and addiction.
Three studies found the dependency risk to be higher with Xanax than with Valium when given at doses equal in potency (strength).
National data on emergency room visits and prescriptions also show that Xanax is more likely to be misused and result in hospitalizations.
Xanax has a higher risk of addiction compared to Valium due to its properties, withdrawal potential, and potency. For instance, Xanax is absorbed faster in the body than Valium and has a smaller volume of distribution. This makes it more prone to abuse, as it absorbs quickly in the body and has a shorter duration, causing people to take more frequent doses.
Withdrawal symptoms from Xanax also tend to be worse and occur sooner due to its shorter half-life.
On the other hand, Valium remains in the body for a longer time and can take longer to be fully eliminated. This results in fewer withdrawal symptoms compared with Xanax. Additionally, Xanax is more potent than Valium, with 1 milligram (mg) of Xanax being equal to 10 mg of Valium.
How to Take Valium and Xanax
| Valium | Xanax |
Available strengths | Tablet: 2 mg, 5 mg, 10 mg; solution: 5 mg per 5 milliliters (mL), 5 mg per mL (concentrate) | Tablet: 0.25 mg, 0.5 mg, 1 mg, 2 mg |
Recommended dosing | Anxiety disorder: 2–10 mg two to four times a day, or 2–10 mg injection every three or four hours as needed; alcohol withdrawal: 10 mg, three or four times during the first 24 hours, reducing to 5 mg, three or four times daily as needed; relief of muscle spasm: 2–10 mg, three or four times daily, or every three to four hours as needed; larger doses may be required for tetanus; seizure disorder: 2–10 mg two to four times a day | Generalized anxiety disorder: 0.25–0.5 mg three times a day; depending on response, the dosage may be adjusted every three to four days up to a maximum of 4 mg daily Panic disorder: 0.5 mg three times a day; depending on the response, the dosage may be increased every three to four days up to 1 mg daily |
Generic availability | Yes | Yes |
Dosing in children and adolescents | The recommended starting dosage in children is 1–2.5 mg, three or four times daily. Dose may be increased gradually as needed and tolerated. | Not approved for use in children or adolescents |
Dosing in older adults (65 and above) | The recommended starting dosage in older adults is 2–2.5 mg, one or two times daily. Dose may be increased gradually as needed and tolerated. | The recommended starting dosage in older adults is 0.25 mg, given two or three times daily. This may be gradually increased if needed and tolerated. |
Who Should Not Take Them?
You should not take Valium if:
You are allergic to it or any of its ingredients.
You have severe liver damage.
You have myasthenia gravis, respiratory failure, or sleep apnea syndrome.
Valium should be used with caution in people with:
Concurrent alcohol use
Depression
Older or frail adults
History of alcohol abuse or drug abuse
Kidney damage
Mild to moderate liver damage
Porphyria (buildup of natural chemicals called porphyrins in the body)
Respiratory disease
Seizure history
Slowed central nervous system
You should not take Xanax if:
You are allergic to it or any of its ingredients.
You are breastfeeding.
Xanax should be used with caution in people with:
Concurrent alcohol use
Depression
Older or frail adults
History of alcohol abuse or drug abuse
Liver damage
Respiratory disease
Seizure history
Sleep apnea
Slowed central nervous system
A smoking habit
Elevated stomach pH (dissolvable form)
Decreased salivary flow (dissolvable form)
Phenylketonuria (phenylalanine-containing form)
Summary
Valium and Xanax are both benzodiazepine medications that work by enhancing the effects of GABA in the brain, reducing anxiety symptoms. However, it is important to use these medications with caution due to the risk of dependence, and long-term use should be avoided.
Both medications have boxed warnings about the risks of abuse, misuse, and addiction, as well as potentially fatal side effects when combined with other substances. Stopping the medication suddenly can also cause serious and life-threatening withdrawal reactions. You may experience similar side effects while taking either medication, such as confusion, dizziness, drowsiness, and dry mouth.
Clinical trials show that Xanax is as effective as Valium—and sometimes more effective—when it comes to reducing anxiety symptoms. While Valium lasts longer in the body, Xanax has a higher risk of addiction.
It is important to work with your healthcare provider to determine the most suitable treatment plan and to avoid drug interactions.
Frequently Asked Questions
Does Xanax or Valium last longer?
When taken orally, Valium lasts for more than 12 hours, while Xanax only lasts for about six hours. Additionally, Valium has a longer half-life compared to Xanax, which means it remains in the body for a longer period and is not metabolized as quickly as Xanax.
Moreover, Valium has an active metabolite called desmethyldiazepam that accumulates in the body, further prolonging its effects. Xanax does not accumulate any metabolites.
What other options are there to treat anxiety?
Other treatment options for anxiety include:
Psychotherapy like cognitive behavioral therapy (CBT), cognitive therapy, and applied relaxation
Medications like selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and other benzodiazepines like Ativan (lorazepam) or Klonopin (clonazepam)
The combination of psychotherapy and medication
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