Ativan (Lorazepam)

Ativan, also sold under the generic name lorazepam, is a prescription drug used to treat anxiety disorders. This medication enhances the activity of certain neurotransmitter chemicals in the brain.

Lorazepam belongs to a group of medicines called benzodiazepines, often referred to as sedatives because they calm and relax the body.

Besides anxiety, Ativan can also be prescribed to treat epilepsy and insomnia. The drug is available in tablet form with doses ranging from 0.25mg to 2mg.

Ativan is classified under the United States Drug Enforcement Administration’s Schedule IV¹ category, meaning it has a low potential for abuse and low risk of dependence; however, Ativan can still be addictive. Your doctor may only prescribe Ativan for a short period to lower the risk of addiction.

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How Ativan works

Lorazepam belongs to the benzodiazepine group of medicines that are used to calm people who are anxious or find it difficult to sleep.

Lorazepam works by blocking a receptor in the brain that releases a chemical messenger called gamma-Aminobutyric acid (GABA), which has a calming effect on the body. GABA usually binds to receptors called GABA-A, which are located on nerve cells in the brain. When this happens, the nerve cell stops sending messages to others.

Benzodiazepines bind to the GABA-A receptors in a different position than GABA does, helping it do its job more effectively.

What is Ativan used to treat?

Ativan is prescribed to treat many different conditions², including:

  • Anxiety

  • Insomnia, or other sleep problems caused by anxiety or depression

  • Sleep disturbance (difficulty falling asleep or waking up in the middle of the night)

  • Epilepsy

  • Restlessness

  • Fatigue

  • Difficulty concentrating

  • Irritability

  • Muscle tension

  • Alcohol dependence

Ativan is also given just prior to anesthetic procedures to have a calming effect on the patient. 

How do you take Ativan?

You can take the medication orally with or without food as directed by your doctor. Your dosage will be based on your medical condition, age, and response to treatment. Ativan can be used as a regular medication or it can be prescribed to be taken as and when needed. 

Ativan can help treat many conditions, but it can be addictive³. If you have a substance abuse problem, this risk may be higher. Take this medication according to the instructions on the label to prevent addiction.

Don't stop taking this medication without talking to your doctor first. If you stop taking Ativan suddenly, your condition may get worse. You may need to decrease your dose slowly.

If you take this medication for a long time, you may need to adjust the dose. If this medication stops working for you, talk with your doctor.

Seeing results

Ativan can be taken orally (as tablets or liquid) or given intravenously, and the length of time it takes for Ativan to take effect depends on how it is taken.

With tablets or liquids, you could expect to feel the effects of the medication within two to three hours⁴. An Ativan injection takes effect in approximately 15 to 30 minutes⁵.

Potential side effects of Ativan

Most adverse reactions to benzo­diazepines, including central nervous system (CNS) effects and respiratory depression, occur at higher doses.

In a sample⁶ of 3,500 patients treated with Ativan for anxiety, the most common adverse reaction was sedation (15.9%), followed by dizziness (6.9%), weakness (4.2%), and unsteadiness (3.4%). The incidence of sedation and unsteadiness increased with age.

Other potential adverse reactions to lorazepam include:

  • Fatigue

  • Drowsiness

  • Amnesia or memory loss

  • Confusion

  • Disorientation

  • Depression

  • Disinhibition

  • Euphoria

  • Suicidal thoughts

  • Convulsions/seizures, tremor, or vertigo

  • Sight problems

  • Slurred speech

  • Sexual problems

  • Headache

  • Respiratory depression

  • Worsening of sleep apnea

  • Gastrointestinal problems including nausea, change in appetite, or constipation

  • Jaundice

  • Dermatological symptoms, including allergic skin reactions or alopecia 

Don’t drive while taking Ativan until you understand how the medication affects your body.

Long-term use of Ativan

Ativan is a safe and effective medication, but it can cause addiction when used over a long time period. It should be prescribed with caution for long-term treatment if you have a history of substance abuse⁵, and you should be closely monitored while you take it.

Other complications of long-term Ativan use⁷ include:

  • Sedation

  • Fatigue

  • Anxiety

  • Confusion

  • Disorientation

  • Memory loss

  • Learning difficulties

  • Mouth sores

  • Abdominal bleeding

  • Kidney problems

  • Headaches

  • Loss of appetite

  • Insomnia

  • Seizures

  • Falls

Long-term Ativan use can also cause non-medical challenges, including:

  • Family difficulties

  • Divorce

  • Financial difficulties

  • Legal challenges, including incarceration

  • Unemployment

  • Withdrawal symptoms

  • Motor vehicle accidents

Missed doses

Take a missed dose as soon as you can, but if it's too late to take the missed dose, wait until the next scheduled dose. Don't take two pills at once.

If you're having trouble sleeping, don't take the missed dose right before bedtime. Take your normal dose the next night instead.

Before undergoing any medical procedure, read any information you were given about your procedure, which may include advice about missed doses.

Overdoses

Seek immediate medical attention if you or someone else has taken an overdose of Ativan. An overdose can be fatal, especially if you combine the medication with other sedatives that slow your breathing.

Overdose symptoms may include severe drowsiness, confusion, slurred speech, weakness, loss of balance or coordination, fainting, slow or irregular heartbeat, or shallow or rapid breathing. 

What to discuss with your doctor before taking Ativan

To be sure Ativan is safe for you to take, tell your doctor if you have any history of these medical issues: 

  • Asthma

  • Chronic obstructive pulmonary disease (COPD)

  • Sleep apnea or another breathing disorder

  • Drug or alcohol addiction

  • Depression, mood problems, or suicidal thoughts or behaviors

  • Liver disease

  • Seizures

  • An allergy to aspirin or yellow food dye

If you're pregnant or planning to get pregnant, tell your doctor. If you take Ativan during pregnancy, there's a chance your baby could be born prematurely and may require medical treatment for several weeks after birth.

Tell your doctor about any other treatment you are receiving, such as talk therapy, medication, or substance abuse treatment. Your doctor can explain how each treatment works with the medications you're taking and decide whether it’s safe for you to take Ativan or not.

You should also let your doctor know if you drink alcohol, use drugs, or both, as you could be at risk of serious health complications when taking Ativan.

Stopping Ativan

Gradually reduce your Ativan dose to minimize the risk of withdrawal symptoms when you stop taking the drug.

If you experience any withdrawal symptoms, talk to your doctor about how to stop taking Ativan safely. They might recommend either stopping the taper or increasing the dosage back to the previous tapered dosage. 

Ativan and pregnancy

If you're planning to become pregnant, you should tell your doctor before taking Ativan.

If you are suffering from an anxiety disorder, you need to weigh up the pros and cons of taking medication containing benzodiazepines, and your doctor can advise you.

Lorazepam increases the risk of preterm labor and low birth weight, so it is not recommended for use during pregnancy⁸. 

Breastfeeding mothers should avoid using Ativan as the medication passes into breast milk.

Interactions with other drugs

Taking Ativan with opioid drugs (including morphine, oxycodone, hydrocodone, methadone, and fentanyl) increases your risk of respiratory depressant (hypoventilation) effects because of actions at different receptors in the central nervous system (CNS) that control breathing.

Your doctor may limit your dose and the duration of your treatment when you take benzodiazepines and opioids together, and you will be monitored carefully for respiratory depression and sedative effects.

Ativan produces increased CNS-acting effects when administered with other CNS depressants, such as barbiturates, antipsychotics, sedatives/hypnotics, anxiolytics, antidepressants, narcotic analgesics, and sedative antihistamines.

Importantly, you must avoid drinking alcohol while taking Ativan, as dangerous side effects could occur. 

Other drugs that may interact with Ativan⁹ include:

  • Clonazepam

  • Valproate

  • Probenecid

  • Theophylline

  • Aminophylline

This is not a complete list and you should discuss all medications you are taking with your doctor to check for potential drug interactions. 

Allergy information

It's rare¹⁰ for someone to experience a severe allergic reaction to Ativan. If you notice any signs of an allergic reaction, including rash, itching/burning, swelling (especially of the face, tongue, and throat), or difficulty breathing, seek immediate medical attention.

Clinical trial history

A four-week randomized, double-blind trial¹¹ comparing lorazepam (mean dose of approximately 3mg per day) with a placebo found that lorazepam effectively reduced anxiety. The improvement rate with lorazepam was found to be 50% higher than the placebo. 

Lorazepam was well-tolerated and did not interact adversely when administered with concomitant non-psychotropic medications.

Tips and advice for taking Ativan

  • Ativan starts working within two to three hours when you take it orally.

  • Feeling drowsy during the day is one of the most common side effects of taking the drug. If you are affected by drowsiness, don't drive, ride a bike, or use tools or machinery until you feel better.

  • Don’t take Ativan for longer than four weeks at a time because there is a risk of addiction.

  • Tell your doctor about any medications you are currently taking as some drugs interact with Ativan and cause dangerous side effects.

  1. Drug scheduling | United States Drug Enforcement Administration

  2. Lorazepam (Ativan) | National Alliance on Mental Illness

  3. Ativan | Drugs.com

  4. Ativan vs. Xanax (2022)

  5. Lorazepam (2022)

  6. Ativan side effects, warnings, and drug interactions | MedicineNet

  7. Ativan addiction: Side effects of long-term use | American Addiction Centers

  8. Is Ativan safe during pregnancy? | American Addiction Centers

  9. Ativan (lorazepam) (2022)

  10. Ativan - uses, side effects, and more | WebMD

  11. A study in the management of anxiety with lorazepam (1978)

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Disclaimer

Here at HealthMatch, we’ve done our best to ensure that the information provided in this article is helpful, up to date, and, most importantly, accurate.

However, we can’t replace the one-to-one advice of a qualified medical practitioner or outline all of the possible risks associated with this particular drug and your circumstances.

It is therefore important for you to note that the information contained in this article does not constitute professional medical or healthcare advice, diagnosis or recommendation of treatment and is not intended to, nor should be used to, replace professional medical advice. This article may not always be up to date and is not exhaustive of all of the risks and considerations relevant to this particular drug. In no circumstances should this article be relied upon without independent consideration and confirmation by a qualified medical practitioner.

Your doctor will be able to explain all possible uses, dosages, precautions, interactions with other drugs, and other potential adverse effects, and you should always talk to them about any kind of medication you are taking, thinking about taking or wanting to stop taking.

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