Precautions for Benzodiazepine Ativan (Lorazepam)

Pharmacist giving a woman a prescription of Ativan
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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).

Indications

Ativan is FDA approved for the treatment of anxiety disorders and for the short-term relief of anxiety symptoms. 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:

  • Insomnia 
  • Agitation 
  • Tremor and akathisia
  • Catatonia
  • Alcohol withdrawal treatment
  • Treating spastic disorders and other types of muscle spasms, such as those seen in people with cerebral palsy or multiple sclerosis
  • Certain types of seizures
  • Chemotherapy-induced nausea and vomiting

Precautions

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 addition, if you have liver or kidney problems, your doctor should monitor the effects of Ativan closely, as you may not metabolize the medication as effectively. The same is true for those who have any breathing problems such as chronic obstructive pulmonary disease (COPD) or sleep apnea. Medications such as Ativan can affect respiration. 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 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.

Possible Interactions

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 it)
  • Antidepressants
  • Allergy medicines that make you drowsy
  • Narcotic painkillers like Vicodin
  • Anticonvulsants (many of which are used as mood stabilizers for bipolar disorder)
  • Anesthetics

Side Effects

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

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. 

Withdrawal

Withdrawal symptoms may occur in some people who stop taking Ativan, especially if they have used them at high enough dosages for many 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 possible that this is a symptom of withdrawal rather 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 uncomfortable but rarely fatal, withdrawal from benzodiazepines carries many risks including fatality.

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

Managing Your Prescription

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.

If your doctor prescribes this drug 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 the side effects of any medication you use.

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  1. Daurat, A., Sagaspe, P., Motak, L, et al. Lorazepam Impairs Highway Driving Performance More Than Heavy Alcohol Consumption. Accid Anal Prev. 2013;60:31-4. doi:10.1016/j.aap.2013.08.004

  2. Lader M, Kyriacou A. Withdrawing Benzodiazepines in Patients with Anxiety Disorders. Curr Psychiatry Rep. 2016;18(1):8. doi:10.1007/s11920-015-0642-5

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