Taking the Benzodiazepine Ativan (Lorazepam)

Indications, Precautions, Side Effects, and Withdrawal Symptoms of Ativan

Pharmacist giving a woman a prescription of Ativan
What are the uses of Ativan, what are some possible side effects, and what precautions do you need to consider?. Ariel Skelley/Blend Images/Getty Images

Ativan, known by the generic name lorazepam, is an anti-anxiety medication in the benzodiazepine family. It has a tranquilizing or quieting effect on the central nervous system. 

It has actions similar to other medications in this family such as Valium (diazepam), Xanax (alprazolam), and Librium (chlordiazepoxide).

What Is Ativan Used to Treat?

Ativan is FDA approved for the treatment of anxiety disorders and for the short-term relief of anxiety symptoms—short term referring to four months or less.

Ativan is also used to treat anxiety associated with depression.

Ativan is not meant to be used for the anxiety associated with everyday life stresses and worries.

Examples of anxiety disorders Ativan is used to treat include:

Ativan is also frequently prescribed short term for other conditions. These include:

What Precautions Are Considered When Taking Ativan?

As with all the benzodiazepines, prolonged use of Ativan may lead to physical and/or psychological dependence (see below), especially when used at higher doses for longer periods of time.

 There is also the potential for abuse in patients with a history of alcohol or drug problems. People who have a history of alcohol or drug problems should be closely monitored while using Ativan.

For the reason that Ativan acts as a central nervous system depressant, the usual warnings about not driving or operating heavy machinery until you know how the drug affects you apply.

In one study, it was found that Ativan could impair driving even more than alcohol.

In people with depression, Ativan should only be prescribed along with antidepressant treatment, as there is concern for possible increased suicide risk. If it is your loved one who has depression and is using Ativan for associated anxiety, become familiar with the risk factors and warning signs for suicide.

In addition, if you have liver or kidney problems, your doctor should monitor your health very carefully while you are taking Ativan. The same is true for those who have any breathing problems such as COPD (chronic obstructive pulmonary disease) or sleep apnea. Medications such as Ativan can decrease the signaling from your brain reminding you to breathe. This can be of concern alone, but especially when Ativan is combined with other central nervous system depressants such as pain medications or alcohol.

Finally, Ativan may cause a paradoxical reaction, which causes a person to become more agitated, not less. This is more commonly seen in children and the elderly.

Can Ativan Interact With Other Medications?

Yes. Ativan should be used with caution in patients who take other drugs that depress the central nervous system.

These include:

  • Alcohol
  • Barbiturates
  • Antipsychotic drugs
  • Other benzodiazepines and sedatives (it's important to note that many people are inadvertently treated with more than one benzodiazepine without realizing that they are essentially overdosing)
  • Antidepressants
  • Allergy medicines that make you drowsy
  • Narcotic painkillers like Vicodin
  • Anticonvulsants (many of which are used as mood stabilizers for bipolar disorder)
  • Anesthetics

Can Ativan Be Taken During Pregnancy?

Ativan is not recommended for use during pregnancy. Also, Ativan is secreted in breast milk, and should not be taken by nursing mothers unless the benefit of taking the drug is considered greater than the risk to the baby.

What Are Common and Serious Side Effects of Ativan?

Ativan depresses or quiets down the nervous system. The most common side effects are sedation, dizziness, weakness, unsteadiness and cognitive changes.

At higher doses, a person may develop respiratory depression. This means their breathing becomes inadequate, so not enough oxygen is getting into the body. This can be dangerous, unfortunately, too often fatal. 

Other Ativan side effects are possible—this list is not all-inclusive. If you have any worries or new symptoms while taking Ativan, please talk to your doctor. 

What Does it Feel Like to Withdraw From Ativan?

Withdrawal symptoms may occur in some people who stop taking Ativan, especially if they have used them for eight weeks or more. Withdrawal from Ativan, unlike many drugs, can be very serious and even result in death. If you have been using benzodiazepine medications for more than a few weeks, always talk to your doctor, even if you have been getting prescriptions from different doctors.

Tapering the Ativan dose down, instead of stopping it abruptly, helps eliminate or minimize any potential withdrawal symptoms. Again it's extremely important to point out that you should never stop benzodiazepines (even if obtained illegally) without talking to a healthcare provider. Your doctor can design a withdrawal schedule which will get you off the drug without risking your health or your life.

Even if you wean off of Ativan, if you have been taking it for some time you may experience uncomfortable withdrawal symptoms. Possible withdrawal symptoms from Ativan include:

  • Irritability
  • Rebound anxiety - Rebound anxiety is a very important symptom to note, as many people were started on Ativan in the first place to alleviate anxiety. If your symptoms of anxiety occur shortly after weaning down your dose or discontinuing your medications altogether, it is much more likely to be a symptom of withdrawal than a revival of your anxiety.
  • Trouble sleeping - Insomnia is extremely common when withdrawing from Ativan. Talk to your doctor about methods to manage your insomnia so that you are not discouraged.
  • Seizures

Addiction and Dependence

Addiction and dependence on benzodiazepine medications are all too common, even if these drugs have been prescribed for clear medical reasons. It's thought that 20 to 30 percent of people who use medications such as Ativan for a long period of time will develop dependence.

Whereas withdrawal from medications such as narcotics can be extremely comfortable but rarely fatal, withdrawal from benzodiazepines carries many risks including fatality.

For those who have become dependent on Ativan, there are many approaches. If you are also experiencing depression, SSRI medications such as Prozac (fluoxetine) may be helpful. Other options include the benzodiazepine antagonist flumazenil or melatonin.

Learn more about addiction and dependence on benzodiazepines such as Ativan.

What Should I Do if my Doctor Recommends Ativan?

Ativan can provide great relief when given for the right purposes. If your doctor prescribes it, please discuss any worries you have and be sure to get all your questions answered.

As a short-term drug Ativan can be almost a miracle drug in some ways as it can relieve nausea due to chemotherapy or for the use acute anxiety symptoms. Unfortunately, these "good" uses of the drugs have, in some ways, led to its underuse for people who can truly benefit from the drug.

Your best bet is to follow closely with your doctor no matter the reason you have been using Ativan. Be honest about your symptoms beforehand, and any symptoms you experience due to withdrawal. There is much that can be done to ease the symptoms of withdrawal without restarting the drug. And there is much that can be done to detoxify you from the drug without risking your life.

If your doctor prescribes this drug in this era it is very likely that there is a clear indication for its use. That said, there are still times when it may be prescribed inappropriately. Your best bet is to be your own advocate in your medical care and carefully consider the possible benefits as well as side effects of any medication you use.

Sources:

Airagnes, G., Pelissolo, A., Lavallee, M., Flament, M., and F Limosin. Benzodiazpeine Misuse in the Elderly: Risk Factors, Consequences, and Management. Current Psychiatry Reports. 201. 18(10):89.

Daurat, A., Sagaspe, P., Motak, L. et al. Lorazepam Impairs Highway Driving Performance More Than Heavy Alcohol Consumption. Accident, Analysis and Prevention. 2013. 60:31-4.

Lader, M., and A. Kyriacou. Withdrawing Benzodiazepines in Patients with Anxiety Disorders. Current Psychiatry Reports. 2016. 18(1):8.

Continue Reading