Ativan vs Xanax vs Valium?

[jfpruitt]

This is a work related question for a new graduate that does case management. I work disability claims for SSA and just finished my nursing degree also. I came across something unusual today that I wanted to run by the veteran RNs because I haven't seen this before in the 5 years I've been working cases. I'm a little weak in my pharmacology and tried to find the answer in some drug books, but still unclear.

I have a clmt that is being prescribed Xanax, ativan and valium for panic attacks. In all of my 5 years in case management, I have yet to see a clmt prescribed all 3 of these by one MD. From what I have discovered, these are all virtually the same? Am I wrong here?

Is one stronger, weaker, faster acting than the others?

When I asked the clmt, she indicated that the Xanax and Valium was for "everyday" panic attacks, and the ativan was more fast acting? She said that the ativan was used when she had a severe unexpected attack that was not controlled by the Xanax or valium? They are all PO meds, so its not like its a hospital setting IV. I'm confused. I was under the impression that Xanax was the stronger of the three and the most 'habit' forming? Or is it the other way around? I tried to even consult a pharmacist who said they were all virtually the same drug except Ativan was stronger and valium was weaker, but Xanax was more habit forming? If Ativan was stronger, wouldn't it be more habit forming? I'm just confused and wanted to get your insight on this for those that use this in a clinical setting? Thanks in advance...

[NiceOnce]

There is a lot of good information in this thread already, so thanks in advance. I was wondering the same thing and learned that ativan is a much faster acting benzo than most. When comparing ativan vs xanax always remember that all the different types are almost equally addictive, and for long term use, I would stray far away.

[J-Swish]

These are all benzo's and can be habit forming. Withdrawals are extremely dangerous (suicidal thought, etc). I would know because I was prescribed Xanax years ago for insomnia but I stopped it cold turkey without tapering and...yeah it got really bad. When the effect wears off, you go into overdrive and perhaps more paranoia and amplified senses. Of course, this is not the same for everyone but it can happen.

These drugs either make you relaxed or sedate. In a sense, they can cause a "high" because once you're relaxed and calm, you would feel great that there is no anxiety around you and you just sort of blend in with your environment sort of like MJ.

[nursemike, ASN, RN]

I had a patient, once, in withdrawal from Benzos, and the doc commented that narcotic withdrawal makes you feel like you're going to die, but benzo withdrawal kills you. (I realize that's an oversimplification). I'm not sure any recent poster was asking, but all sorts of people look at these boards, so it might be worth mentioning that the term "narcotic" is sometimes used informally to refer to any controlled substance, as in it will be a narcotics division police officer who arrests you for selling them on the street. My only personal experience with benzodiazepines or narcotics was fairly recently, with Fentanyl and Versed for my second colonoscopy. They made me very sleepy and wore off very quickly (I had my first scope "naturally" and the discomfort was not bad, but once was enough.)

When I push IV ativan, it's usually for seizures, and it's usually awesome. I admitted a patient once who'd had three doses of 5mg Valium en route (for seizures). As soon as they weren't totally snowed, but still unconscious, one extremity began moving rhythmically. Pushed 2mg ativan, movement stopped and pt was wide awake.

Any CNS depressant can produce feelings of euphoria. I like bourbon, once I learned how to dose appropriately.