Valium vs Ativan

[hkml]

Can anyone tell me the reasons why a doctor would choose to prescribe Valium over Ativan or vice versa? Does it have anything to do with their half lives? If it does than why would a doctor choose to prescribe a long-acting benzo over a short-acting one? Any responses are appreciated.

[kalie1979]

i have never been on either of them, but my mom takes valium and she is a zombie, and my grandmother takes ativan, and she can still fuction without shaking and anxiety... i hope i helped you.  goodluck

kalie

[Ryan7591]

Ativan is five times more potent than Valium (ie: 2 mg of Ativan is equivalent to 10 mg of Valium), and has a half-life of 12 hours. The duration of action is 8 hours, and is frequently dosed three times daily. Upon repeated dosing, Ativan reaches steady-state, but does not accumulate. The fact that it does not accumulate is attractive, as this reduces the side effects (ie: excessive sedation). Ativan can be used to treat mild-to-severe anxiety or panic anxiety.

Valium is relatively weak in comparison to Ativan, and is used to treat very mild, generalized or "tension" anxiety states. Its main use today is to treat muscle spasm. Valium carries a bi-phasic half-life of 20 hours (plus your age) for Diazepam, and 36-200 hours for the active metabolite N-Desmethyldiazepam. The duration of action is 4-6 hours, despite the prolonged elimination half-life, and is most frequently dosed four times daily. Upon repeated dosing, the active metabolite accumulates to 5-7 times that of steady-state. The main problem with Valium is that it is 98% bound to plasma proteins, is highly lipophilic, and is rapidly redistributed to adipose (fat) tissue. The initial distribution phase ranges from 1-3 hours, which is the length of time the drug remains in the central nervous system. This explains the short duration of clinical effect.

In the case of Ativan vs. Valium, the half-life means nil. In determining which one is best, one must look at the clinical diagnosis. If it is very mild anxiety or muscle spasm, the Valium would be a good option. If the anxiety is more severe, or involves a component of panic, Ativan is a better option.

Both carry the risk of physical and psychological dependency when used long-term, and the severity of this risk is highly variable between individuals. Ideally, they should be used for short-term only (not greater than four months). Both can be used on an "as-needed" basis safely with little to no risk. The greatest risk is when they are used daily, as they will eventually lose their efficacy and begin to induce the very symptoms in which they were designed to supress (rebound anxiety).

As with any drug, the benefits should clearly outweigh the risks. It would thus be advantageous to explore alternative options, leaving the Benzodiazepines as an option of last resort (or, for as-needed use only). More often than not, they compound anxiety disorders when used over the long-term.

Ryan

[hkml]

I think I only have mild anxiety but have been prescribed Ativan.  Should I ask about being switched to Valium?

[Ryan7591]

No, the Ativan is fine. If you've been on the Ativan for any length of time, you may very well find that Valium is less effective or ineffective.

In addition, the Valium would require a period of roughly two weeks to accumulate in your system to fully replace the Ativan. This is a function of Valium's long elimination half-life.

Ryan

[abby10]

If you're going to take ativan, listen to your body, listen very closly to the above reference about the drug causing rebound anxiety. It will happen and you may not realize it is actually the ativan.  It's no fun having 20 times the anxiety you had in the first place, simply because you took this drug.  If an addiction/dependency occurs, do a slow tapper with a klonopin or valium.



abby

[hkml]

If dependency does occur, why would Valium be used?

[abby10]

The general opinion is that Valium has a longer half life and stays in the system longer. I've never heard about the valium being stored in the fat tissue more than other benzodiazepines. So at this point, I don't know about that one way or the other. I would prefer to use a weaker, milder benzo because my little brain receptors are pretty beat up at this point.

But for someone just getting started out in the benzo scene, I would recommed "don't". Unless you can take any benzo (Xanax is too powerful) occasionally, "as-needed". Otherwise be prepared.

Personally, my whole addiction started with 1mg Ativan. I never saw it coming.  

abby

[Ryan7591]

The Valium concept stems back to a Professor from the UK. The theory is that Valium (due to its long terminal half-life) could be used as a substitute for the shorter-acting benzos and ease the withdrawal process by allowing for a gradual decline of the plasma level.

The half-life theory itself holds some credibility, although I personally wouldn't choose Valium, given its bizarre pharmacokinetic profile. While it may indeed have a prolonged terminal half-life, the duration of action is not long (4-6 hours). 98% of what does accumulate does so in fat tissue, and depending on the time frame it was used, could literally take years to exit the body entirely.

The other issue is that Valium only binds to the alpha 1 and 5 subunits of the GABA(a) molecule. Ativan binds to all four (1, 2,3,5). What that means is that Valium does not bind as tightly to the GABA(a) molecule as Ativan, and as such, it cannot replace it entirely from a pharmacological perspective. Ativan has what is known as a "greater affinity" for GABA(a). There are major differences between Ativan and Valium for this reason, giving the perception that Ativan is much stronger (even when equivalent dosages are used).

Done correctly, you can taper directly from Ativan if need be. It does reach steady-state if dosed three times daily, and a very gradual taper will result in a smooth, steady decline of the plasma level (although it probably won't feel very smooth). Ativan has an intermediate half-life. From a potency standpoint, it is five times less potent than Klonopin or Xanax, and five times more potent than Valium. It's right in the middle.

Having taken Valium at dosages between 40-120 mg/day, it is a very "hard" drug in my experience, and at the 40 mg dose, tolerance quickly became an issue for me. I personally could not imagine trying to taper from it, but others have apparently had some success with it. As with anything, it really does depend on the person.

In all honesty, none of these drugs are pleasant to withdrawal from. That's why you shouldn't use them over the long-term. Not a single one of them is recommended for use beyond four months, and NONE of them have been evaluated beyond nine weeks in clinical trials. There is a reason for that, and the reason is that they ALL lose their effectiveness. The manufacturers will not publish such data. It may take two weeks or twenty years. It all depends on the person.


Ryan

[abby10]

From what I've read the pharmaceutical companies don't include the people that walked away from the clinical trials (for Xanax) after 8 weeks because they were going nuts. Pfizer won't commit on a time frame to stop the Xanax... for life I suppose. My "idiot" psychiatrist actually told me I would have to "stay on Xanax for life". No kidding!

I have the dubious distinction of being referred to John Hopkins in Baltimore, Maryland, because my 3rd neurologist "released" me, he said he couldn't help me and that no neurologist in the tri-county could. The first appointment possible isn't until May 18, 2009. I was also told to see a pharmapsychiatrist? at John Hopkins. Frankly, any doctor with the title "psychiatrist" isn't someone I ever want to see again.

I'm in "no man's land" at this point. I stopped all benzo's on Oct 29, 2008. I don't know how I survived everything. I was sort of getting better, but these "seizure like" episodes kept happening everyday. They were so awful I don't even want to go there. But one day with the banging in my head (torture), I said it's Valium or a gun. I can't live like this indefinitely, the months are turning into years. I chose the Valium. I took 2.5mg and the banging in my head stopped, and I slept, wonderful sleep. After that I took 1mg a day, then 2mg, then 3mg, then leveled off at 4mg a day. It's just what my body said to do. It's hard to keep a 6 hour schedule though. I don't believe my brain can live without a benzo to date.

I'm functioning (limited). Mild increase in memory impairment, but symptoms are dramatically reduced. I fear that the violent symptoms will return, I can't increase anymore benzos. I try not to think about it. I don't want a benzo that will have a greater affinity (based on what I understand).  But I don't want a benzo in my body for more than 90 days after discontinuation either. All bets are off at this point. I'm hoping my brain can find homeostasis somehow. I mean it has to eventually.

abby

[hkml]

Since you say the duration of action is similar for both Ativan and Valium, out
of curiosity, if one were to take a high dose of each (on different occasions) enough to cause deep
sleep would there be a difference as to when one would wake up?