Ativan vs Xanax vs Valium?

  1. 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...
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    About jfpruitt

    Joined: Aug '01; Posts: 214; Likes: 1


  3. by   P_RN
    This sounds strange to me. I've never taken Xanax, but IV valium caused me to have PVCs and I was told to tell any anes. about that. I take 1/2 mg of Ativan if I can't sleep and that seems pretty strong.
  4. by   Shamrock
    I would be puzzled also as to why
    someone would have a prescription
    for all three. I do not believe any one
    of the mentioned drugs are any less
    habit forming than any of the others.
    Is she on scheduled doses or are they
    PRN? Can you contact the physicians
    office and get her/his rationale for these choices? Your client must have
    the stamina of a horse if she can take all three at the same time!!
  5. by   yannadey
    I've had clients on daily Valium with either prn Xanax or Ativan for severe agitation but never all three, you should call her Dr. & let him explain the rationale.
  6. by   PhePhe
    My doctor tried me on all 3 of those bennies when I was suffering from depression. To me, they were all the same, I got the same mild effect from all of them. I am of the opinion that they are NOT strong enough when someone is having a panic attack unless you take a big dose. I was dissappointed in all of them.
  7. by   Scavenger'sWife
    I totally agree with yannadey. The MD should be called. He probably did NOT mean for this pt to take all 3 of these drugs. All of them are benzodiazepines and have virtually the same use and side effects. Xanax is mostly used for depression. Valium is used for relief of anxiety, alcohol withdrawal and some seizure disorders. (And I have seen it given as an adjunct med for muscle spasms.) The bad thing about Xanax is that is has an active metabolite that accumulates with prolonged use in patients with renal or hepatic dysfunction. This can result in respiratory depression or even coma. Ativan is usually used for short-tern relief of anxiety or for pre-op sedation. It is approved for anxiety disorders long-term also, so I would really question it's use together with the Valium.

    Ativan has a slightly shorter onset if given PO, but isn't really "stronger". But since it is frequently given IV, it has a very quick onset in that case, and may be therefore preferred.

    They all have a potential for abuse and are all scheduled drugs. So again, call the MD. My guess is the patient may have told the doc that one of the drugs wasn't "working" and he wanted her to try one of the others, not take all of them!
  8. by   Shamrock
    [QUOTE]Originally posted by PhePhe
    [B]My doctor tried me on all 3 of those bennies when I was suffering from depression.

    At the same time??

    xanx (alprazolam)
    • func. class: anti-anxiety
    • chem class: benzodiazepine
    • action: depresses subcortical levels of the cns, including limbic system, reticular formation.
    • uses: anxiety, panic disorders, anxiety with depressive symptoms
    • pharmacokinetics: po: onset 30 min, peak 1-2 hr, duration 4-6 hr, therapeutic response 2-3 days, half life 12-15 hrs

    valium (diazepam)
    • func. class: anti-anxiety
    • chem. class: benzodiazepine
    • action: potentiates the actions of gaba, especially in limbic system, reticular formation; enhances presympathethic inhibition, inhibits spinal polysynaptic afferent paths.
    • uses: anxiety, acute alcohol withdrawal, adjunct in seizure disorders; preoperatively as a relaxant. skeletal muscle relaxation; rectally for acute repetitive seizures.
    • investigational uses: panic attacks
    • pharmacokinetics: po: rapidly absorbed. onset 1/2 hr, duration 2-3 hr; crosses the blood brain barrier; half-life 20-50 hrs.

    ativan (lorazepam)
    • func. class: sedative, hypnotic; anti-anxiety
    • chem class: benzodiazepine
    • action: potentiates the actions of gaba, especially in system adn reticular formation.
    • uses: anxiety, irritability in psychiatric or organic disorders, preoperatively, insomnia, adjunct in endoscopic procedures.
    • pharmacokinetics: po: onset 1/2 hr, peak 1-6 hr, duration 24-48 hr; half-life 14 hr.

    mosby's 2000 nursing drug reference

    so it would appear that even though all three are benzodiazepines...all three work differently on the cns, limbic, & gaba systems. as a result, there's a difference in the onset, peak, duration, & half-life of each. it also would appear that valium is the only one that crosses the blood brain barrier & have the longest half life. in-addition to ativan being an anti-anxiety, it's also a sedative & hypnotic med as well. ativan has also been used in seizure disorders as well...but that wouldn't be the purpose in this case.

    hope this helps some ~ cheers!
  10. by   FROGGYLEGS
    Ativan can also be used sublingually for a more rapid onset.

    To the best of my understanding Xanax shouldn't be used for an "extended" period of time. Ativan is used for long term therapy. Although I do know folks who have taken Xanax regularly for years.

    I haven't ever heard of using them together myself. I have seen patients take Librium, which is sort of a delayed release benzo and also have a PRN ativan or xanax.

    Here lately I haven't seen many people on Xanax and even fewer on Valium. It would seem that Ativan is becoming the norm.

    Also, Ativan seems to be the milder of the three.
  11. by   jfpruitt
    Thanks for the info. I talked with the clmt again, and she doesn't take them all at once, but has prescriptions for all three and just takes them prn. She said the doctor told her to use the Ativan first, then the Xanax, then Valium last. Of course, not all my clmts are the best historians, so, I may need to call the MD to clarify his specific orders. I still haven't got a clear answer as to which one is strongest of the 3. Only that Ativan is the fastest.
  12. by   nimbex
    Well, all three ARE habit forming, but with a patient with an anxiety disorder, they are ordered anyway.

    Everyone responds differently to narcotics, period. But I have found that scheduled doses work the best, with a designated PRN. such as ativan 1 mg. QID with xanax .25 mg BID then valium 5 mg. Q6hr. prn.

    With scheduled doses, you work to eilimatate the anxiety and hold on to one for break through... there must be one or two meds to maintain a therapudic level to help this patient cope.

    Addiction is a varriable response that is measured once success in managing lifestyle has been achieved., not before, usually added with therapy to teach copig mechanismims to decrease the lenght of medication therapy.
  13. by   Nurse Nevada
    I've heard that Xanax causes loss of memory. Anyone familiar with this?
  14. by   jfpruitt
    This may be a stupid question coming from a new grad, but are all 3 considered narcotics? I was just thinking something like hydrocodone or percocet was a narcotic??? I guess I'm nieve, but what is the appeal of these drugs from a non-therapeutic standpoint? Do they make you high or something? I've never taken any of these. I can understand the addiction behind pain meds b/c they do make a person "feel good", but not sure how that works with these.

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