Lorazepam (Ativan): Uses, Side Effects, Dosage, & More

Ativan, with the active ingredient lorazepam, is a short to intermediate-acting benzodiazepine for adults. Doses range from 1 mg to 10 mg a day. Ativan can be given once daily or every 4-6 hours as needed. Ativan uses include the management of anxiety disorders or tension. Ativan side effects include drowsiness, dizziness, weakness, and unsteadiness.

If you’re considering Ativan, you may have some difficulty finding a doctor to provide an assessment and prescription online. Talkiatry is one of the few online psychiatry platforms that can and will prescribe benzodiazepines, like Ativan, which are controlled substances. They can provide an assessment and may offer you an Ativan prescription if they determine the medication may help your symptoms.

What is Ativan (Lorazepam)?

Ativan is a schedule IV controlled substance. Benzodiazepines and controlled substances have the potential for being abused and the possibility of causing dependence when abused. Patients can develop substance use disorder while on Ativan. You will be monitored closely to ensure you do not misuse, abuse, or become addicted to this drug. Ativan is not approved for use in children. Ativan is approved for treatment for individuals aged 12 and older.¹

How Does Ativan Work?

Ativan works on the neurotransmitter, GABA. It will tell your brain to release GABA which makes your nervous system less active. This allows your body to relax, thus decreasing anxiety and increasing drowsiness.

What is Ativan Used to Treat?

If you have symptoms of anxiety, please contact your provider. It is never too early to get help with your symptoms of anxiety to see if Ativan is a good treatment option for you. Ativan  is approved for use in children aged 12 and older. Ativan comes in two forms: tablets and as an injectable.

Ativan tablets are commonly used as an FDA-approved medication to treat:^{1, 2, 3, 4}

• Anxiety disorders or tension

Ativan injection is commonly used as an FDA-approved medication to treat:

• Seizures (status epilepticus)
• Ease anxiety before surgery

This article will be focusing on Ativan tablets.

Ativan also has off-label (non-FDA-approved) uses listed below. Providers can choose to use a medication off-label because, in their professional judgment, the benefits may outweigh the risks in specific patients.

Ativan may also be used off-label (non-FDA-approved) for treating:¹

• Akathisia (inability to remain still)
• Catatonia (not reacting to one’s environment)
• Chemotherapy-induced nausea and vomiting
• Intoxication
• Drowsiness (mechanically ventilated patients in the ICU)
• Serotonin syndrome
• Substance withdrawal
• Vertigo

Who Should Not Take Ativan?

You should discuss the risks of Ativan, in addition to the benefits, with your provider. Ativan may be the preferred benzodiazepine in patients because it is relatively short-acting with an inactive metabolite. Inactive metabolites of a drug are chemicals formed when a drug is broken down by the body. These inactive metabolites do not have any effects on the body. Other benzodiazepines may have inactive metabolites that can be harmful to the body or cause additional side effects. Therapy should be individualized to the patient.

The use of benzodiazepines, including Ativan, exposes patients to risks of abuse, misuse, and addiction, which can lead to overdose or death. Abuse and misuse of benzodiazepines commonly happen when patients use other medications, alcohol, and/or illicit substances together.¹

People who may need to avoid taking Ativan include:¹

• Patients with allergies to other anti-anxiety medications
• Patients with certain health problems such as glaucoma, depression, kidney disease, or liver disease
• Patients with sleep apnea or sleeping problems
• Pregnant or breast-feeding women
• Patients taking opioid medications
• Older adult patients with dementia

Ativan Dosages for FDA-Approved Treatment

FDA approval of a drug means that the drug’s effects have been reviewed by the Center for Drug Evaluation & Research and the drug is determined to provide benefits that outweigh its potential risks.⁵

Ativan doses range from 0.5 mg to 2 mg every 4 to 6 hours as needed up to 10 mg/day, based on response and tolerability. Ativan may be given alone or in combination with an antipsychotic.¹

Ativan is generally used short-term for symptom relief until preferred therapy (eg. serotonin reuptake inhibitors) is effective. Long-term low-dose Ativan (1 mg/day) therapy may be used in some patients, when preferred treatments are ineffective or poorly tolerated. Use with caution in patients with PTSD, as Ativan may worsen PTSD symptoms.⁶

In patients with liver problems, lower doses of Ativan may be needed.⁷ Use with caution in individuals with kidney problems, especially if using for long periods or at high doses. Lower doses may be needed in patients with lung disease, including chronic obstructive pulmonary disease (COPD) or sleep apnea. Ativan may cause difficulty breathing in patients with lung diseases.¹

Ativan Forms & Strengths

Ativan comes as a tablet and as an injectable, but this article focuses on Ativan tablets that are FDA-approved to treat anxiety and tension. Generic lorazepam comes in other forms in addition to these. 2 Ativan tablets come in the following strengths: 0.5 mg, 1 mg and 2 mg. The correct dose for an individual is determined by many factors, including, but not limited to, the disorder being treated, the age of the patient, and the severity of symptoms.

Your provider will also look at the other medications you are on to determine your dose. There have been many clinical studies done to determine the best dose of Ativan for you based on your individual characteristics. At first, your provider may have you try a lower dose fewer times per day to see how you respond to the medication before increasing the dose for maximum effects.

Ativan tablets will take about 20-30 minutes for full effect.^{1, 2, 3, 4} Remember to take medications as prescribed by your healthcare provider. Your pharmacist is a great resource to get more information on how to accurately take these Ativan dosage forms.

How Should I Take Ativan?

Take Ativan as prescribed by your provider and read all the information that is given to you. Ativan can be taken with or without food. If taking Ativan upsets your stomach, take it with food.¹

What Happens If I Miss A Dose of Ativan?

If you take Ativan on a regular basis, take a missed dose as soon as you remember. If it is close to the time for your next dose, skip the missed dose and take Ativan at the next scheduled time. Do not take two doses at the same time and do not take extra doses of Ativan. Do not take Ativan more often than your provider has prescribed.¹

Side Effects of Ativan

When started on Ativan, monitor for signs of drowsiness and difficulty breathing. Please let your healthcare provider know if you develop an allergic reaction, hallucinations, or a change in balance.¹

Common Side Effects of Ativan

Some people may experience side effects from Ativan. While they may not be severe, they may feel uncomfortable or disruptive to daily life at times.

Common side effects of Ativan include:¹

• Drowsiness
• Dizziness
• Weakness
• Unsteadiness

Severe Side Effects of Ativan

Though it is rare, some individuals have severe and sometimes deadly side effects when taking Ativan. Tell your provider or get medical help immediately if you experience any severe side effect.

Severe side effects of Ativan include:^{1, 2, 3, 4}

• Change in balance
• Feeling confused
• Trouble sleeping
• Memory loss
• Fainting
• Change in eyesight
• Dark urine or yellow skin/eyes
• Muscle weakness

This is not a comprehensive list of side effects. Speak with your doctor about any side effects you experience while taking Ativan.

Benzodiazepine Withdrawal

Long-term use of Ativan and other benzodiazepines may result in the development of tolerance. If you abruptly discontinue or rapidly decrease your Ativan dose, this can produce benzodiazepine withdrawal symptoms. Withdrawal can be life-threatening if not recognized and treated. If you have any of the signs and symptoms below, please seek immediate medical care.

Signs and symptoms of Ativan withdrawal can include:¹

• Tremors
• Anxiety
• Perceptual disturbances (distortions and hallucinations)
• Seizures
• Dizziness and fainting
• Urinary problems

Allergic Reactions to Ativan

Make sure you look for signs of allergic reactions when you start Ativan. Common signs of an allergic reaction include rash, hives, and/or itching.

Other signs of allergic reactions to Ativan may include:¹

• Red, swollen, blistered, or peeling skin
• Wheezing
• Tightness in the chest or throat
• Trouble breathing, swallowing, or talking
• Unusual hoarseness
• Swelling of the mouth, face, lips, tongue, or throat

Do not take Ativan if you have a history of allergic reaction to any other benzodiazepine (e.g. alprazolam, diazepam, clonazepam, Valium, Xanax, Versed, Klonopin).

If you want to stop taking Ativan, talk with your healthcare provider. They will help you develop a taper to slowly stop taking your medication safely.

Ativan Warnings & Precautions

Using benzodiazepines and opioids together may result in enhanced drowsiness, difficulty breathing, coma, and death. Limit Ativan and opioid use together to the minimum time required and monitor for drowsiness and difficulty breathing.⁹

Using Ativan exposes patients to risks of abuse, misuse, and addiction, which can lead to overdose or death. Avoid alcohol, and illicit substances, which are associated with an increased frequency of serious potentially harmful outcomes.¹

Long-term use of Ativan and other benzodiazepines for several days to weeks may lead to physical dependence. The risks of dependence and withdrawal increase with longer treatment duration and higher daily doses.³

Precautions for Ativan include:

• Potential for misuse and addiction: The cause of addiction to Ativan is not fully understood, however, using Ativan increases the dopamine levels in the brain thus there is a “reward” with the use of these drugs.^{11, 12} If you or someone you know has the potential for misuse or addiction to Ativan, please seek immediate medical help.
• Potential for tolerance: Tolerance develops to the sedative, hypnotic, and antiseizure effects of Ativan.¹³
• Possible increase in suicidal ideation: Taking Ativan may put you at an increased risk of suicidal ideation.¹⁴
• Taking Ativan while pregnant: Ativan may be used during pregnancy, but it may also pose a risk to an unborn fetus, particularly if taken late in pregnancy. Talk with your healthcare provider if you are pregnant or plan to become pregnant before taking anxiety medications while pregnant.
• Tartrazine allergy: Some Ativan formulations may contain tartrazine (FD&C Yellow No. 5), which may cause allergic-type reactions.⁴
• Debilitated patients: Initial doses should be at the lower end of the dosing range for debilitated patients.
• Older adult patients: Risk of death has been found highest within the first 4 months of use in older adult dementia patients. ¹⁵
• Fall risk: Use with extreme caution in patients who are at risk of falls; benzodiazepines have been associated with falls and traumatic injury.⁶

Interactions With Ativan

There are potentially harmful interactions Ativan can have with medications, substances, and herbs. The medications listed below may increase the amount of Ativan in your body to toxic levels. Your provider or pharmacist may adjust the doses of your other medications to account for this increase.

Substances you should avoid while taking Ativan include:¹

• Other benzodiazepines: Reduce the dose of other benzodiazepines when combined with Ativan and monitor for excessive drowsiness or difficulty breathing.
• Central nervous system (CNS) depressants: Ativan may enhance the toxic effect of other CNS Depressants (e.g. trazodone)
• Cannabinoid-Containing Products: Ativan may enhance the effect of cannabinoid-containing products.
• Alcohol: Alcohol may enhance the effect of Ativan.
• Melatonin: Melatonin may enhance the effect of Ativan.
• Methadone: Ativan may enhance the effect of Methadone.
• Zolpidem: Ativan may enhance the effect of Zolpidem (Ambien).

This is not a complete list of possible interactions with Ativan. You should talk with your healthcare provider about any prescription medications, over-the-counter medications, herbs, or supplements you are taking or plan to take while taking Ativan.

Can You Overdose on Ativan?

Yes, it is possible to overdose on Ativan. Be sure to take your Ativan as prescribed by your provider.

Symptoms of Ativan overdose include:¹

• Excessive drowsiness
• Slurred speech
• Unusual eye movements
• Loss of coordination
• Extreme difficulty breathing

What Should You Do If You Take Too Much Ativan?

If you take too much Ativan, contact your provider as soon as possible. Flumazenil is the antidote for Ativan. Flumazenil use is reserved for certain clinical scenarios including reversing its effects after medical procedures or accidental ingestion in children.^{1, 10}

Questions To Ask Your Healthcare Provider About Ativan

If you are having symptoms of anxiety, contact your healthcare provider (e.g. pharmacist, doctor, psychiatrist, therapist) about Ativan as a possible treatment option. If started on Ativan, be sure to monitor for the most common side effects of drowsiness and difficulty breathing.  Finding the right therapist can also be a beneficial part of anxiety treatment.

Questions to ask your healthcare team about Ativan include:

• Does Ativan interact with any of the medications I’m currently taking?
• Can I use Ativan along with therapy to treat anxiety?
• How long does it take Ativan to start working?
• What is the best way to take Ativan (e.g. can it be crushed, morning or evening, with or without food)?
• How soon might I notice side effects from taking Ativan?
• Will side effects from Ativan get better over time?
• Am I at risk for more severe symptoms if I am already taking other anxiety medications?
• What is the best dosage to ensure fewer side effects?
• Are there drugs I am taking that could have negative interactions?
• When should I reach out to you if I am experiencing side effects?
• Is there anything I should tell my therapist about this new medication?
• What if my symptoms become worse while taking Ativan?
• Would estazolam, another intermediate-acting benzodiazepine, be an alternative to Ativan?

How To Get An Ativan Prescription

Make an appointment to see your healthcare provider to discuss your symptoms of anxiety to determine if Ativan is a good option for treatment.  The provider should send a prescription to your preferred pharmacy to get filled for you to pick up. There may also be delivery and mail options at your preferred pharmacy if needed. Another option here would include working with an online psychiatry service.