Xanax Vs. Zoloft: Drug Comparison

Xanax^® (alprazolam) is a benzodiazepine medication used to treat anxiety and panic disorders by enhancing the activity of GABA, a neurotransmitter that calms the nervous system. Its FDA-approved indications include the treatment of generalized anxiety disorder (GAD) and panic disorder with or without agoraphobia. Xanax is available in tablet, extended-release tablet, and oral solution forms, typically taken once to multiple times daily depending on the dose. Common side effects include impaired coordination, low blood pressure, difficulty speaking, and increased libido. Serious risks include dependence, withdrawal, and respiratory depression, especially when combined with opioids or alcohol. Xanax carries a boxed warning for the risk of abuse, dependence, and potentially fatal respiratory depression when used with other central nervous system (CNS) depressants.

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)

Xanax (alprazolam) is indicated for the:

• Acute treatment of generalized anxiety disorder in adults

• Treatment of panic disorder with or without agoraphobia in adults

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 three times daily

• Comes in 0.25 mg, 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

The most common adverse reactions reported in clinical trials for generalized anxiety disorder and panic disorder (incidence >5% and at least twice that of placebo) include:

• Impaired coordination

• Low blood pressure

• Difficulty forming or pronouncing words

• Increased libido

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

• Known hypersensitivity to alprazolam or other benzodiazepines

• Concomitant use with strong cytochrome P450 3A (CYP3A) inhibitors, except ritonavir

• Drug interactions: Opioids, other central nervous system (CNS) depressants, digoxin, CYP3A inhibitors (except ritonavir), CYP3A inducers

• 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

• Effects on driving and operating machinery

• Patients with depression: Exercise caution in patients with signs or symptoms of depression

• Neonatal sedation and withdrawal syndrome

• Breastfeeding: Breastfeeding not recommended

• 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 for use in 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 Xanax, exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death. Before prescribing Xanax and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction.

• Abrupt discontinuation or rapid dosage reduction of Xanax 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 Xanax 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 Xanax^®. See the Full Prescribing Information for more complete information. Alprazolam, the active ingredient in Xanax, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient alprazolam.

*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.