What Is the Difference Between Diazepam and Alprazolam? - Step To Health

What Is the Difference Between Diazepam and Alprazolam?

Diazepam and alprazolam are drugs in the benzodiazepine family, so they have a lot in common. Read on to find out how and what they are used for.
What Is the Difference Between Diazepam and Alprazolam?

Last update: 23 November, 2021

Diazepam and alprazolam are part of the benzodiazepine family, along with clonazepam, nitrazepam, chlordiazepoxide, and others. They’re used in the treatment of various disorders including depression and anxiety.

In general, they have similar characteristics, although there are also differences between them. In particular, diazepam is more effective as a relaxant, and alprazolam as an anxiolytic and hypnotic.

However, if used long-term, benzodiazepines can have a number of consequences and side effects. They’re considered to be addictive and are, therefore, recommended for short-term treatment. They should also be avoided in combination with alcohol.

What are benzodiazepines?

Benzodiazepines are a group, or family, of drugs. The most common ones are diazepam, alprazolam, lorazepam, nitrazepam, and chlordiazepoxide. They affect the production of the neurotransmitter known as gamma-aminobutyric acid (abbreviated GABA).

When the body doesn’t produce enough of this chemical messenger – which acts throughout the body – then symptoms of anxiety and nervousness occur. However, by increasing GABA levels in the brain, these drugs produce a relaxing effect, aiding sleep and relieving anxiety, agitation and stress.

Once taken, benzodiazepines are rapidly and widely distributed in the body, reaching peak levels within one to two hours. Their half-life is 12 to 15 hours. The remains are then excreted through the urine.

Diazepam and alprazolam

Diazepam is a derivative of 1,4-benzodiazepine. Its formula is C16H13CIN20. It comes in tablets, which can be 2.5, 5, 10, and up to 25 milligrams (mg). There are also drops in solution for oral administration, of 2 milligrams per milliliter (mg/ml). It is marketed under names such as Valium ®, Ansium ®, Aneurol ®, and Tepazepan ®.

Apart from the active ingredient, which is diazepam, the tablets have other components. These include lactose, corn starch, tartrazine, carmellose sodium, povidone, indigotin, colloidal silica, magnesium stearate, talc, and erythrosine.

Alprazolam is also a drug that belongs to the benzodiazepine family. Its formula is C17H13CIN4, which is very similar to diazepam. It also comes in tablets ranging from 0.25 mg to 2 mg. Its most common trade names are Xanax ®, Niravam ®, Trankimazin ®, and Tafil ®.

As for excipients, alprazolam is accompanied by lactose, sodium benzoate, microcrystalline cellulose, corn starch, povidone, magnesium stearate, colloidal silica, aluminum oxide, indigotin and others.

Alprazolam and diazepam for sleep.
Some sleep disorders are treated with benzodiazepines.

With diazepam, the recommended dose varies from case to case. It should be individualized according to need and patient characteristics.

In general, 2 to 10 mg, 2 or 4 times daily, is suggested for adults with anxiety, musculoskeletal spasms, those in anticonvulsant therapy, and also for symptomatic relief during alcohol withdrawal.

Special dosages are available for children, the elderly, or patients with renal or hepatic insufficiency. At most, 2 to 2.5 mg, 1 or 2 times a day is recommended, depending on need and tolerance levels. However, its use is restricted for children under 6 months of age.

In the case of alprazolam, the minimum effective dose should be determined according to the severity of symptoms and the patient’s response. Consideration should be given to whether the person has received previous psychotropic treatment or is elderly.

For both drugs, the dose should be increased as needed. Preferably, it should be administered in the afternoon or evening.

The duration of treatment should be as short as possible, not to exceed 12 weeks. Withdrawal of the medication is done gradually.

You may also be interested in: Your Guide to Anti-Anxiety Medications

Uses of diazepam and alprazolam

Like other benzodiazepines, diazepam and alprazolam increase GABA activity, producing an overall relaxing effect, aiding in the treatment of people with bipolar disorder, anxiety disorders, or other similar disorders.

In particular, diazepam is recommended for the symptomatic suppression of anxiety and nervous tension due to transient situational states. It’s also used for the relief of agitation, tremors and hallucinations in patients with alcohol withdrawal.

It’s also an adjuvant for seizure disorders and musculoskeletal pain, whether due to inflammation or trauma. It can also be used to treat spasticity in conditions such as cerebral palsy and paraplegia, athetosis, and generalized rigidity syndrome.

Meanwhile, alprazolam is also recommended in the treatment of generalized anxiety states, particularly associated with depression. It’s also recommended in the treatment of panic attacks.

Interactions of benzodiazepines

The sedative effect of both diazepam and alprazolam may be enhanced if consumed at the same time as alcoholic beverages. Therefore, drinking alcohol isn’t recommended if you’re under treatment with these drugs.

Additionally, there are several medications that should not be administered concomitantly. Compounds such as cytochrome P450, which inhibits certain liver enzymes, also enhance the activity of benzodiazepines. In turn, diazepam may affect the metabolic elimination of phenytoin.

Drugs that interact with benzodiazepines include cisapride, neuroleptics and antiepileptics, hypnotics, antidepressants, and narcotic analgesics (opioids).

In the case of alprazolam, co-administration with antifungals (such as ketoconazole) isn’t recommended. It should also be used with special care, including dose reduction, if you’re also taking fluoxetine, cimetidine, oral contraceptives, diltiazem, macrolide antibiotics, ritonavir, or digoxin.

Side effects

With benzodiazepines, one of the biggest problems is the dependence that patients can develop after a few weeks of use. And this likelihood increases with age. In fact, there are more repercussions in older adults.

On the other hand, there’s also a risk of developing tolerance over time. This means that your body will “ask” you to increase the dose to maintain the therapeutic effects.

Thirdly, stopping these drugs can cause withdrawal symptoms, especially if the withdrawal is carried out abruptly. Some of the symptoms that may occur with abrupt withdrawal are as follows:

  • Abdominal cramps
  • Hyperhidrosis
  • Convulsions
  • Tachycardia
  • Tremors
  • Disorientation and hallucinations
  • Irritability and nervousness
  • Anterograde amnesia
  • Suicidal thoughts

Diazepam effects

Apart from those already mentioned, there may be other side effects associated with taking diazepam. These include emotional dullness, headaches, muscle weakness, gastrointestinal disturbances, and changes in libido. Studies have linked dysarthria to sustained use of diazepam in older adults.

Effects of alprazolam

Depending on the dosage, age, sensitivity, and other factors, alprazolam may impair attention, as well as reaction and maneuvering ability. Therefore, it isn’t advisable to drive or operate machinery when you’re taking it.

A woman driving nervously.
Benzodiazepines are drugs that are contraindicated for driving while being used as a treatment.

Contraindications of diazepam and alprazolam

Due to their conditions or ailments, some people shouldn’t take diazepam or alprazolam. Let’s look at the contraindications that are common to both:

  • Chronic obstructive pulmonary disease (COPD)
  • Severe liver failure
  • Acute angle-closure glaucoma
  • Myasthenia gravis
  • Pregnancy or breast-feeding
  • Post-traumatic stress disorder
  • Alcoholism

Neither should diazepam be consumed if the person has a history of drug dependence, sleep apnea syndrome, severe chronic hypercapnia, hereditary galactose intolerance, glucose or sucrose malabsorption, or allergy to acetylsalicylic acid.

Which is better: diazepam or alprazolam?

Both drugs have similar effects, both in mitigating certain symptoms and the adverse reactions they may cause. For this reason, they’re contraindicated in some cases.

There are also differences between them. For example, diazepam tends to act quickly and remain active for a longer period of time, as some of the presentations contain more milligrams of the active ingredient. It can be used to treat children and is effective for muscle spasms and seizures. In contrast, alprazolam is approved for panic disorder, but is more addictive.

As for which drug is best or most appropriate, that will be determined by the doctor, based on the patient’s characteristics, previous treatment history, and current conditions. Remember that both are psychotropic drugs, i.e., they’re sensitive products that can only be acquired with a prescription.

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