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
Serax
Ativan vs. Serax Dosage
Ativan
Serax
| 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 |
| 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
| 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
| 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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