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At some time or another, everyone encounters situations that seem to turn your world upside down, such as a heartbreaking divorce or the tragic loss of a loved one. You may be feeling constantly on edge, and it’s affecting your sleep, work, and relationships.
In difficult situations, it’s common to turn to your healthcare professional for help. They may suggest a prescription medication such as Ativan (lorazepam) for temporary relief. It’s a benzodiazepine (“benzo”) drug known for its calming effects.
Read on to learn more about lorazepam, its usual dosage, uses, side effects, and risks.
What is lorazepam (Ativan)?
Lorazepam is a prescription drug that’s considered an anxiolytic or anti-anxiety medication. The brand name for lorazepam is Ativan. It belongs to a class of medications called benzodiazepines. Benzodiazepines work by attaching to specific receptors in your brain, boosting the activity of the brain chemical gamma-aminobutyric acid (GABA). GABA blocks certain brain signals, slowing down the activity of the brain and nervous system. The result is a calming effect on your central nervous system (CNS) (Bounds, 2020).
Anxiolytics: uses, side effects, and risks
All benzodiazepines are designated as schedule IV controlled substances. This means that they carry a risk for drug abuse and dependence, but the risk is lower than other controlled substance categories. The federal government has established special rules that healthcare professionals must follow to prescribe and dispense them (DEA, n.d.).
Lorazepam is available in several forms: an oral tablet, an oral solution, and an injection. However, the rest of this article will focus on the tablet form of lorazepam, which comes in three different strengths: 0.5 milligrams (mg), 1 mg, and 2 mg. The drug is considered an “intermediate-acting” benzodiazepine. It starts working soon after you take your dose and reaches its maximum effects in your body within two hours. Its effects usually last 6 to 8 hours (Bausch Health, 2021).
Ativan (lorazepam) was first approved by the Food and Drug Administration (FDA) in 1977 (Ghiasi, 2021). In 2020, the FDA announced the requirement for all benzodiazepine drugs to carry updated boxed warnings due to the risk of abuse, addiction, and other serious risks (For more details, see the Important Warnings section below) (FDA, 2020).
What is lorazepam (Ativan) used for?
Lorazepam tablets are FDA-approved to manage anxiety disorders and short-term relief of anxiety or anxiety symptoms related to depression. It’s also approved to treat short-term insomnia due to anxiety or situational stress (Bausch Health, 2021).
Even though lorazepam is FDA-approved for these uses, it’s important to note that other medications and non-drug therapies are generally preferred for the long-term management of conditions like generalized anxiety disorder. Lorazepam, and all benzodiazepines, carry risks of drug addiction and can cause dangerous effects when combined with alcohol or opioid painkillers (Bausch Health, 2021; Bystritsky, 2020).
Because of this, lorazepam is often prescribed as a limited, short-term, or “as needed” treatment for anxiety. For example, a healthcare provider may suggest taking lorazepam only as needed for panic attacks during the first few weeks of treatment with an SSRI antidepressant such as paroxetine (Paxil). This is because all SSRIs take several weeks of treatment to reach their full effectiveness in treating mood and anxiety disorders. SSRIs are meant to be a long-term treatment and can reduce the need to take anti-anxiety drugs such as lorazepam (Bystritsky, 2020).
SSRIs: everything you need to know
Lorazepam can also be used “off-label.” This is when a drug is prescribed to treat conditions other than its FDA-approved uses —standard practice when a healthcare professional deems a medication appropriate for their patient (FDA, 2018).
Some common off-label uses for lorazepam include (Ghiasi, 2021):
- Panic Disorder, an anxiety disorder in which you have recurrent panic attacks.
- Alcohol withdrawal symptoms occur when someone stops consuming alcohol after a period of heavy drinking. Some common alcohol withdrawal symptoms are anxiety and tremors.
- Delirium is a mental state in which a person becomes confused and disoriented and affects the ability to think and communicate clearly.
- Long-term insomnia, a sleep problem in which you have trouble falling asleep or staying asleep. However, benzodiazepines are not considered a first-line treatment option for insomnia by the American Academy of Sleep Medicine. They should only be prescribed when other treatment options aren’t effective or can’t be taken (Sateia, 2017).
Long-term treatment that continues for more than four months is technically considered off-label. This is because lorazepam was FDA-approved based on clinical studies in which the drug was taken for up to four months (Bausch Health, 2021).
Lorazepam (Ativan) dosage
Lorazepam tablets are available in three strengths: 0.5 mg, 1 mg, and 2 mg. The typical lorazepam dosage to treat anxiety ranges from 1 to 4 mg per day. It’s often prescribed as medication that you only take when you experience certain symptoms, such as a panic attack, and not part of your daily schedule (Bausch Health, 2021).
But, be sure to follow the dosing prescribed by your healthcare provider, and do not take the drug more often than prescribed. Your healthcare provider may adjust the dosage based on your symptoms, side effects, and any other medications you’re taking.
Side effects of lorazepam (Ativan)
The most common side effects of lorazepam (Ativan) include (Bausch Health, 2021):
Important warnings: what to know before taking lorazepam (Ativan)
The FDA has issued several boxed warnings for all benzodiazepine drugs, including lorazepam. Boxed warnings are the strongest type of warning from the FDA. These include (Bausch Health, 2021; FDA, 2020):
Risk of life-threatening side effects when used with opioid painkillers
Taking lorazepam with opioids can cause dangerous side effects. These may include severe drowsiness, respiratory depression (slowed breathing), coma, and, in rare cases, death. Examples of opioids include hydrocodone, oxycodone, fentanyl, and tramadol, and street drugs such as heroin. You shouldn’t take lorazepam with an opioid unless you and your healthcare provider have discussed all of the risks and have established a plan to monitor and manage these risks.
Alprazolam (Xanax): dosage, uses, side effects
Risk of abuse and addiction
Even if you take lorazepam as prescribed, it’s possible to become addicted to it. You may start to feel that you need it, physically and mentally. This can lead to taking the drug more than prescribed, which can raise your risk of overdose.
Risk of dependence and withdrawal
Taking lorazepam can lead to physical dependence. Therefore, withdrawal can occur if you suddenly stop taking it. Withdrawal can cause harmful effects, especially if you took high doses of lorazepam for a long time before you stopped it. If you and your healthcare provider decide that you’ll stop taking lorazepam, they’ll guide you on reducing your dose slowly over time.
You should not take lorazepam if you’ve had a past allergic reaction to it or any other benzodiazepine drug. Also, you should not take this medication if you have an eye problem called acute narrow-angle glaucoma.
Older adults (ages 65 and older) have a higher risk of adverse effects with benzodiazepines and should take them cautiously, usually in lower doses. Before taking lorazepam, be sure to tell your healthcare provider if you’ve ever had kidney, liver, or breathing problems such as sleep apnea. Also, tell your healthcare provider if you’re pregnant, breastfeeding, or have plans to become pregnant or breastfeed.
- Bausch Health. (2021). Ativan (lorazepam) tablets. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/017794s048lbl.pdf
- Bounds, C.G., Nelson, V.L. (2020). Benzodiazepines. [Updated 2020 Nov 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470159/
- Bystritsky, A. (2020). Pharmacotherapy for generalized anxiety disorder in adults. In M.B. Stein & M. Friedman (Eds.). Retrieved July 26, 2021 from https://www.uptodate.com/contents/pharmacotherapy-for-generalized-anxiety-disorder-in-adults
- Food and Drug Administration (FDA). (2018). Understanding unapproved use of approved drugs “off label”. Retrieved from https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label
- Food and Drug Administration (FDA). (2020). FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. Retrieved from https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class
- Drug Enforcement Agency (DEA). (n.d.). Drug scheduling. Retrieved from https://www.dea.gov/drug-information/drug-scheduling
- Ghiasi, N., Bhansali, R.K., Marwaha, R. (2021). Lorazepam. [Updated 2021 Feb 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532890/
- Sateia, M.J., Buysse, D.J., Krystal, A.D., Neubauer, D.N., Heald, J.L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine; 13(2):307–349. Retrieved from https://aasm.org/resources/clinicalguidelines/040515.pdf
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.