Ativan Vs. Zoloft: 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.

Zoloft^® (sertraline) is a selective serotonin reuptake inhibitor (SSRI) used to treat mood disorders by increasing available serotonin levels in the brain, which helps improve mood and reduce symptoms of anxiety and depression. Its FDA-approved indications include the treatment of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder (PD), post-traumatic stress disorder (PTSD), social anxiety disorder (SAD), and premenstrual dysphoric disorder (PMDD). Off-label uses may include the treatment of eating disorders and generalized anxiety disorder (GAD). Zoloft is available in tablet and oral solution forms, typically taken once daily. Common side effects include nausea, dizziness, 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 treatment period.

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

Zoloft (sertraline hydrochloride) is indicated for the treatment of:

• Major depressive disorder (MDD)

• Obsessive-compulsive disorder (OCD)

• Panic disorder (PD)

• Posttraumatic stress disorder (PTSD)

• Social anxiety disorder (SAD)

• Premenstrual dysphoric disorder (PMDD)

• 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 25 mg, 50 mg, and 100 mg tablets and 20 mg/mL oral solution

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 common adverse reactions (≥5% and twice placebo) in pooled placebo-controlled MDD, OCD, PD, PTSD, SAD and PMDD clinical trials were:

• Nausea

• Diarrhea/Loose stool

• Tremor

• Indigestion

• Decreased appetite

• Excessive sweating

• Ejaculation failure

• Decreased libido

• Hypersensitivity to benzodiazepines or to any components of the formulation

• Acute narrow-angle glaucoma

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

• Concomitant use of monoamine oxidase inhibitors (MAOIs), or use within 14 days of stopping MAOIs

• Concomitant use of pimozide

• Known hypersensitivity to sertraline or excipients

• Zoloft oral solution only: Concomitant use of disulfiram

• Drug interactions: protein-bound drugs, CYP2D6 substrates

• 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

• Increased risk of bleeding

• Activation of mania/hypomania

• Seizures

• Angle closure glaucoma

• QTc prolongation

• Sexual dysfunction

• Pregnancy: Third trimester use may increase risk for persistent pulmonary hypertension and withdrawal 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

Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients.

Closely monitor for clinical worsening and emergence of suicidal thoughts and behaviors.

*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 Zoloft^®. See the Full Prescribing Information for more complete information. Sertraline, the active ingredient in Zoloft, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient sertraline.