Diazepam vs. Alprazolam

Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

This lesson is going to go over some of the many similarities and differences between diazepam and alprazolam. You'll learn what they're used for, if they have different side effects, and what special precautions should be taken.

Diazepam vs. Alprazolam

Both can be used to help manage anxiety disorders. But one can be used to help save your life while the other one wouldn't be. One can also be used in panic disorders, but the other one isn't indicated for this.

Which one is which? Find out as we go over some of the many similarities and differences between two medications called diazepam and alprazolam.

Basic Differences and Similarities


In the U.S. these medications have numerous different brand names. Alprazolam is best known as Xanax or Niravam while diazepam is best known as Valium.

Dosage Forms

Alprazolam comes in oral dosage forms, including tablets, disintegrating tablets, extended release tablets, and as a liquid. Diazepam comes in an oral form as well, including as a tablet and liquid. But diazepam can also be injected into a muscle or into a vein. Diazepam can be administered rectally in a gel form as well.

Diazepam's levels can peak in about a minute within the body when given intravenously but may take up to 2.5 hours when given orally with food.

Alprazolam can peak in as little as an hour if given in immediate release form but can take up to 9 hours in the extended release form.



Both of these medications are broadly classed as benzodiazepines. They work by triggering a sequence of events that hyperpolarizes neurons. In other words, a person's brain cells enter a less excited state and a more stable state.

Uses, Contraindications, Side Effects, & Interactions


This is exactly what we'd want in people with anxiety disorders, as it will help the brain relax. Both drugs can be used to help treat anxiety disorders. Alprazolam can be used to manage panic disorders as well.

Diazepam has many other uses, however, beyond anxiety disorders. It can be used to manage seizures, including status epilepticus, which is a dangerously prolonged seizure. Diazepam can also be used to relieve skeletal muscle spasms, to relieve the symptoms of acute ethanol (alcohol) withdrawal, and to relieve anxiety prior to surgery.


As well as their uses, both medications have their contraindications, or scenarios where they shouldn't be used. Neither medication should be used in people with a documented history of allergic reactions to the drug or any other ingredient found in the dosage form. It's also possible that having a documented allergy to one benzodiazepine may make it more likely that the person will have an allergic reaction to a different benzodiazepine. This is known as allergenic cross-reactivity. Thus, people with such medical histories should use benzodiazepines with caution.

Neither diazepam nor alprazolam should be used in people with acute narrow angle glaucoma, which is a situation where the internal pressure of the eye increases suddenly and rapidly.

There are some differences in the contraindications, however. Alprazolam's use should also be avoided in people who are taking anti-fungal medications similar in their mechanism of action to ketoconazole and itraconazole.

Diazepam has numerous additional contraindications of its own, including: infants under the age of 6 months, people with myasthenia gravis, those with sleep apnea, sudden alcohol intoxication, individuals with severe liver impairment, and those with severe respiratory impairment.

Side Effects

The reason these contraindications exist is because people taking diazepam or alprazolam under their respective contraindications are more likely to have severe adverse effects. The adverse reactions for both of these medications are quite similar, and include everything from confusion and skin rashes. Differences in adverse reactions exist, however, as it appears people taking alprazolam are more likely to experience fluctuations in weight when compared to diazepam.


Side effects can also increase in frequency or severity when diazepam and alprazolam are used alongside medications with which they interact poorly. Neither medication should be used with pain relieving medications called opioids, unless absolutely necessary and with restricted doses and durations of treatment. This is because the use of benzodiazepines and opioids at the same time may lead to profound sedation, coma, and death.

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