Benzodiazepines are medicines prescribed for treating conditions like insomnia, seizures and anxiety. This drug class works by enhancing the effects of gamma-aminobutyric acid or GABA, creating a calming effect on the brain and nervous system.
While benzodiazepines can be very effective for relief in the short term, they also have a risk of dependence and other side effects.
Among the many benzodiazepines available, Valium (diazepam) and Xanax, alprazolam, are two of the most widely used.
Despite their similar classifications, these medications have distinct differences in uses, effects and potential risks. Understanding these distinctions is needed for anyone considering treatment options for anxiety or related disorders.
We’ll explore the differences when comparing Valium vs. Xanax, providing insights into each.
What Are Valium and Xanax?
Valium is the brand name for diazepam. This benzo is commonly prescribed to treat:
- Anxiety
- Muscle spasms
- Seizures
It helps decrease feelings of anxiety and tension, and Valium is also used in certain situations to manage alcohol withdrawal symptoms and as a sedative before medical procedures.
Approved by the FDA in 1963, Valium was one of the first benzodiazepines introduced for medical use.
The rapid onset of action and effectiveness made it a popular choice. Over the years, Valium has become a well-recognized mediation in the mental health community. However, use has declined in favor of newer alternatives that may have fewer risks of dependence.
Xanax, known generically as alprazolam, is another widely prescribed benzo used primarily for managing panic and anxiety disorders.
It’s especially effective for treating generalized anxiety disorder (GAD) and panic attacks because it works quickly.
Xanax gained FDA approval in 1981, and it’s especially useful for individuals experiencing acute anxiety episodes.
Mechanism of Action
GABA is the primary inhibitory neurotransmitter in the brain, and Valium works by interacting with it. When someone takes Valium, it binds to a specific site on the GABA receptor, increasing its affinity for GABA.
The increased interaction amplifies the effect of GABA, causing a calming effect on the central nervous system.
Because of its potent effects, Valium has benefits, but it also carries the risk of drowsiness, sedation and impaired coordination. The risk is greater when it’s used in higher doses or blended with other substances that depress the central nervous system.
Xanax also acts on the GABA receptors in the brain, but it’s known for its rapid action onset and relatively short half-life compared to Valium.
The potency and speed of the effects of Xanax can lead to a higher potential for dependence and withdrawal symptoms, especially when used for extended periods. Due to these risks, healthcare providers usually only recommend Xanax for short-term management rather than a long-term anxiety solution.
Both Valium and Xanax leverage the calming properties of GABA. Still, their differing mechanisms and effects on the central nervous system highlight the importance of understanding which medication might be more suitable based on individual treatment needs.
Differences in Uses
Valium is often prescribed for:
- Generalized anxiety disorder (GAD)
- Muscle spasms
- Seizure disorders
- Management of alcohol withdrawal symptoms
Because of the longer half-life, Valium may be preferred when a person needs extended relief from anxiety or muscle relaxation.
Xanax is primarily used to treat:
- Anxiety disorders
- Panic disorders
When someone needs quick relief, Xanax may be preferred over Valium or other benzos.
As well as their common medical uses, both Valium and Xanax may be prescribed off-label for conditions not specifically approved by the FDA.
Off-label Valium uses include:
- Insomnia
- Depression
- Phobias
- Muscle tension in conditions like fibromyalgia
- Preoperative anxiety
- Conditions involving muscle spasticity
Xanax is often used off-label to treat:
- Insomnia
- Anxiety associated with depression
- Post-traumatic stress disorder (PTSD)
- Specific phobias
- Situational anxiety
Dosage and Administration
When Valium is prescribed, typical starting doses range from 2 mg to 10 mg, taken two to four times a day, depending on symptom severity. For muscle spasms, a common starting dose could range from 5 mg to 10 taken three times a day.
Depending on a patient’s response, doses might be gradually increased by 2 mg to 5 mg as needed, but they typically shouldn’t go above 30 mg for anxiety or muscle spasms. Higher doses may be required for seizure disorders.
Xanax dosing guidelines typically start with 0.25 mg to 0.5 mg. For panic conditions, the initial dose may be more than that.
Factors that influence dosage include:
- Age: Older adults may require lower doses because of higher benzodiazepine sensitivity and the risk of side effects like cognitive impairment and sedation.
- Weight: Body weight can impact drug metabolism and distribution, with heavier people potentially requiring higher doses.
- Medical history: A patient’s medical history plays a critical role in determining dosage. Someone with a history of a substance use disorder or kidney or liver impairment may need careful monitoring and dosage adjustments. The same can be true for someone with a history of respiratory issues.
Side Effects and Risks
When comparing Valium vs. Xanax, both share a range of common side effects, but the intensity and prevalence of these can vary between the two.
Common side effects of Valium include:
- Drowsiness
- Dizziness
- Fatigue
- Impaired coordination
- Blurred vision
- Dry mouth
- Appetite changes
- Constipation
Xanax is associated with similar side effects, and some users also experience euphoria, contributing to its potential for abuse. Other side effects can include:
- Headache
- Nausea
- Changes in libido
- More immediate sedation compared to Valium
Both Valium and Xanax carry serious risks, especially related to dependence and withdrawal.
- Dependence: Both medicines have a potential for physical and psychological dependence, especially when used over long periods or at high doses. Patients may develop tolerance, requiring increasing doses to achieve the same therapeutic effect.
- Withdrawal symptoms: If dependence occurs, abruptly discontinuing either medication can lead to withdrawal symptoms. Common withdrawal symptoms can include irritability, insomnia, anxiety and, in severe cases, seizures and delirium. The dangerousness and length of withdrawal can vary based on how long the drug is used and the dosage.
- Overdose potential: Both Valium and Xanax can lead to overdose, especially when combined with depressants like opioids or alcohol.
Long-term Valium or Xanax use raises considerations that patients and healthcare providers have to address.
As mentioned, extended use can lead to tolerance where higher doses are required for similar effects and dependence, which complicates efforts to stop using either drug. For this reason, healthcare providers usually recommend using the medications for the shortest duration possible.
Treatment for Benzodiazepine Addiction
If you or a loved one is struggling with anxiety or substance use, understanding your treatment choices can help you make educated decisions about your health. At First Step Behavioral Health, we offer comprehensive support tailored to your needs. Reach out to discover how we can support you on your journey to recovery.
References:
- National Institute of Health (NIH): Diazepam
- U.S. Food and Drug Administration (FDA): Valium tablets
- NIH: Alprazolam
- Psychiatry Online: Benzodiazepine Use and Misuse Among Adults in the United States
