How Long Does Ativan (Lorazepam) Stay in Your System?

Ativan (lorazepam) is a benzodiazepine sedative used to treat anxiety and seizures. It may also be prescribed for people who are undergoing alcohol withdrawal, for nausea from chemotherapy, and for irritable bowel syndrome. It depresses the central nervous system and as a result, has risks when combined with other depressants or alcohol, including the possibility of fatal respiratory depression.

Ativan is classified as a Schedule IV drug, which means that it has a lower potential for misuse and lower risk of dependence than Schedule II and III drugs. But Ativan can be habit-forming. As a result, it's usually prescribed only for short periods.

With long-term use, you can build a tolerance such that larger doses are needed to achieve the same effect. Stopping Ativan after using it for a long period can result in withdrawal symptoms of anxiety, sleeplessness, and irritability.

While you have Ativan in your system, it is important to understand how it might interact with other medications and substances. You need to be alert for the symptoms of an overdose or severe side effects and work closely with your doctor to avoid these situations.

How Long Does It Take to Feel Effects?

Benzodiazepines, including Ativan, have sedative and hypnotic effects. The drug works by enhancing the effects of a natural chemical called GABA, which depresses the central nervous system (CNS), leading to a calming or relaxing effect. 

Ativan can be given as tablets, liquid concentrate, or by injection. The different routes have different timetables for when they take effect. With tablets or liquids, the peak effects are seen in two hours. An injection of Ativan begins to have effects in 15 to 30 minutes, and it lasts for 12 to 24 hours.

How Long Does Ativan Last?

While lorazepam is a fast-acting drug, it has a relatively long half-life. The half-life of lorazepam is 12 hours, meaning that it decreases in concentration in the body by half every 12 hours.

The drug is metabolized primarily by the liver and then eliminated from the body by the kidneys through urine. Ativan may be present up to nine days past the last use.

Blood

Ativan can first be detected by blood tests six hours after ingestion. Blood tests can also detect the substance for three days after the last use. However, this detection window may be longer in cases where people have been taking Ativan at higher doses for three days or longer. 

Urine

Ativan is eliminated in the urine for one to six weeks, depending on how much is administered and for how long. Urine screening tests can detect Ativan in samples up to six days after the last use.

In those who have been taking the drug regularly or at higher doses, this detection window may be somewhat longer. If testing looks for the metabolite lorazepam-glucuronide, which is produced as the drug is broken down by the body, detection may take place up to nine days after the last use.

Hair

As with other drugs, Ativan can be detected in hair samples for much longer than with other methods. It can be detected with a hair test for up to 30 days after use. 

Saliva

Saliva tests have found that Ativan could be detected in samples for up to eight hours after use. However, saliva tests are rarely used to screen for benzodiazepines such as Ativan. 

False Positive Testing

Some medications may result in a false positive urine screen for Ativan. The antidepressant medication Zoloft (sertraline) and prescription non-steroidal anti-inflammatory drug Daypro (oxaprozin) reportedly can cause a false-positive urine test for benzodiazepines like Ativan. Always disclose any prescription or over-the-counter medications so lab clinicians can accurately interpret your drug screen results.

Factors That Affect Detection Time

There are a number of things that can influence how long Ativan remains in a person's system. While rates usually follow a fairly consistent timeline, some people metabolize and clear the drug more quickly than others.

Biological Factors

Some of the factors that can influence how long Ativan remains in your body include the following.

• Age: Older people tend to clear the drug more slowly than younger people. This is likely because older individuals have slower metabolisms, decreased organ function, lower blood flow, and other health issues that can affect how quickly the drug is processed and excreted.
• Kidney function: Research has found that liver impairment does not have much of an impact on Ativan clearance rates; however, kidney problems are associated with prolonged drug half-life.
• Height and weight: Taller, heavier people typically clear the drug more quickly than shorter, lighter individuals.

Dosage and Frequency of Use

Higher doses of Ativan take longer to metabolize. The drug is also detectable for longer periods in individuals who have been taking the drug for a longer period of time.

Use of Other Substances

The concurrent use of other substances can have an impact on how quickly each is processed and excreted from the body. For example, consuming alcohol while using Ativan reduces clearance rates by 18%. Researchers believe that short-term alcohol consumption impairs the coupling of the drug or its metabolites with other molecules, which slows the metabolism process.

How to Get Ativan Out of Your System

Ativan has a relatively long half-life. Like other benzodiazepines, its use can lead to physical dependence, and to withdrawal symptoms when you stop taking the drug.

Once you have safely stopped taking Ativan, there may be a few things that you can do to speed up how quickly the drug completely clears your system. Because Ativan is excreted through urine, staying well-hydrated by drinking plenty of fluids may slightly increase how quickly the drug is removed from your system.

Symptoms of Overdose

An overdose with Ativan is most commonly seen when taken with alcohol or opiate medications like Vicodin (hydrocodone) and OxyContin (oxycodone). This combination can be life-threatening, and it is important that your family or household members know what symptoms to look for so they can get emergency help quickly.

If you suspect that someone has overdosed on Ativan, call 911 immediately. The signs of an Ativan overdose include:

• Unusual dizziness
• Light-headedness
• Extreme sleepiness
• Slowed or difficulty breathing
• Unresponsiveness

Precautions

You risk serious breathing problems, sedation, or coma when you take Ativan with alcohol or other medications that can depress breathing. To prevent accidental overdose or other complications:

• Do not use alcohol while taking Ativan.
• Do not take any street drugs, as they may contain substances that can depress breathing.
• If you are breastfeeding, be aware that this drug passes through into your milk and may affect your baby.
• If you are pregnant or plan to become pregnant, discuss this with your doctor.
• If you are depressed or have suicidal thoughts, avoid Ativan.
• If you are older, you may experience more effects of Ativan, such as drowsiness.
• Do not smoke cigarettes or use tobacco products, as these can reduce the effects of Ativan.
• If you take or plan to take any opiate or opioid medications, discuss them with your doctor as they can result in a life-threatening reaction with Ativan. These include medications with codeine or hydrocodone (such as for a cough or pain), fentanyl, hydromorphone, Demerol, methadone, morphine, oxycodone, and tramadol.

Getting Help

If you need help stopping Ativan use, start by talking to your doctor. Physical dependence can occur even if you take the drug exactly as prescribed. Quitting Ativan suddenly can be dangerous or even life-threatening due to the increased risk of seizures during the withdrawal process. You must be monitored by a medical professional as you go through the withdrawal process.

In most cases, you can detox from the drug on an outpatient basis. There are no medications approved to treat Ativan dependence, but the standard approach is to slowly reduce the amount of the drug used over a period of time to prevent severe withdrawal symptoms. Your doctor will monitor your progress as you slowly taper off of the drug.

Your doctor may also recommend other treatments such as psychotherapy. Types of psychotherapy that may be used during drug recovery include cognitive-behavioral therapy and dialectical behavioral therapy. If you need help with your treatment, ask your doctor to refer you to a psychiatrist or another mental health professional who specializes in addiction recovery.