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
Valium
Ativan vs. Valium Dosage
Ativan
Valium
| 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 | 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
| 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
| 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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