Lorazepam

What is lorazepam (Ativan)?

Lorazepam is a prescription drug belonging to a class of medications called benzodiazepines. It works by boosting the action of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and by depressing all levels of central nervous system (CNS) activity. This causes sedation, resulting in feelings of sleepiness and relaxation, as well as anticonvulsant effects.¹

Lorazepam is available in generic and branded forms, and it’s most commonly known as Ativan. The drug is available as a tablet, capsule, and liquid taken orally and as a solution for intravenous (IV) injection. The latter is only administered by healthcare professionals in a monitored medical setting. The drug is approved for use in patients 12 years and older as its safety and effectiveness have not been established in children under 12; however, there are situations where the drug is used off-label in younger children.¹ ² ³

In its immediate-release oral forms, lorazepam is approved by the US Food and Drug Administration (FDA) for the treatment of anxiety disorders and for the short-term management of symptoms of anxiety or anxiety associated with depressive symptoms. The extended-release form is indicated for the treatment of anxiety disorders and replaces a stable, evenly divided, three-times daily dosing schedule with lorazepam tablets. The injectable form is FDA-approved for treating status epilepticus (prolonged seizures) and for preanesthetic sedation before surgery or other medical procedures.³ ⁴ ⁵

What You Need To Know About Anxiety

Additionally, doctors prescribe lorazepam off-label for the acute or short-term treatment of insomnia, panic disorder, delirium tremens, psychogenic catatonia, some adverse effects of alcohol withdrawal, and chemotherapy-related nausea and vomiting. The drug is commonly used off-label for pediatric patients in the treatment of acute status epilepticus, for procedural sedation, to prevent chemotherapy-related vomiting, and for anxiety in particular circumstances.⁶

How do you take lorazepam?

How you take lorazepam will vary based on the form and strength you’re prescribed.

Drug forms and strengths

Lorazepam is available in four forms:

• Immediate-release tablets for oral use

• Immediate-release liquid for oral use

• Extended-release capsules for oral use

• Solution for IV injection

Lorazepam tablets are available in the following strengths:⁷

• 0.5mg

• 1mg

• 2mg

Lorazepam liquid for oral use is available in the following strength:⁸

• 2mg/mL

Lorazepam extended-release capsules are available in the following strengths:⁴

• 1mg

• 1.5mg

• 2mg

• 3mg

Lorazepam solution for injection is available in the following strengths:⁵

• 2mg/mL

• 4mg/mL

Lorazepam tablets are taken orally. You can take them with or without food, but taking them with food can ease stomach upset caused by the medication. Don’t crush, break, or chew the tablets.⁷

Lorazepam liquid, like tablets, is taken orally. Use the supplied medicine dropper to measure the correct dose, and stir it into water, juice, applesauce, or pudding. Consume the entire mixture right away.⁸

In its extended-release capsule form, lorazepam is taken once daily in the morning. You can take the capsules with or without food, but be careful not to chew or crush the capsules. If you struggle with swallowing medications, you can break open the capsule and sprinkle its contents into a tablespoon of applesauce. Consume the entire mixture without chewing within two hours.⁴

Your doctor will decide which dose is best for you based on several factors, including:

• Your age

• The form of lorazepam you’ll take

• The condition being treated

• Any other medical issues you have that may affect your body’s handling of the drug

When switching from lorazepam tablets to extended-release capsules, your doctor will likely match your daily dose. For example, if your current treatment includes three 1mg lorazepam tablets spread evenly across the day, your doctor may prescribe one 3mg extended-release capsule once daily.⁴

When starting therapy with lorazepam, doctors typically prescribe a low dose of the medication and adjust it over time as needed to achieve the desired results. 

Seeing results

Lorazepam works quickly, even when taken orally. You’ll see the maximum effect of an immediate-release lorazepam tablet or the liquid 2–3 hours after taking it, but you’ll start feeling the effects within 30 minutes. Extended-release capsules are specifically designed to deliver the medication gradually over a longer period, and the maximum effect is achieved within 7–24 hours.

The drug starts working in just 1–3 minutes when administered IV.

Warnings and potential side effects

Lorazepam has several US FDA boxed warnings, outlined below.³ ⁷

People who use lorazepam face the risk of dependence, misuse, addiction, and overdose, which may be fatal, particularly when taken with other illicit drugs, alcohol, and sedatives. Continued use of lorazepam carries a risk of physical dependence, and the risk increases with treatment duration and dose. People taking lorazepam regularly should not discontinue it without guidance from their doctor, as abruptly stopping may trigger severe and potentially fatal withdrawal reactions.

Using benzodiazepines, including lorazepam, alongside opioids increases the risk of severe adverse effects, such as extreme sedation, life-threatening respiratory depression, coma, and death. Only the minimum doses needed for treatment should be given, and patients should be monitored for signs of oversedation. Concurrent use of benzodiazepines and opioids should be avoided when alternative treatment options are adequately effective.

Lorazepam can cause both mild and severe side effects. The lists below don’t include every possible side effect. If you’re taking lorazepam and are concerned that something doesn’t feel right, consult your doctor.

The most common side effects associated with lorazepam are mild and resolve without intervention within a few days to weeks. 

Common side effects of lorazepam include:

• Drowsiness

• Memory problems and difficulty concentrating

• Confusion

• Fatigue

• Restlessness

• Dizziness, vertigo

• Poor coordination, unsteadiness

• Weakness

• Headaches

• Changes in libido

When administered through an IV, lorazepam may cause mild irritation at the injection site.

Severe adverse effects of lorazepam include:

• Low blood pressure, resulting in lightheadedness, dizziness, and fainting

• Slowed breathing

• Suicidal thoughts

• Oversedation, causing slowed respiratory rate and loss of consciousness

• Stiff muscles

• Uncontrollable limb movements

• Seizures

• Nausea

• Vomiting

• Visual disturbances (double or blurred vision)

If you experience severe side effects after taking lorazepam, call your doctor immediately. If your symptoms are exceptionally concerning or life-threatening, call 911. 

Additionally, if you experience a paradoxical reaction (one that’s the opposite of the drug’s intended effect), such as hallucinations, aggression, hostility, agitation, or rage, seek urgent medical care or see your doctor.

Don’t drive or engage in activities requiring alertness until you know how your dose of lorazepam affects you.

Long-term use of lorazepam

Lorazepam is safe and effective for most people when taken as directed. However, studies have not established the safety of its use beyond four months. Therefore, alternative therapies should be considered when the condition being treated is expected to last longer than four months.³

People taking lorazepam long-term should undergo periodic blood counts and liver function tests, as some patients have developed leukopenia (fewer white blood cells than normal) while others have experienced elevated levels of lactate dehydrogenase, which may signal liver disease.³

People who use lorazepam may experience rebound effects, wherein the symptoms being treated get worse, making it difficult to stop using the drug.

If you’ve been using lorazepam too long, work with your doctor to find alternatives that can help you stop taking it.

Missed doses

If you forget a dose, take it as soon as you remember. However, if it’s nearly time for your next dose, skip the missed dose. Never take two doses at once, as a higher dose will increase your risk of severe side effects, and your body may react unpredictably. 

Overdoses

Taking too much lorazepam can cause toxic (and sometimes fatal) effects.

Symptoms of a lorazepam overdose may include:³

• Difficulty breathing

• Difficulty talking

• Confusion

• Low blood pressure

• Low muscle tone

• Lethargy

• Extreme drowsiness or inability to stay awake

• Slowed respiration

• Coma

Overdoses are most common among people taking lorazepam alongside other drugs or alcohol. Do not drink alcohol while taking lorazepam. If you or someone in your care experiences any signs of an overdose, seek emergency care.

What to discuss with your doctor before starting lorazepam

Before taking lorazepam, speak with your doctor about what to expect. Additionally, let your doctor know if you:¹ ²

• Are taking any other medication, vitamins, or supplements (regularly or even occasionally)

• Have any medication allergies

• Have an alcohol or substance use disorder

• Plan to have surgery or other medical procedures, including dental surgery

• Have (or have a history of) depression, suicidal thoughts, or are taking medication for depression

• Have (or have a history of) seizures

• Have lung, heart, or liver disease

• Are pregnant, trying to conceive, or breastfeeding

• Have acute narrow-angle glaucoma

• Have sleep apnea

Stopping lorazepam

Some people experience unpleasant withdrawal symptoms when they stop taking lorazepam. These symptoms may occur after taking lorazepam for as little as one week, but the risk is higher the longer you take the drug.

Withdrawal symptoms can include any of the following:³ ⁷

• Headaches

• Muscle pain

• Dizziness and blurred vision

• Decreased appetite

• Nausea, vomiting, or diarrhea

• Tremors and involuntary movements

• Convulsions

• Panic attacks or anxiety

• Hallucinations

• Irritability

• Restlessness

• Suicidal thoughts or behaviors

If you plan to stop taking lorazepam, your doctor can help you do it gradually, reducing your risk of these symptoms.

Lorazepam and pregnancy

Pregnancy

Lorazepam has been designated by the US FDA as a pregnancy category D drug. Studies in pregnant women have demonstrated risks to the fetus. However, your doctor will assess your situation and may decide the benefits outweigh the potential risks in your case.⁹ ¹⁰

Analysis of umbilical cord blood indicates the drug transfers through the placenta. In some cases, infants born to mothers who have been taking benzodiazepines in the weeks leading up to delivery experience withdrawal symptoms.³

Breastfeeding

Researchers have detected lorazepam in breast milk. Thus, taking lorazepam while breastfeeding is rarely recommended. When passed through breast milk, benzodiazepines can lead to sedation and poor feeding in the infant.³

Interactions with other drugs

Lorazepam can interact with other medications. Some drugs make lorazepam more effective, while others dampen its effects. The opposite is also true; lorazepam can make other drugs you’re taking more or less effective.

Drugs known to interact with lorazepam include:³

• Opiates and opioids, including morphine, fentanyl, oxycodone, methadone, and hydrocodone

• Antidepressants, such as Zoloft 

• Antianxiety medications, such as buspirone and other benzodiazepines 

• Probenecid

• Anticonvulsants such as valproic acid and divalproex

• Ambien

• Tylenol

• Antipsychotics such as clozapine

• Antihistamines 

• Barbiturates 

• Muscle relaxants

People taking the extended-release capsule form of lorazepam should not start treatment with a uridine glucuronyl transferase (UGT) inhibitor as it may change the body’s handling of lorazepam and increase exposure. If you need to start taking a UGT inhibitor while taking extended-release lorazepam, ask your doctor for guidance on safely switching to lorazepam immediate-release tablets.⁴

Allergy information

Allergic reactions to lorazepam are rare and require urgent medical attention. Seek immediate care if you experience any of the following symptoms while taking lorazepam: 

• Rash, hives

• Vomiting

• Trouble breathing

• Severe dizziness

• Itching and swelling (especially in or around the face, tongue, or throat)

Drug approval history

1977: The US FDA approves Ativan (lorazepam) in its original tablet form for the short-term treatment of anxiety and anxiety with depressive symptoms¹¹

1980: The US FDA approves lorazepam injections for the treatment of status epilepticus and for preanesthetic sedation in patients 18 and older¹¹

1991: The US FDA approves Intensol (lorazepam liquid for oral use)¹²

2021: The US FDA approves Loreev XR extended-release capsules for use in adults¹³

Tips and advice for taking lorazepam

The following tips can help you maximize the effectiveness and safety of lorazepam:

• Speak with your doctor if you begin taking any new medications, herbs, or supplements while being treated with lorazepam

• Don’t engage in activities requiring alertness until you know how your dose of lorazepam affects you

• If you feel confused after taking lorazepam, consult your doctor immediately

• If you’re taking lorazepam regularly and wish to stop, ask your doctor how you can do it safely

• If you’re having surgery, don’t take lorazepam to relax ahead of surgery unless your doctor advises it (they may administer the drug before surgery, and taking more than your usual dose may be dangerous)

• Store your medication between 68° and 77°F, and keep it away from direct light and heat

• Keep your medicine out of the reach of children