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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.
Luis Alvarez / Getty Images
Understanding Anxiety DisordersThe 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 DisorderThere are several types of anxiety disorders, including generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder.
Symptoms & CausesCommon 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 FactorsRisk 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.
TreatmentAnxiety 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 DisorderAn 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 StatisticsAccording 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 UsesAtivan 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 VariationsIn 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 WorksAtivan 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 UsesKlonopin 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 VariationsKlonopin 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 WorksAs 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 GuidelinesThe following will outline general dosing guidelines associated with Ativan and Klonopin.
AtivanAtivan 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:
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 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.
The following outlines basic safety protocols regarding the active use of Ativan vs. Klonopin.
AtivanWhen 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.
KlonopinKlonopin 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 EfficacyExperts 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 OptionsTalk 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 & PrecautionsAtivan 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 EffectsAtivan 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 EffectsExperiencing 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
Urticaria (hives)
Itching
Swelling of the face, eyes, and mouth
Wheezing
Shortness of breath
Ativan may also cause severe side effects such as:
Warning & PrecautionsConsult 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 InteractionSo 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:
SummaryAnxiety 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 QuestionsHow 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.
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Side Effect(s) Of Lorazepam
Review the side-effects of Lorazepam as documented in medical literature. The term "side effects" refers to unintended effects that can occur as a result of taking the medication. In majority of the instances these side-effects are mild and easily tolerable, however sometimes they can be more severe and can be detrimental. If the side effects are not tolerable adjusting the dosage or switching to a different medication can help to manage or overcome side effects. If you have any doubts or questions, we recommend seeking advice from your doctor or pharmacist. Most Common - Dizziness, weakness and unsteadiness.Central Nervous System - Drowsiness, memory loss, confusion, disorientation, depression, emotional state, suicidal thought/attempt, incoordination, weakness, convulsions/seizures, tremor, fainting, visual disturbances, slurred speech, change in libido, impotence, headache and coma.
Respiratory - Respiratory depression and worsening of obstructive pulmonary disease.
Gastrointestinal - Nausea, change in appetite, constipation and jaundice.
Hypersensitivity reactions - Shock.
Skin - Hair loss.
Other Precautions : *Avoid excess dosage.Arimidex Side Effects: What You Should Know
Arimidex (anastrozole) is a brand-name oral tablet that's prescribed for certain types of breast cancer in some people. As with other drugs, Arimidex can cause side effects, such as headache and bone pain.
Arimidex is approved to treat the following types of breast cancer in females* who have gone through menopause:
* Sex and gender exist on spectrums. Use of the term "female" in this article refers to sex assigned at birth.
Arimidex can cause certain side effects, some of which are more common than others. These side effects may be temporary, lasting a few days to weeks. But if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.
These are just a few of the more common side effects reported by people who took Arimidex in clinical studies. These side effects can vary depending on which condition the drug is being used to treat.
More common side effects in people taking Arimidex for early breast cancer include:
More common side effects in people taking Arimidex for locally advanced or metastatic breast cancer include:
* For more information about this side effect, see "Side effect specifics" below.
Mild side effects can occur with Arimidex use. But they didn't vary significantly among the types of breast cancer the drug is used to treat. This list doesn't include all possible mild side effects of Arimidex. For more information, you can refer to the medication's prescribing information.
Mild side effects that have been reported with Arimidex include:
These side effects may be temporary, lasting a few days to weeks. But if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.
Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking Arimidex and want to tell the FDA about it, visit MedWatch.
* For more information about this side effect, see "Side effect specifics" below.
Arimidex may cause serious side effects. But they didn't vary based on which type of breast cancer the drug is being used to treat. The list below may not include all possible serious side effects of Arimidex. For more information, you can refer to the medication's prescribing information.
If you develop serious side effects while taking Arimidex, call your doctor right away. If the side effects seem life threatening or you think you're having a medical emergency, immediately call 911 or your local emergency number.
Serious side effects that have been reported and their symptoms include:
* For more information about this side effect, see "Side effect specifics" below.
Long-term side effectsMost Arimidex side effects are temporary, lasting a few days to weeks.
However, in rare cases, Arimidex can cause some side effects that are long term. For example, decreased bone density and carpal tunnel syndrome can be long-term conditions that require treatment. Other long-term side effects that are described below in "Side effect specifics" include heart-related side effects and liver problems.
If your side effects last longer than a few days to weeks, bother you, or become severe, talk with your doctor or pharmacist.
Arimidex may cause several side effects. Here are some frequently asked questions about the drug's side effects and their answers.
What are the side effects of Arimidex after 5 years?If you have been taking Arimidex for 5 years, you may have fewer mild side effects than someone who recently started treatment. This is because some mild side effects last a short time.
Serious side effects of Arimidex are expected to be the same regardless of how long you take the drug. Certain side effects, such as decreased bone density, may last a long time. To learn more, see "Long-term side effects" above.
For more information about side effects of Arimidex, talk with your doctor.
How do Arimidex's side effects differ between males and females?Arimidex is not approved for use in males.* The drug has been studied for treating gynecomastia in male children ages 11 to 18 years. However, the treatment wasn't found to be effective for this purpose. Common side effects reported in the study include acne and headache.
To learn about side effects that Arimidex may cause in females,* you can refer to the rest of this article. You can also talk with your doctor or pharmacist.
* Sex and gender exist on spectrums. Use of the terms "male" and "female" in this article refers to sex assigned at birth.
Is hair loss a side effect of Arimidex?Hair loss wasn't reported as a side effect of Arimidex in clinical studies. But in very rare cases, a few people taking the medication reported hair thinning.
If you're concerned about hair loss or thinning while taking Arimidex, talk with your doctor or pharmacist. They may be able to recommend a treatment. Or your doctor may suggest a medication other than Arimidex.
Can Arimidex cause any permanent damage?Most Arimidex side effects are temporary, lasting a few days to weeks. But in rare cases, Arimidex can cause some side effects that are long term. To learn more, see "Long-term side effects" in the "Serious side effects of Arimidex" section above. You can also speak with your doctor or pharmacist.
Should I expect liver problems, such as liver toxicity, with Arimidex?Liver problems weren't reported in clinical studies of Arimidex. But rare cases have been reported since the medication was approved. Because these cases happened outside of the studies, it's not known for certain if Arimidex or another factor caused the liver problems. Another factor could include using a different medication during Arimidex treatment.
The majority of people who reported liver problems with Arimidex didn't experience any symptoms. In most cases, the only change noted is a slight increase in liver enzymes. However, in very rare instances, more severe problems such as hepatitis can occur.
Symptoms of severe liver problems can include:
Liver toxicity refers to injury to your liver due to a medication. A breast cancer drug called Soltamox (tamoxifen), which is similar to Arimidex, has been known to cause liver toxicity in some cases.
If you develop symptoms of liver problems while taking Arimidex, talk with your doctor. They'll likely have you stop taking the medication and suggest other treatments for your condition.
Learn more about some of the side effects that Arimidex may cause.
Heart-related side effectsArimidex can cause new or worsening heart-related side effects. These include heart attack, angina (chest pain or tightness), and cardiovascular problems caused by lack of blood flow to the heart. (The term "cardiovascular" refers to the heart and blood vessels.)
The side effects weren't common in clinical studies of the drug. They were most common in people who already had heart disease.*
Symptoms of heart-related side effects can include:
Some studies have shown that drugs such as Arimidex aren't any more likely to cause heart-related side effects than a placebo. (A placebo is a treatment with no active drug). But other studies have shown the opposite. These studies showed that Arimidex and similar drugs may be more likely to cause heart-related side effects, including heart failure and cardiotoxicity (heart damage).
* For details, see the "Precautions for Arimidex" section below.
What you can doIf you have heart disease, be sure to talk with your doctor before you start taking Arimidex. They may decide that a different treatment is a better choice for you.
HeadacheHeadache is a possible side effect from Arimidex treatment. This was commonly reported in clinical studies of the drug.
What you can doTalk with your doctor or pharmacist if you develop headaches while taking Arimidex. They may recommend a treatment such as an over-the-counter pain (OTC) reliever. This can include acetaminophen (Tylenol) and ibuprofen (Advil, Motrin). Keep in mind that you should not take any other medications, including OTC ones, with Arimidex unless you first speak with your doctor. They can tell you which drugs are safe for you to take with Arimidex.
Bone painIt's possible to have bone pain with Arimidex treatment. This was a common side effect reported in clinical studies.
What you can doTalk with your doctor if you develop bone pain while taking Arimidex. They may recommend a treatment such as an OTC pain reliever. Examples include acetaminophen and ibuprofen. Keep in mind that you should not take any other medications, including OTC ones, with Arimidex unless you first speak with your doctor. They can tell you which drugs are safe for you to take with Arimidex.
If your bone pain does not go away, your doctor will likely recommend trying a treatment other than Arimidex for your condition.
Allergic reactionAs with most drugs, Arimidex can cause an allergic reaction in some people. But this was very rare in clinical studies.
Symptoms can be mild or serious and can include:
For mild symptoms of an allergic reaction, call your doctor right away. They may recommend ways to ease your symptoms and determine whether you should keep taking Arimidex. However, if your symptoms are serious and you think you're having a medical emergency, immediately call 911 or your local emergency number.
Be sure to talk with your doctor about your health history before you take Arimidex. This drug may not be the right treatment for you if you have certain medical conditions or other factors that affect your health. The conditions and factors to consider include:
High cholesterol. Taking Arimidex can increase your cholesterol levels. Your doctor will monitor your levels while you take Arimidex. If you already have high cholesterol, they may monitor you more closely. If you take medication for high cholesterol, your doctor may adjust the dosage if your cholesterol levels rise.
Ischemic heart disease. Before you take Arimidex, talk with your doctor about any heart problems you may have. If you have angina or have had a heart attack, your heart problems may worsen if you take Arimidex. Your doctor may recommend a different treatment for your condition.
Osteoporosis. Taking Arimidex can reduce the strength of your bones. This can worsen osteoporosis if you already have the condition. Worsened osteoporosis may increase your risk of broken bones. If you have osteoporosis, your doctor may prescribe a treatment to help protect your bones while you take Arimidex.
Severe liver problems. There have been a few reports of liver problems, such as hepatitis, since Arimidex was approved. If you have a liver problem, taking Arimidex may make it worse. Before you take the drug, talk with your doctor about any liver problems you may have. They may recommend a different treatment for your condition.
Allergic reaction. If you've had an allergic reaction to Arimidex or any of its ingredients, your doctor will likely not prescribe Arimidex. Talk with your doctor about which other treatments may be better choices for you.
Alcohol with ArimidexThere's no known direct interaction between drinking alcohol and taking Arimidex.
However, alcohol could worsen some side effects of Arimidex, including headache, nausea, and tiredness. The combination of alcohol and Arimidex may also increase your risk of osteoporosis.
If you drink alcohol, ask your doctor how much, if any, is safe for you to consume during your Arimidex treatment.
Pregnancy and breastfeeding while taking ArimidexHere's some information on pregnancy, breastfeeding, and Arimidex.
Pregnancy. Arimidex may harm a fetus if taken during pregnancy due to how the drug works. Arimidex hasn't been studied in pregnant people. If you can become pregnant, your doctor will order a pregnancy test before you start taking the medication.
You should use birth control while taking Arimidex and for 3 weeks or more after your last dose. Your doctor can recommend a birth control method that's suited for you.
Breastfeeding. You should not breastfeed while taking Arimidex and for at least 2 weeks after your last dose. The drug hasn't been studied to see how it affects milk production or a child who's breastfed. If you're breastfeeding or considering it, talk with your doctor. They can advise you on the best ways to feed your child and other treatment options.
Side effects can occur while taking Arimidex, but they're usually mild. Most mild side effects of the drug go away with time and don't require medical attention.
You should talk with your doctor right away if you become pregnant while taking Arimidex.
If you'd like to learn more about Arimidex, talk with your doctor or pharmacist. They can help answer any questions you have about side effects from taking the drug.
Besides talking with your doctor, you can do some research on your own. These articles might help:
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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