Ativan Vs. Lexapro: Drug Comparison

Ativan^® (lorazepam) is a Schedule IV benzodiazepine medication used to treat anxiety disorders by enhancing the effects of GABA, a neurotransmitter that calms the brain and nervous system. FDA-approved indications include the treatment of anxiety disorders and short-term relief of anxiety symptoms and as a preoperative sedative. Off-label uses may include managing insomnia, seizure disorders, or alcohol withdrawal. It is available in forms including tablets, oral solutions, and injections. Common side effects include drowsiness, dizziness, and weakness, and its sedative effects can be heightened when combined with central nervous system (CNS) depressants such as alcohol or opioids. Ativan carries a boxed warning due to the risk of severe sedation, respiratory depression, and dependence when used with opioids. As a Schedule IV drug, it also has the potential for addiction and abuse, especially with prolonged or high-dose use. Ativan is contraindicated in patients with hypersensitivity to benzodiazepines or any formulation components, as well as those with acute narrow-angle glaucoma.

Lexapro^® (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) used to treat anxiety and depression by increasing available serotonin levels in the brain, which helps improve mood and reduce anxiety. Its FDA-approved indications include the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in adults and adolescents. Off-label uses may include treating panic disorder, obsessive-compulsive disorder (OCD), and social anxiety disorder. Lexapro is available in tablet and oral solution forms, taken once daily. Common side effects include nausea, insomnia, and sexual dysfunction, and it carries a boxed warning for an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults, particularly during the initial stages of treatment.

Benzodiazepine

Selective serotonin reuptake inhibitor (SSRI)

Ativan (lorazepam) is indicated:

• For the management of anxiety disorders or for the short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms

Lexapro (escitalopram) is indicated for the:

• Treatment of major depressive disorder (MDD) in adults and pediatric patients 12 years of age and older

• Treatment of generalized anxiety disorder (GAD) in adults and pediatric patients 7 years and older

• Typically taken orally with specific dosing depending on what's being treated

• Comes in 0.5 mg, 1 mg, and 2 mg tablets

• Typically taken orally once daily

• Comes in 5 mg, 10 mg (scored), and 20 mg (scored) tablets

In a sample of about 3,500 patients treated for anxiety, the most frequent adverse reactions to Ativan were:

• Sedation (15.9%)

• Dizziness (6.9%)

• Weakness (4.2%)

• Unsteadiness (3.4%)

Most commonly observed adverse reactions (incidence ≥ 5% and at least twice the incidence of placebo patients) are:

• Insomnia

• Ejaculation disorder (primarily ejaculatory delay),

• Nausea

• Sweating increased

• Fatigue and sleepiness

• Decreased libido

• Inability to orgasm

• Hypersensitivity to benzodiazepines or to any components of the formulation

• Acute narrow-angle glaucoma

• Drug interactions: opioids, CNS depressants, clozapine, valproate, probenecid, theophylline, aminophylline

• Do not use MAOIs intended to treat psychiatric disorders with Lexapro or within 14 days of stopping treatment with Lexapro. Do not use Lexapro within 14 days of stopping an MAOI intended to treat psychiatric disorders. In addition, do not start Lexapro in a patient who is being treated with linezolid or intravenous methylene blue

• Concomitant use of pimozide

• Known hypersensitivity to escitalopram or citalopram or any of the inactive ingredients

• Drug interactions: SSRIs, SNRIs, tryptophan, drugs that affect hemostasis (NSAIDs, aspirin, warfarin)

• Risks from concomitant use with opioids

• Abuse, misuse, and addiction

• Dependence and withdrawal reactions

• Neonatal sedation and withdrawal syndrome

• Pregnancy: Use of Ativan late in pregnancy can result in sedation (respiratory depression, lethargy, hypotonia) and/or withdrawal symptoms (hyperreflexia, irritability, restlessness, tremors, inconsolable crying, and feeding difficulties) in newborns

• Breastfeeding: Breastfeeding patients should monitor infants for excessive sedation, poor feeding, and poor weight gain, and seek medical attention if they notice these signs

• Serotonin syndrome

• Discontinuation syndrome

• Seizures

• Activation of mania/hypomania

• Low blood sodium: Can occur in association with syndrome of inappropriate antidiuretic hormone secretion

• Increased risk of bleeding

• Interference with cognitive and motor performance

• Angle closure glaucoma

• Use in patients with concomitant illness

• Sexual dysfunction

• Pregnancy: SSRI use, particularly later in pregnancy, may increase the risk for persistent pulmonary hypertension and symptoms of poor adaptation (respiratory distress, temperature instability, feeding difficulties, hypotonia, tremor, irritability) in the neonate

WARNING: RISKS FROM CONCOMITANT USE WITH OPIOIDS; ABUSE, MISUSE, AND ADDICTION; and DEPENDENCE AND WITHDRAWAL REACTIONS

Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs for patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation.

The use of benzodiazepines, including Ativan, exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death. Abuse and misuse of benzodiazepines commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes. Before prescribing Ativan and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction.

The continued use of benzodiazepines, including Ativan, may lead to clinically significant physical dependence. The risks of dependence and withdrawal increase with longer treatment duration and higher daily dose. Abrupt discontinuation or rapid dosage reduction of Ativan after continued use may precipitate acute withdrawal reactions, which can be life-threatening. To reduce the risk of withdrawal reactions, use a gradual taper to discontinue Ativan or reduce the dosage.

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of suicidal thoughts and behavior in pediatric and young adult patients taking antidepressants. Closely monitor all antidepressant-treated patients for clinical worsening and emergence of suicidal thoughts and behaviors. Lexapro is not approved for use in pediatric patients less than 7 years of age.

*This information is from the label for brand name Ativan^®. See the Full Prescribing Information for more complete information. Lorazepam, the active ingredient in Ativan, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient lorazepam.

*This information is from the label for brand name Lexapro^®. See the Full Prescribing Information for more complete information. Escitalopram, the active ingredient in Lexapro, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient escitalopram.