Alprazolam (Xanax) and Clonazepam (Klonopin) are both benzodiazepines that help to calm anxiety, and treat other disorders. Alprazolam (Xanax) is used to treat anxiety disorders, panic disorders, and anxiety associated with depression. Clonazepam (Klonopin) may be prescribed for epilepsy, as well as for panic disorder, seizures, anxiety disorders, parasomnia, OCD and clinical depression.
|Prescribed for||Management of acute symptoms of anxiety disorders, panic disorders, anxiety caused by depression||Panic disorders, seizures, epilepsy, sometimes insomnia|
|Pregnancy cat.||D (US) [Unsafe during pregnancy; see article for details]||C (AU) D (US) [Unsafe during pregnancy; see article for details]|
|Dependence liability||High (addictive)||High (addictive)|
|Side effects||Drowsiness, dizziness, blurred vision, headache, memory problems, trouble concentrating, sleep problems, swelling in limbs, muscle weakness, lack of balance and coordination, slurred speech, upset stomach, nausea, vomiting, sweatiness, dry mouth etc.||Drowsiness, dizziness, memory problems, feeling tired, muscle weakness, loss of balance, slurred speech, drooling or dry mouth, runny or stuffy nose, loss of appetite, nausea, blurred vision, headache, sleep problems, skin rash or weight changes|
|Half-life||Immediate release: 11.2 hours; Extended release: 10.7–15.8 hours||18-50 hours|
|Forms||Tablets (0.25, 0.5, 1 or 2mg)||Tablets (0.5mg, 1mg and 2mg) and dissolving tablets (0.5mg, 1mg and 2mg)|
|Restrictions||Should not be used by people with narrow-angle glaucoma or who are taking Sporanix or Nizoral.||Should not be used by people who have severe liver disease, narrow-angle glaucoma, or who are allergic to other benzodiazepines|
|Legal status||POM (UK) Schedule IV (US)||Prescription Only (S4) (AU) Schedule IV (CA) schedule Q (UK) Schedule IV (US)|
|Effect||Increases GABA in brain||Increases GABA in brain|
|Metabolism||Hepatic, via Cytochrome P450 3A4||Hepatic CYP3A4|
|Intake||Oral||Oral, I.M., I.V, sublingual|
Klonopin is available in 0.5mg, 1mg and 2mg tablets, and in 0.125mg, 0.25mg, 0.5mg, 1mg and 2mg disintegrating tablets.
Xanax is available in 0.25mg, 0.5mg, 1mg and 2mg tablets. The 2mg tablets are multi-scored and can be divided.
How Klonopin Works
This video shows how Klonopin or Clonazepam works and can help people with epilepsy:
How Xanax Works
How Xanax or Alprazolam works:
Klonopin may be prescribed for epilepsy, as well as for panic disorder, seizures, anxiety disorders, parasomnia, OCD and clinical depression.
Xanax is used to treat anxiety disorders, panic disorders, and anxiety associated with depression.
Klonopin and Xanax will have different effectiveness for different individuals. A study by Massachusetts General Hospital in 1991 found that Klonopin and Xanax were equally effective at treating panic disorders .
To test the reported antipanic efficacy of clonazepam, the authors randomized 72 subjects with panic disorder to 6 weeks of treatment with either alprazolam, clonazepam, or placebo. Endpoint analysis demonstrated a significant beneficial effect of both active treatments, but not placebo treatment, on the frequency of panic attacks, overall phobia ratings, and the extent of disability. Comparison of the two active treatments revealed no significant differences and no consistent tendency for one agent to be favored over another, although power to detect small differences was limited. Sedation and ataxia were the most common side effects reported, but these effects were mild and transient and did not interfere with treatment outcome. The results of this double-blind, placebo-controlled trial are consistent with previous reports of clonazepam's antipanic efficacy.
The following scientific studies provide useful information relevant to the effects of xanax and klonopin:
- A 1997 study found that alprazolam (xanax) increases physiological activation (heart rate, respiratory rate) under acute stress conditions and hinders therapeutic effects of exposure in flying phobia. In other words, Xanax did not always help people who have a fear of flying.
- A study published in 2011 examined the effects of klonopin (clonazepam) and xanax (alprazolam) and concluded that the immune system and blood vessels can be adversely affected to a greater extent by short-term chronic administration of Xanax than by klonopin, and these toxic effects are aggravated by stress.
- Co-administration with Prozac (Fluoxetine): A 1992 research study found that when Xanax is co-administered with Prozac, the half-life of Xanax is prolonged and its clearance is impaired. Prozac has no such effect on klonopin.
- A 1988 study found that it is possible to substitute clonazepam for alprazolam when patients become dependent on alprazolam.
- A study in 2000 examined old medical records from 1989 and 1990 to determine whether Xanax or klonopin cause an increase in uninhibited "problem" behavior such as self-injury or assault. The study concluded that the risk of such behaviors was no different than when a placebo was administered.
Klonopin should not be taken for more than 9 weeks without a doctor’s advice. Doses higher than 0.5 – 1 mg per day are associated with significant sedation.
For adults with anxiety disorder, initial Xanax doses are of 0.25mg to 0.5mg, three times daily. This dose may be increased up to 4mg in divided doses. Dosage must be decreased gradually.
Common Klonopin side effects include drowsiness, dizziness, memory problems, feeling tired, muscle weakness, loss of balance, slurred speech, drooling or dry mouth, runny or stuffy nose, loss of appetite, nausea, blurred vision, headache, sleep problems, skin rash or weight changes. More serious side effects can include confusion, hallucinations, involuntary eye movements, pounding heartbeats, painful urination, pale skin, easy bruising, and seizures.
Common Xanax side effects include drowsiness, dizziness, blurred vision, headache, memory problems, trouble concentrating, sleep problems, swelling in hands and feet, muscle weakness, lack of balance and coordination, slurred speech, upset stomach, nausea, vomiting, increased sweating, dry mouth, stuffy nose, appetite or weight changes, and loss of interest in sex. More serious side effects include depressed mood, confusion, chest pain, tremor, seizure and jaundice.
Klonopin should not be used by people who have severe liver disease, narrow-angle glaucoma, or who are allergic to other benzodiazepines. It should not be mixed with alcohol.
Xanax also should not be used by people allergic to benzodiazepines or by women who are pregnant. Those with narrow-angle glaucoma and those who are taking Sporanix or Nizoral should also not take Xanax. It should not be mixed with alcohol.
Klonopin can be addictive, and so dosage should be reduced gradually. Withdrawal symptoms include anxiety, irritability, insomnia, tremors, seizures and potentially exacerbated panic disorder.
Xanax also has a danger of withdrawal, and so dosage should be reduced gradually (usually 0.5mg every three days).
Klonopin and Xanax abuse occurs when the drug is used over an extended period of time. Signs of abuse include using the drug every day, always having it on hand, needing to take valium to get the day started, willingness to do something illegal to acquire it, taking it without medical reason, and needing to take a larger dose to get the same results as before.
Klonopin is the second most frequently used benzodiazepine that leads to emergency department visits, including drug abuse, overdose and adverse reactions to legitimate use of the medication.