Nora asked
I ran out of my alprazolam 1mg. Can I take a 0.5mg clonazepam instead?
Answer
Both Xanax (alprazolam) and Klonopin (clonazepam) are classified as benzodiazepines, but have several characteristics that differentiate them from one another. In fact, within the benzodiazepine class as a whole, individual drugs are differentiated primarily by their pharmacokinetic profiles, which result in large differences in:
- Onset of action
- Duration of action
- Presence of active or non-active metabolites
- Metabolic pathways (e.g. metabolized via CYP liver enzymes or without CYP enzyme involvement)
Below, we discuss the key differences between Xanax (alprazolam) and Klonopin (clonazepam).
Xanax Information
Xanax (alprazolam) is considered a rapid acting benzodiazepine, with a short duration of action. Other key characteristics include:
- It is metabolized by CYP liver enzymes and therefore has many potential drug interactions.
- Metabolism produces active metabolites, although they are thought to be only minimally active.
Due to its rapid onset of action, Xanax may act faster when it comes to treating symptoms (e.g. symptoms of anxiety) but it has been associated with high rates of rebound anxiety and withdrawal symptoms. In addition, it has a higher risk of abuse. In fact, alprazolam is one of the most abused benzodiazepines.
While benzodiazepines in generally aren't often recommended for insomnia, the fast onset and short duration of action of Xanax may be better suited for treating certain sleep disorders on an intermittent basis.
Klonopin Information
Klonopin (clonazepam) is considered a rapid to intermediate acting benzodiazepine, with an intermediate to long duration of action. Like Xanax, Klonopin:
- Is metabolized by CYP liver enzymes (increased likelihood of drug interactions)
- Produces active metabolites (although most sources state they are clinically insignificant)
Due to the longer duration of action of Klonopin, it may be better suited in certain patients, including those treating persistant anxiety disorders and for the treatment of epilepsy. In addition, if a patient has been taking a rapid acting, short duration benzodiazepine (e.g. Xanax), Klonopin is often used to aid these individuals in tapering off their medication as it has a long duration of action and can reduce the likelihood of withdrawal symptoms.
Comparing Xanax To Klonopin: Summary
Onset Of Action
Xanax: Rapid (Onset of action 15-30 minutes after administration with peak concentrations reached within 1-2 hours)
Klonopin: Rapid to intermediate (Onset of action around 30 minutes after administration with peak concentrations reached within 1-4 hours)
Duration Of Action
Xanax: Short (generally dosed two to four times daily)
Klonopin: Intermediate to long (generally dosed twice daily)
Active Metabolites?
Xanax: Yes (minimally active)
Klonopin: Yes (thought to be insignificant)
Metabolism
Xanax: CYP3A4 (more likely to have drug interactions)
Klonopin: CYP3A4 (more likely to have drug interactions)
Indications
Xanax and Klonopin are both used for a wide range of indications but:
- Klonopin may be preferred for panic disorders and preventing seizures due to it's longer duration of action. Xanax generally should not be used long term.
- In regard to extended use, the risk of withdrawal and rebound symptoms with Klonopin are lower than with Xanax.
Can You Switch Between Xanax And Klonopin?
You can certainly switch between Klonopin and Xanax based on what you and your doctor think will best treat your symptoms. However, if you have only been prescribed one, you should not switch, or use someone else's medication, without speaking with your doctor.
Taking Klonopin instead of Xanax without first checking with your doctor could cause your symptoms to not be appropriately treated. There are other factors to consider as well, such as drug interactions with concomitant medications and your risk of withdrawal, based on how long you have been taking Xanax.
