Xanax is the trade name of alprazolam. Alprazolam is a short acting anxiolytic drug that is used or the treatment of various anxiety disorders like panic disorder, general anxiety disorders and social anxiety disorders. It belongs to the benzodiazepine class and binds strongly to GABA A receptors. Alprazolam is a chemical analogue of triazolam which differs in the absence of a chlorine atom at the o-position of the6- phenyl ring. Further, the molecule acts as a sedative and anticonvulsant agent. The peak effects are achieved within 1.5 to 1.6 hours in case of panic disorder. The common side effects include sedation, drowsiness, hypotension and impaired balance. The drug is associated with potential withdrawal symptoms as it may cause habit forming property. Further the drug can cause CNS (Central Nervous System depression).

Valium is the trade name of diazepam, which is also a benzodiazepine. The indications of Valium are anxiety, withdrawal symptoms related to alcohol and other benzodiazepines, muscle spasms, seizures, insomnia and restless leg syndrome. The drug is also used to cause memory loss, especially in conditions like post traumatic stress disorder. Common side effects include sleepiness and lack of co-ordination. However, severe side effects are rare and may include suicidal thoughts and increased risk of seizures.

Both the above drugs act on the GABA-A receptors. These receptors are ligand gated chloride channels. Hence when such drug on these receptors, entry of chloride ions takes place in the post-synaptic membrane and causes its hyperpolarisation. Hence the drugs act to reduce the firing of action potential in the subsequent neurones and cause a calming effect on the mind. These drugs act on the limbic system structures that are associated with emotion and learning. The GABA-A receptor is a heterodimer and consists of alpha, beta and gamma subunits, which are responsible for specific actions like sedation, myorelaxant, memory loss (anterograde amnesia) and anticonvulsive actions. Detailed comparisons of both these drugs are explained below:

Features	Valium(diazepam)	Xanax(alprazolam)
Chemical Compound	Benzodiazepine	Benzodiazepine
Chemical structure
Mechanism of Action	GABA-A receptor agonists and stimulates entry of Chloride ions in adjacent neurones and inhibits them	GABA-A receptor agonists and stimulates entry of Chloride ions in adjacent neurones and inhibits them
Increases dopamine concentration in striatum	No	Yes
Indications	Mainly used to treat insomnia associated with anxiety, alcohol withdrawal syndrome and panic attacks. Also used to treat vertigo, tetanus, adjunct treatment for paraplegia or tetraplegia	Various anxiety and anxiety related disorders like GAD, Panic Disorders. It is primarily an anxiolytic
Suppresses Hypothalamus Pituitary adrenal axis	weakly	strongly
Used to treat Benzodiazepine withdrawal symptom	Yes	No
Treatment of Status Epilepticus	Used as First line therapy and acts as potent anticonvulsant	Not recommended, as it can cause seizures
Treatment of Eclampsia	Yes	No
Contraindications	Ataxia ( loss of gait), hypoventilation, hepatic problems, dialysis, Pregnant women, coma and severe depression, myasthenia gravis	Dizziness, Hypotension and loss of balance. Must not be given with alcohol
Pediatric use	Not recommended below 18 years of age, except for epilepsy	May be given below 18 years with medical supervision
Elderly patients	May cause cardiac arrest , hence should be administered with care and monitoring with individuals suffering from cardiac ailments	Can be given in elderly
Withdrawal symptoms	Not severe, as the elimination half life is prolonged	Mean plasma elimination half life is shorter about 11.2 hours
Side effects	Depression, sedation	Jaundice, hallucinations and sedation
Drug Dependence	Low	High
Route of administration	Orally, IV (in diluted form) and IM and suppository. The IM route has slow absorption.	Mainly oral
Onset of Action	Very fast within 5 minutes and 15-30 minutes of IV administration  and IM respectively	Slow release
Peak effects	Within 15 minutes to one hour	1.5-1.6 hours or even weeks
Bioavailability	Very high	Lesser
Protein Binding	96-99%	80%

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