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Compare alprazolam alternatives | Klonopin | Zoloft | Cymbalta | Buspirone | Vistaril | Natural alternatives | How to switch meds
For reasons both good and bad, Xanax, the brand name for alprazolam, has been a widely known anxiety medication for many years. A rapid onset of action and effectiveness have brought cheers, but the jeers are every bit as loud based on the potential for sedation, addiction, and withdrawal. These negative attributes are why healthcare providers usually recommend an alternative drug for anxiety treatment and why most patients would choose a different option instead. Whatever your reason for wanting another anxiolytic drug, you are in the right place to learn more about your choices.
What can I take in place of alprazolam?
Alprazolam belongs to the benzodiazepine category of anxiolytic medications, which exerts its effects by enhancing the action of gamma-aminobutyric acid (GABA) in the central nervous system. Since GABA is an inhibitory neurotransmitter or brain cell signaling chemical, increasing its action via a benzodiazepine leads to a sedating or calming effect. This drug category has a few other members who could be chosen instead of alprazolam for treating anxiety. All benzodiazepines are listed as controlled substances by the Drug Enforcement Administration (DEA) due to their potential for abuse.
Since benzodiazepines’ duration of action is relatively short and has a litany of adverse effects, steering toward a different anxiolytic drug category may be best. A longer-lasting and a better-tolerated option may be found in the selective serotonin reuptake inhibitor, (SSRI) or serotonin and norepinephrine reuptake inhibitor (SNRI) classes. These Xanax alternatives provide a more steady action by increasing the levels of the neurotransmitter serotonin in the spaces between nerve cells. Of course, no perfect option exists, so you should understand the detailed pros and cons.
Compare Xanax (alprazolam) alternatives |
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| Drug name | Uses | Dosage | Savings options |
| Xanax (alprazolam) | Generalized anxiety disorder, panic disorder | 0.25 to 0.5 mg three times daily | Xanax coupons |
| Klonopin (clonazepam) | Panic disorder, seizure disorder, anxiety (off-label) | 0.25 to 0.5 mg three times daily | Klonopin coupons |
| Ativan (lorazepam) | Anxiety, insomnia | 0.5 to 1 mg two to three times daily | Ativan coupons |
| Valium (diazepam) | Anxiety, alcohol withdrawal, muscle spasm, seizure disorder | 2 to 10 mg two to four times daily | Valium coupons |
| Oxazepam | Anxiety, alcohol withdrawal | 10 to 30 mg three to four times daily | Oxazepam coupons |
| Chlordiazepoxide | Anxiety, alcohol withdrawal | 5 to 10 mg three to four times daily | Chlordiazepoxide coupons |
| Lexapro (escitalopram) | Major depressive disorder, generalized anxiety disorder | 10 to 20 mg once daily | Lexapro coupons |
| Zoloft (sertraline) | Major depressive disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, premenstrual dysphoric disorder, social anxiety disorder | 50 to 200 mg once daily | Zoloft coupons |
| Celexa (citalopram) | Major depressive disorder, anxiety (off-label) | 20 to 40 mg once daily | Celexa coupons |
| Prozac (fluoxetine) | Major depressive disorder, obsessive-compulsive disorder, bulimia nervosa, panic disorder, bipolar 1 disorder, anxiety (off-label) | 20 to 80 mg once daily for major depressive disorder | Prozac coupons |
| Paxil (paroxetine) | Major depressive disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, generalized anxiety disorder, social anxiety disorder | 20 to 50 mg once daily | Paxil coupons |
| Buspirone | Anxiety | 7.5 to 10 mg two to three times daily | Buspirone coupons |
| Effexor XR (venlafaxine extended-release) | Major depressive disorder, panic disorder, generalized anxiety disorder, social anxiety disorder | 75 to 225 mg once daily | Effexor XR coupons |
| Cymbalta (duloxetine) | Major depressive disorder, generalized anxiety disorder, diabetic neuropathic pain, fibromyalgia, chronic musculoskeletal pain | 60 mg once daily | Cymbalta coupons |
| Vistaril (hydroxyzine) | Anxiety, pruritus (itching) | 50 to 100 mg every 6 hours as needed | Vistaril coupons |
| Neurontin (gabapentin) | Seizure disorder, post-herpetic neuralgia, anxiety (off-label) | 300 mg per day | Neurontin coupons |
Top 5 alprazolam alternatives
The following are some of the most common alternatives to alprazolam.
1. Klonopin
As a fellow benzodiazepine (benzo), Klonopin does not escape the hazards or side effects of Xanax, namely the potential for abuse and physical dependence, as well as sedation and unsteadiness. These concerns are heightened for anyone with a history of substance abuse or older adults with a greater risk of falls. These agents are also best avoided in concurrent opiate pain relievers due to the danger of respiratory depression (reduced breathing) and death.
While Klonopin does not avoid these problems, it does have an advantage over how Xanax works. It has a longer duration of action, having a half-life of 12 to 40 hours, compared to the short-acting benzo Xanax which has a half-life of one to 12 hours. The longer-lasting effects can provide a more steady degree of anxiety relief and reduce the chance of withdrawal when stopping. Keep in mind that common side effects could last longer as well, though.
RELATED: Klonopin vs. Xanax: Differences, similarities, and which is better for you
2. Zoloft
A classic SSRI, Zoloft remains a common first-line choice for anxiety treatment. SSRIs are a type of antidepressant and anti-anxiety medication. They are not habit-forming, are not controlled substances, and provide an excellent long-term treatment option for anxiety. They have less risk for dependence and drowsiness compared to Xanax. However, like other SSRIs, Zoloft can be associated with side effects such as weight gain and sexual dysfunction.
Expense is generally not a problem within the SSRI or benzodiazepine categories since most members have a generic version available. For added savings, show your SingleCare discount card to your pharmacist.
Another feature to understand about SSRI use for anxiety compared to benzos is the slower onset of action. Full effectiveness for SSRIs can take six to eight weeks as opposed to a matter of hours for benzos. The added safety of Zoloft and other SSRIs comes at the cost of requiring your patience in getting relief.
RELATED: Zoloft vs. Xanax: Differences, similarities, and which is better for you
3. Cymbalta
Strong arguments abound for avoiding benzodiazepines, and SSRIs have good reasons to be the go-to drug class for most cases of anxiety. However, there is a chance you may not like either, and an SNRI antidepressant/anti-anxiety drug like Cymbalta could be preferable. SNRIs avoid the controlled substance designation and provide a long-acting steady state of relief. A lower risk than most SSRIs of sexual dysfunction and weight gain could be appealing too.
RELATED: Cymbalta vs. Zoloft: Differences, similarities, and which is better for you
4. Buspirone
Buspirone is a partial agonist at certain serotonin receptors, and as a serotonergic drug, it has utility in anxiety treatment. Like Xanax, it can be used alongside an SSRI or SNRI for additional benefit if the SSRI or SNRI alone is not providing complete resolution of the symptoms of anxiety. Buspirone augmentation in this manner is often preferable to a benzodiazepine due to the lower abuse and sedation risk. Once again, your patience may be tested, however, since buspirone does not act as quickly as benzos.
RELATED: Buspirone vs. Xanax: Differences, similarities, and which is better for you
5. Vistaril
Fast-acting and short-lasting effectiveness is a hallmark of Vistaril, making it similar to Xanax in these ways, but Vistaril produces anxiety relief via an antihistamine action. It is not a controlled substance like Xanax, however, so it could be a more appealing short-term or as-needed option in conjunction with an SSRI or SNRI. The primary problem with Vistaril is its potential for troublesome sedation.
RELATED: Vistaril vs. Xanax: Differences, similarities, and which is better for you
Natural alternatives to alprazolam
The potential for side effects with alprazolam, other benzodiazepines, or other anxiolytic drug categories could be a compelling reason for you to look for other solutions. Counseling, specifically cognitive behavioral therapy (CBT), can be a worthwhile non-pharmacologic approach to anxiety treatment. CBT can stand alone or be used adjunctively along with meds. Meditation, yoga, and Tai Chi can be helpful too. Exercise is even a simple but effective measure of anxiety relief.
Over-the-counter (OTC) supplements might also be of interest to you. L-theanine, for example, is derived from green tea extract and has been used for anxiety, although studies have thus far found both negative and positive results. Ashwagandha is another extract used for anxiety with some successful clinical trials, although the data is limited.
How to switch to an alprazolam alternative
Whether you are considering an OTC supplement or a different prescription drug in place of alprazolam, you can now feel better prepared to get medical advice from your mental health provider. This is the necessary next step because you certainly should not make any changes on your own. The risks of withdrawal symptoms and adverse effects are too great. Instead, schedule a time to speak to the prescribing healthcare professional about your concerns and ideas. Jointly, the best plan for your anxiety management can be established, whether it involves alprazolam or a different option.
