Clonazepam vs. Alprazolam

Instructor: Kaitlin Baker

Kaitlin has taught nursing students and has a master's degree in nursing leaderhsip, as well as a bachelor's degree in English literature.

This lesson will discuss 2 benzodiazepines: clonazepam (Klonopin) and alprazolam (Xanax). We will talk about why both medications are used, comparing and contrasting how they work, effectiveness, side effects, and safety.

Benzodiazepines: A Treatment for Anxiety

Pounding heart, sweaty palms, racing heart. Tom has felt these sensations before, but only during times when you might expect them, such as before a big football game or an important presentation at work. Now, Tom is simply sitting at his desk, finishing up the work day. He knows that at times these sensations can be normal reactions to stressful events, but today they are happening for seemingly no reason at all, and are incredibly severe. Tom feels hot, suffocated, and incredibly panicked.

For people who suffer from various forms of anxiety and panic disorders, these symptoms are all too familiar. Many times, patients will find relief from taking benzodiazepines, a class of medications primarily used to treat anxiety. Two common benzodiazepines are clonazepam (brand name Klonopin) and alprazolam (brand name Xanax).

Anxiety is a common reason for taking benzodiazepines.

These medications are both included in the same general class of drugs, but they also have their differences in the specific reasons they are used, in how they work, in their side effects, and their safety. When Tom goes to see his doctor, they have a discussion about these two medications to decide which would be better for him.

Benzodiazepines: The Whys and Hows

In general, benzodiazepines work by affecting the brain's neurotransmitters (chemicals released to aid communication between nerves in the brain). GABA (gamma-aminobutyric acid) is a neurotransmitter that calms down nerve activity, and it is thought that over-active nerves may be a contributing factor in anxiety. Both Klonopin and Xanax work by enhancing the release of GABA, which calms down over-active nerves.

There are differences in how Klonopin and Xanax work even though they are both benzodiazepines.

Why Use Xanax or Klonopin?

  • Xanax is prescribed for the treatment of panic and anxiety disorders. Xanax works by enhancing chemicals that calm the brain, essentially re-balancing chemicals that can become unbalanced in moments of anxiety.
  • Klonopin is used for panic disorders as well, but may also be effective in treating seizures, epilepsy, and insomnia. Klonopin works similarly to Xanax, but it does so in a slower, gentler way.

Dose Differences

In comparing the doses, 0.5 milligram (mg) of Xanax is approximately equal to 0.5 mg of Klonopin, so on the most basic level, they are equivalent. However, it may be worth noting that some people metabolize Xanax in a unique way. People of Asian descent and people with liver or kidney disease or even old age have a harder time breaking down and using Xanax in the body. Also, some medical conditions can affect how quickly Klonopin is eliminated from the body. For those reasons, the two drugs are not exactly equivalent.

Xanax tablets

Klonopin tablets

Effectiveness (and how long they last)

The effects of Klonopin last longer than the effects of Xanax in the body, which means that Klonopin does not need to be taken as frequently. Xanax must be taken regularly in order to maintain its effect and keep its levels constant in the blood. Xanax is absorbed, and therefore takes effect more quickly, making it ideal to treat acute panic attacks or anxiety that must be addressed at once.

  • Xanax is referred to as an intermediate-acting agent. It takes effect in minutes, reaches peak concentrations within 1 to 2 hours, and its effects can last up to 4 to 6 hours.
  • Klonopin is referred to as a long-acting agent. Its effect may not be felt for 1 to 4 hours, although speed of absorption depends on the person. Its effect may last up to 12 hours.

Xanax and Klonopin compared

In general, and depending on the patient's specific needs, Xanax is more ideal for use on an as-needed basis, and Klonopin is better for long-standing anxiety.

Side Effects

Both Klonopin and Xanax are not without side effects. It is important to note that not all side effects are certain to occur, and not every person experiences side effects. Both drugs can cause dependence, especially when taken at high doses and/or frequently over long periods of time. Dependence is not the same as addiction, but is a state in which the body adapts to the medication and develops a tolerance (needing more of a drug for a certain effect) and will potentially go into withdrawal (specific physical or mental symptoms, including agitation, tremors, muscle cramping, hallucination, and/ or seizures) if the drug is abruptly stopped. Dependence may accompany addiction, but dependence in and of itself does not equal addiction. Xanax has been noted to contribute to more severe withdrawal reactions when stopped abruptly.

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