Ativan vs. Valium

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

Key Takeaways

  • Ativan and Valium are both benzodiazepines approved for anxiety, but Valium also treats muscle spasms, alcohol withdrawal, and seizures, while Ativan's injectable form is used for preanesthetic sedation.

  • Ativan is typically dosed once to three times daily, while Valium often requires two to four doses a day depending on the condition being treated.

  • Both carry boxed warnings for abuse, dependence, and dangerous interactions with opioids, and neither is recommended for long-term use beyond four months without reassessment.

Ativan vs. Valium Drug Summary

Ativan

Ativan (lorazepam) is a benzodiazepine used to manage anxiety disorders and short-term anxiety symptoms, including anxiety linked to depression. It comes as an oral tablet, oral concentrate, or injection, with the injectable form also used for preanesthetic sedation. Typical oral dosing ranges from 2 to 6 mg a day, split into two or three doses.

Valium

Valium (diazepam) is a benzodiazepine used for anxiety disorders, acute alcohol withdrawal, muscle spasms, and as an add-on therapy for certain seizure disorders. It is taken as an oral tablet, with doses ranging from 2 mg to 10 mg given two to four times a day depending on the condition treated. It has been prescribed since the 1960s and remains one of the most widely used benzodiazepines.

Ativan vs. Valium Side Effects

Ativan

Most common
Sedation (up to 15.9%)
Dizziness (up to 6.9%)
Weakness (up to 4.2%)
Ataxia (1% to 10%)

Valium

Most common
Muscle weakness (most common)
Ataxia (most common)
Drowsiness (most common)
Fatigue (most common)

Ativan vs. Valium 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

Valium

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2 mg to 2.5 mg At the start
Maximum dose 5 mg to 10 mg If needed
Dose changes 2 increases As tolerated

Ativan vs. Valium Indications

Ativan

Ativan is FDA-approved for the management and short-term relief of anxiety disorders, including anxiety accompanied by depressive symptoms. Its injectable form is also approved for preanesthetic sedation. Doctors sometimes use it off-label for status epilepticus or insomnia related to anxiety.

  • Management of anxiety disorders

  • Short-term relief of anxiety symptoms

  • Anxiety associated with depressive symptoms

  • Preanesthetic sedation (injection)

  • Off-label: status epilepticus, insomnia

Valium

Valium is FDA-approved for anxiety disorders, acute alcohol withdrawal symptoms, and skeletal muscle spasm relief. It is also approved as an add-on treatment for certain convulsive disorders. Off-label, it is sometimes used for insomnia, panic attacks, or easing benzodiazepine withdrawal.

  • Management of anxiety disorders

  • Acute alcohol withdrawal symptoms

  • Adjunct for skeletal muscle spasm

  • Adjunct for convulsive disorders

  • Off-label: insomnia, panic attacks

Ativan vs. Valium Pros and Cons

Ativan

Ativan offers flexible dosing options, including tablets, oral concentrate, and injection, and is approved specifically for anxiety with depressive symptoms. It is not approved for muscle spasms, alcohol withdrawal, or seizures, and older adults may be more prone to sedation and unsteadiness.

Pros

  • Available as tablet, oral concentrate, and injection for varied use cases

  • Specifically approved for anxiety with depressive symptoms

  • Simpler dosing, typically two to three times daily

  • Typically costs roughly $10 to $40 a month without insurance, less than brand Valium

Cons

  • Not approved for muscle spasms, alcohol withdrawal, or seizures

  • No rectal or nasal spray formulation for emergency seizure control

  • Sedation and unsteadiness risk increases notably with age

Valium

Valium covers a broader range of approved uses, including alcohol withdrawal, muscle spasm, and seizure adjunct therapy, and is available in more delivery forms such as rectal gel and nasal spray. Brand-name Valium is considerably more expensive than Ativan, though generic diazepam is usually affordable.

Pros

  • Approved for alcohol withdrawal and muscle spasm relief, not just anxiety

  • Approved as an add-on therapy for convulsive disorders

  • Available in more forms, including rectal gel and nasal spray for emergencies

  • Generic diazepam typically costs roughly $10 to $20 a month without insurance

Cons

  • Brand Valium runs roughly $340 to $525 per 100 tablets without insurance

  • Often requires more frequent dosing, up to four times a day

  • Label does not report specific percentage rates for common side effects

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