Ativan Withdrawal: Symptoms, Timeline, & What to Do

What is Ativan Withdrawal?

Ativan is a medication with the active ingredient lorazepam. It is a short to intermediate-acting benzodiazepine for adults used to manage anxiety disorders or tension. Ativan has a boxed warning for the potential abuse, misuse, addiction, dependence, and withdrawal symptoms. Ativan withdrawal is caused by abrupt discontinuation or a significant dose reduction when there is physical dependence present. The risk of dependence and withdrawal increases with longer treatment duration and higher daily doses of Ativan.¹

Withdrawal signs and symptoms can be acute (minor) or protracted (lasting longer). Acute signs and symptoms can last for 4 to 6 weeks and include symptoms such as involuntary movements, anxiety, blurred vision, depression, fatigue, nausea, and diarrhea.

Also, long-term signs and symptoms persist beyond 4 to 6 weeks and may last more than 12 months. The symptoms include anxiety, cognitive impairment, insomnia, depression, and weakness. To reduce the risk of withdrawal reactions, use a gradual taper to discontinue Ativan or reduce the dosage slowly.¹

Factors That Influence Ativan Withdrawal

Ativan withdrawal can be influenced by a variety of factors. For example, when Ativan is used for long periods of time or at high doses, the risk of experiencing withdrawal symptoms increases. Another factor is that stopping Ativan immediately, without tapering (slowly decreasing the dose), more often than not, causes withdrawal.

When medications that cause central nervous system depression are used in combination with Ativan, the risk of withdrawal increases. Other factors that can influence Ativan withdrawal include misuse and availability of social support. Discussions should take place between the patient and a healthcare professional about any relevant factors and concerns.¹

Factors that influence Ativan withdrawal include:¹

• Length of time taken: Prolonged use of Ativan can increase the risk of experiencing withdrawal symptoms
• Dosage: Higher daily doses can increase withdrawal symptoms
• Abrupt cessation: Stopping abrupting likely causes withdrawal symptoms
• Used in combination with other CNS depressants: Can increase the severity of withdrawal symptoms when taken together
• Misuse: Regularly exceeding prescribed limits can increase the risk of withdrawal
• Lack of social support: Not being supported by others can lead to feelings of isolation and stress that may influence Ativan withdrawal

Causes of Ativan Withdrawal

Missing a dose, switching medications, and quitting cold turkey are some potential causes of Ativan withdrawal. It is essential to follow directions prescribed by a healthcare professional to decrease the chances of experiencing withdrawal symptoms. Taking Ativan for extended periods of time, with high daily doses, and in combination with other CNS depressants (e.g. Ambien for sleep), can increase the likelihood of experiencing withdrawal symptoms. To minimize the risk of Ativan withdrawal, gradual tapering (slowly decreasing the dose) under medical supervision is recommended.¹

Individuals may want to stop taking Ativan if they experience unwanted side effects or if the medication is no longer effectively addressing their symptoms. Ativan can interfere with daily functioning, and it is advisable to discuss concerns with a healthcare professional before stopping Ativan abruptly.¹

Ativan Withdrawal Symptoms

The continued use of Ativan, along with other factors, may lead to physical dependence. Physical dependence can manifest into withdrawal symptoms when abruptly discontinued or when a decrease in dose occurs. These symptoms can vary in severity and include anxiety, insomnia, restlessness, irritability, sweating, and muscle twitching.

Age can impact withdrawal. Older individuals may experience heightened sensitivity to medications, potentially leading to more pronounced withdrawal effects. Individual responses will be different, and it is crucial to consult with a healthcare professional, including your provider and pharmacist, to address concerns. Ativan side effects vary tremendously; some are common, some are serious, some are rare, and some may warrant immediate medical attention.¹

Common Ativan Withdrawal Symptoms

Ativan withdrawal symptoms can be both physical and psychological. Common physical symptoms are associated with the body’s reaction to the absence of Ativan, such as nausea, abnormal involuntary movements, diarrhea, and dizziness. Common psychological withdrawal symptoms involve emotional and mental aspects such as anxiety, irritability, depression, and depersonalization. Acute (short term) symptoms last for up to 4 to 6 weeks, while protracted (long-term) symptoms last beyond 4 to 6 weeks to more than 12 months.¹

Common Ativan withdrawal symptoms include:*¹

• Blurred vision
• Anxiety
• Depression
• Involuntary movements
• Dizziness
• Nausea
• Irritability
• Cognitive impairment
• Insomnia
• Restlessness

*All medications, including Ativan, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor or pharmacist about any questions you have and to understand the potential side effects and benefits of any medication.

Serious Ativan Withdrawal Symptoms

Serious Ativan withdrawal symptoms may include intense anxiety and depression, hallucinations, mania, seizures, high blood pressure, and suicidality. Severe symptoms are uncommon, but it is essential to seek immediate medical attention.

Longer use of Ativan or higher doses can increase the severity of withdrawal. Other factors like abruptly discontinuing Ativan, personal variation in sensitivity, the presence of other medical or mental health conditions, and concurrent use of other medications can increase the severity of symptoms.¹

Serious Ativan withdrawal symptoms include:

• Seizures
• High blood pressure
• Suicidality
• Intense anxiety
• Hallucinations

*All medications, including Ativan, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor or pharmacist about any questions you have and to understand the potential side effects and benefits of any medication.

Treatment & Management of Ativan Withdrawal

Some patients experiencing Ativan withdrawal symptoms need serious medical attention, while others need psychosocial treatment and education. The treatment and management of Ativan withdrawal is specific to the patient. Some common strategies include using medications to prevent or manage symptoms, the use of medical supervision, behavioral therapies, and support groups.

Medications such as phenobarbital are used in patients experiencing withdrawal symptoms. Phenobarbital is long-acting and effectively prevents serious symptoms such as seizures and psychosis in patients experiencing withdrawal from Ativan. Medical supervision is also used to make decisions moving forward regarding tapering Ativan and the overall management of symptoms. Behavioral therapies and support groups are also vital to the management of withdrawal symptoms by providing coping skills and techniques.^{1, 2}

Tapering Off Ativan

To reduce the risk of withdrawal reactions, a gradual taper from Ativan should only be done under the supervision of a healthcare professional. Tapering schedules are individualized based on the patient’s lifestyle, environment, and reasons for taking Ativan. The tapering schedule should take place over a minimum of 1 month but typically ranges from 4 to 12 weeks, and a recommended dosage reduction of 10 to 15 percent each week.

Tapering off Ativan can involve switching to a longer-acting benzodiazepine, decreasing the times Ativan is taken or the dose. If a patient develops withdrawal symptoms, it is common to pause the schedule or increase the dosage to the previous tapered dosage level.^{1, 2}.

Supportive Therapies

Supportive therapies during Ativan withdrawal may include counseling, cognitive-behavioral therapy (CBT), and relaxation techniques to manage symptoms. These settings often provide a multidisciplinary team that is tailored to the needs of the patient.

CBT is an example of a supportive therapy that works by giving the patient usable skills to use in everyday life that change unwanted thoughts and behavioral patterns. Consulting with a healthcare professional is crucial to determine the most suitable supportive therapies based on needs and circumstances.²

Managing Physical Symptoms

Managing physical symptoms of Ativan withdrawal can be challenging. Over-the-counter medications and lifestyle modifications can make management easier. It is essential to consult with a healthcare professional before trying any over-the-counter options like acetaminophen for pain relief and antihistamines for sleep disturbances, but they can be valuable when experiencing symptoms.

Lifestyle modifications such as implementing relaxation techniques into each day, exercising, eating healthy, getting adequate sleep, and reducing stressors can be beneficial in managing physical symptoms.

Managing Psychological Symptoms

There are various approaches to managing psychological symptoms, such as therapy, support groups, and the use of other medications. Going through Ativan withdrawal can be isolating and psychologically challenging. Therapy and support groups can help patients feel empowered and supported. Sometimes medications like longer-acting benzodiazepines are needed to replace Ativan to manage any psychological symptoms.²

Discontinuation of Ativan After Long-Term Treatment

Discontinuing Ativan after longer-term use should be done gradually under medical supervision to avoid withdrawal symptoms. Discontinuation of Ativan after long-term treatment looks different for each patient. Tapering off Ativan should take place over a minimum of 1 month, but generally takes 4 to 12 weeks. Other medications can be used to decrease withdrawal symptoms that become apparent when tapering off Ativan.²

Discontinuation of Ativan While Pregnant

The discontinuation of Ativan while pregnant can result in withdrawal symptoms for both the mother and the developing fetus. It is pertinent to work closely with a healthcare professional to create a gradual tapering schedule to minimize risk and ensure the well-being of both the pregnant individual and the baby.¹

Preparing for Ativan Discontinuation

Healthcare professionals can provide information on common withdrawal symptoms and severe symptoms to look out for that allow the patient to prepare for the discontinuation. A tapering schedule can help reduce symptoms and severity due to the gradual decrease in the dose taken.

Withdrawal symptoms vary from person to person, so patients are recommended to reach out to a healthcare professional so that they can make an individualized plan that sets the patient up for success.¹

How Long Does Ativan Withdrawal Last?

The length of time Ativan withdrawal lasts is specific to the patient. Acute withdrawal symptoms may be present for up to 4 to 6 weeks, while protracted withdrawal symptoms may last beyond 4 to 6 weeks to more than 12 months. Talk to a healthcare professional, including your provider and pharmacist, about how to manage symptoms.¹

Ativan Withdrawal Timeline

Ativan is readily absorbed in the body and is completely removed from the body within a few days, so withdrawal symptoms can start quickly following the last dose. Initial withdrawal symptoms can consist of anxiety, difficulty sleeping, headache, and nausea. If symptoms continue past the acute phase that lasts for up to 4 to 6 weeks, protracted withdrawal syndrome is likely to take place. Protracted symptoms can consist of anxiety, vomiting, depression, and headache. Individual differences affect the Ativan withdrawal timeline.¹

Factors that may influence the withdrawal timeline of Ativan include:¹

• Dosage
• Individual differences
• Length of time on Ativan
• Concurrence of medications
• Cold turkey or tapered
• Support

Here’s what you may expect for the withdrawal timeline for Ativan:

Days 1-3: The main symptoms can consist of anxiety, increased blood pressure, and difficulty sleeping.

Days 4-7: Common withdrawal symptoms during days 4-7 include anxiety, headache, tremors, and difficulty concentrating.

Days 8-14: Symptoms present during this time include anxiety, irritability, mood swings, and tremors

Weeks 2-4: Common symptoms include drug cravings, weight loss, headache, and depression

How Long Does it Take to Get Ativan Out of Your System?

The excretion of Ativan can vary depending on the person. A person’s age, metabolism, weight, liver function, and more can influence the duration of time Ativan is in the body. Typically, Ativan is excreted within 3 days of the last dose, but different metabolites can show up in the urine after 6 days of the last dose.¹

How Do I Safely Stop Taking Ativan?

Speak to a healthcare professional to safely stop Ativan. Healthcare professionals can provide ample resources and can make individualized plans for their patients that are wanting to stop Ativan.

Tapering schedules and counseling resources such as cognitive behavioral therapy can prevent or improve withdrawal symptoms when done under the medical supervision of a primary physician or psychiatrist. There are also online psychiatry services available if you need to find a provider. It may be beneficial to find a therapist to address your needs and concerns about stopping Ativan or when experiencing withdrawal symptoms.

When to Seek Professional Help for Ativan (Lorazepam) Withdrawal

Patients should seek medical help before discontinuing or reducing the dose of Ativan. Consulting a healthcare professional when withdrawal symptoms are present can help reduce symptoms and provide ways to cope with them.

A tapering schedule under medical supervision can help reduce common symptoms such as blurred vision, anxiety, and involuntary movements, and severe symptoms such as seizures, high blood pressure, and intense anxiety and depression. When severe symptoms are present, seek immediate medical attention.¹