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Medical News Today: What is the difference between clonazepam and Xanax?

Xanax and clonazepam are both medicines that affect a person’s central nervous system by slowing it down. They belong to a family of drugs called benzodiazepines. Doctors tend to prescribe them to treat anxiety and panic disorders.

The most common use of Xanax is as an anti-anxiety medication. Created in 1969 by the pharmaceutical company Upjohn, there are now more than 50 million prescriptions for Xanax written each year. Xanax is the brand name of a drug called alprazolam.

Clonazepam is used to treat seizure disorders, among other things. It is an anticonvulsant and antiepileptic medication. Doctors may also prescribe clonazepam for panic disorder.

Xanax and clonazepam affect the central nervous system (CNS) and have the potential for abuse, with some people becoming dependent on them.

What are they usually used for?

Xanax and clonazepam pill bottles on keyboard with stethoscope.
A doctor may prescribe Xanax or clonazepam to treat panic discorders.

Xanax is a useful medication for people who experience panic attacks. The drug helps to relieve the symptoms and reduce the frequency of attacks.

Some doctors prescribe Xanax for depression, but there is limited evidence that it is effective unless the person also has anxiety alongside depression.

Clonazepam, which is available under the brand name Klonopin, is also a benzodiazepine. Doctors use it to treat seizure disorders in both adults and children. It can help address chemical imbalances in the brain and can also treat panic attacks.

Taking clonazepam increases a person’s levels of gamma-aminobutyric acid (GABA), a chemical that sends signals around the CNS.

A lack of GABA can cause people to become excitable and may lead to panic attacks or seizures. More GABA in the body helps to reduce instances of panic attacks and seizures.

How do they differ?

At first glance, Xanax and clonazepam are very similar. Both medicines are benzodiazepines, CNS depressants, and most often used to treat anxiety or panic attacks.

Both are short-acting drugs, but clonazepam stays in the body longer than Xanax. The half-life for Xanax is between 6 to 25 hours, while for clonazepam it is 22 to 54 hours.

Clonazepam can also treat seizures where Xanax does not. Both drugs have their different off-label uses, as described below.

Dosage comparison

Dosages usually differ, depending on the individual, and what a doctor is trying to treat.

Clonazepam dosage

For panic and anxiety, the dosage for adults is 0.25 milligrams (mg) twice a day.

A doctor can increase the dosage in increments of 0.125 mg to 0.25 mg every 3 days until the panic is under control. The maximum dose does not usually exceed 4 mg per day.

For seizures, the dosage for adults is 0.5 mg three times a day. A doctor can increase the dosage in increments of 0.5 to 1 mg until the seizures are under control. The maximum dose should not exceed 20 mg per day.

Xanax dosage

For anxiety disorders, the dosage for adults typically starts at 0.25 to 0.5 mg three times per day. A doctor may incrementally increase the dosage to maximize the effect. The maximum dose does not usually exceed 4 mg per day.

For panic disorders, the required dose of Xanax may exceed 4 mg per day.

Controlled trials involving 1,700 people showed that Xanax might work for panic disorder where participants were given doses between 1 to 10 mg per day.

Changing dosage

Whether prescribing clonazepam or Xanax, a doctor will usually start at the lowest possible dosage, regularly reassess the dosage, and consider reducing it, for example, if panic attacks stop.

If a doctor advises reducing the dosage, they must ensure this is done slowly. If a person stops taking either drug abruptly, it could result in withdrawal symptoms.

Both Xanax and clonazepam typically begin taking effect after a few hours or days of starting the medication.

A dose of Xanax will affect a person for a few hours. A dose of clonazepam can last around three times longer.

Benzodiazepine dependence

Long-term use of benzodiazepines can lead to dependence on these drugs, particularly if a person uses them for longer than 6 months.

As Xanax remains in the body for less time than clonazepam, it may carry a higher risk of dependency.

It is critical that a person does not stop taking either drug suddenly. Doing so can lead to adverse effects, such as life-threatening seizures, as well as withdrawal symptoms.

A doctor or pharmacist should carefully monitor how a person uses benzodiazepines to reduce the risk of dependence.

Forms comparison

Clonazepam comes in the form of an oral tablet that a person swallows. There is also a version that dissolves in the mouth.

Xanax is available in immediate-release and extended-release oral tablets, as well as an oral solution.

Side effects

Woman rubbing eyes because she is tired, drowsy, and fatigued
Drowsiness and fatigue are potential side effects of clonazepam.

Clonazepam

The more common side effects of clonazepam include:

If any of these side effects develop, a person should talk to their doctor.

Rarer and more severe side effects of clonazepam include:

  • depressed mood or suicidal thoughts
  • seizures, especially if a person stops taking the drug suddenly
  • hallucinations
  • mood swings and behavioral changes
  • sweating
  • abnormal eye movements
  • anxiety
  • difficulty speaking
  • insomnia
  • excessive bleeding and bruising from reduced platelets in the blood
  • menstrual problems
  • difficulty urinating

If any of these side effects develop, a person should get immediate medical attention.

Xanax

The more common side effects of Xanax include:

  • drowsiness and fatigue
  • light-headedness
  • headaches
  • nausea
  • dry mouth
  • irritability
  • becoming talkative
  • forgetfulness or difficulty concentrating
  • trouble passing urine
  • constipation
  • joint pain
  • changes in appetite
  • changes in weight
  • sexual dysfunction

If any of these side effects develop, a person should make an appointment to see their doctor.

Rarer and more severe side effects of Xanax include:

  • yellowing of the skin or eyes
  • difficulty speaking
  • poor coordination and balance
  • seizures
  • mood swings
  • hallucinations
  • confusion or memory problems
  • depression or suicidal thoughts
  • severe skin rash

If any of these side effects or other effects that may be due to these drugs, develop a person should seek immediate medical attention.

As both Xanax and clonazepam may cause drowsiness and poor coordination, people taking these drugs should be cautious about driving or operating machinery.

With either drug, a severe allergic reaction is unlikely. However, if a person develops signs of a reaction, such as a rash, difficulty breathing, itching, or swelling, they should call for emergency help.

Interactions

Marijuana buds and joint.
Marijuana can affect Xanax and clonazepam.

People taking Xanax or clonazepam should not mix them with alcohol or opioid medication. Doing so can cause dangerous side effects that could be fatal.

Other CNS depressants can interact with Xanax or clonazepam and change the way they work. Such changes can also lead to severe side effects.

Other CNS depressants include:

  • marijuana
  • antihistamines
  • sedatives and sleeping pills
  • tranquilizers
  • mood stabilizers
  • muscle relaxants
  • seizure medications
  • pain medications

Before starting a new medication, a person should tell their doctor or pharmacist about any other medicines they are taking or intending to take.

Off-label uses

Off-label uses are uses that are not indicated on the United States Food and Drug Administration-approved packaging, but for which a doctor might still prescribe the drug.

Off-label uses for Xanax include for the following:

Off-label uses for clonazepam include for the following:

Which is the best one to use?

Although clonazepam and Xanax are similar types of drugs, there are times when one might be better to use than the other.

Xanax is not an anti-seizure medication. Hence, a person trying to control and treat seizures may find clonazepam useful.

People with anxiety disorders should make an appointment with their doctor to discuss the various treatment options plus the pros and cons of each.

The doctor will ask about a person’s symptoms and medical history. They will consider any current medication the individual is taking before advising what prescription is most suitable.

Some people react badly to particular medications or find them ineffective. If this is the case, a person should talk to their doctor who can make an alternative recommendation.

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