Ativan vs. Serax

See how Ativan and Serax compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Ativan and Serax are both benzodiazepines approved for anxiety, but Ativan also comes as an injection and Serax is specifically approved for alcohol withdrawal symptoms.

  • Serax has no active metabolites, which is why it's often chosen for older adults or people with liver problems, while Ativan's metabolite can build up in kidney failure.

  • Ativan is usually taken once or twice a day, while Serax typically needs to be taken three to four times a day.

Ativan vs. Serax Drug Summary

Ativan

Ativan (lorazepam) is a benzodiazepine used to manage anxiety disorders and for short-term relief of anxiety symptoms. It comes as oral tablets, an oral concentrate, and an injectable form used for preanesthetic sedation. Typical maintenance doses range from 1 to 10 mg per day, usually split into multiple doses.

Serax

Serax (oxazepam) is a benzodiazepine used to manage anxiety disorders and for short-term relief of anxiety symptoms, including symptoms of alcohol withdrawal. It is available only as an oral capsule, taken three to four times a day. Typical doses range from 10 mg to 30 mg per dose depending on how severe the symptoms are.

Ativan vs. Serax Side Effects

Ativan

Most common
Sedation (up to 15.9%)
Dizziness (up to 6.9%)
Weakness (up to 4.2%)
Unsteadiness (up to 3.4%)

Serax

Most common
Drowsiness (up to 10%)
Dizziness (up to 5%)
Vertigo (up to 3%)
Headache (up to 3%)

Ativan vs. Serax Dosage

Ativan

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 0.05 mg/kg IM At the start
Maximum dose 1 to 10 mg/day If needed
Dose changes 2 increases As tolerated

Serax

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10-15 mg 3-4x daily At the start
Maximum dose 15-30 mg 3-4x daily If needed
Dose changes 1 increase As tolerated

Ativan vs. Serax Indications

Ativan

Ativan is FDA-approved to manage anxiety disorders, for short-term relief of anxiety symptoms, and for anxiety linked to depressive symptoms. Its injectable form is also approved for preanesthetic sedation. It's sometimes used off-label for insomnia related to anxiety or for status epilepticus.

  • Management of anxiety disorders

  • Short-term relief of anxiety symptoms

  • Anxiety associated with depressive symptoms

Serax

Serax is FDA-approved to manage anxiety disorders, for short-term relief of anxiety symptoms, and for relief of symptoms during alcohol withdrawal. It's now available only as generic oxazepam, since the brand-name product has been discontinued. It's sometimes used off-label for insomnia.

  • Management of anxiety disorders

  • Short-term relief of anxiety symptoms

  • Relief of alcohol withdrawal symptoms

Ativan vs. Serax Pros and Cons

Ativan

Ativan comes in tablet, oral concentrate, and injectable forms, plus an extended-release option for once-daily dosing. It has a long track record for anxiety and typically costs less out of pocket than Serax. Its main drawbacks are a metabolite that can build up in kidney failure and a sedation risk that increases with age.

Pros

  • Available as tablets, oral concentrate, and injection

  • Extended-release option (Loreev XR) for once-daily use

  • Decades of established clinical use for anxiety

  • Lower typical monthly cost, roughly $10 to $40 without insurance

Cons

  • Active metabolite builds up in kidney failure, unlike oxazepam

  • Sedation and unsteadiness risk increases notably with age

  • Not recommended for patients with hepatic or renal failure

  • Sedation reported in up to about 16% of patients in trials

Serax

Serax (oxazepam) has no active metabolites and a short half-life, which is why it's often chosen for older adults or people with liver impairment. It's also specifically approved for alcohol withdrawal symptoms. Its main drawbacks are a three-to-four-times-daily dosing schedule and a higher typical monthly cost than Ativan.

Pros

  • No active metabolites, useful for liver-impaired patients

  • Short half-life reduces buildup risk in the elderly

  • Considered a safer choice with significant hepatic impairment

  • Specifically approved for alcohol withdrawal symptoms

Cons

  • Requires dosing three to four times daily

  • Higher typical monthly cost, roughly $90 to $145 without insurance

  • Brand-name product discontinued; only generic oxazepam is sold

  • 15 mg capsules contain tartrazine dye, a concern for sensitive patients

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