About Ativan | Lorazepam
Ativan is a sedative medication most commonly used to treat anxiety.
Other accepted uses include treating insomnia (see sleep
disorders fact sheet), symptoms of severe alcohol withdrawal,
relieving serial seizures in children (sublingual form), as
a muscle relaxant, and reducing the suffering of chemotherapy
patients who experience vomiting during treatment. Ativan
is not generally recommended for long-term use, over 4 months
duration, as this may increase the likelihood of physical
withdrawal symptoms.
Ativan works by increasing the activity of a neurotransmitter called
GABA (gamma-aminobutyric acid), which inhibits the nervous system,
reducing states of mental and physical overexcitement. Lorazepam
is a member of the benzodiazepine group of drugs, a class of antidepressants,
anti-panic agents, sleep medications, and muscle relaxants.
Ativan is only available by prescription.
Ativan Side Effects
Ativan (lorazepam) is generally considered a safe medication with
a low risk of adverse side effects. If side effects do occur,
they are likely to happen at the beginning of treatment, and
are typically reduced with continued treatment or lower dosages.
If any side effect should persist, become bothersome, or if
an allergic or paradoxical reaction develops, contact your
doctor.
Expected Ativan Side Effects: Drowsiness and mild nervous
system depression during the day following use at bedtime are normal
and expected side effects of this medication. Normal use may cause
mild central nervous system depression, but dosage should be managed
to minimize this. Do not drive or perform any other potentially
hazardous activities until you are familiar with your reaction to
this medication and know how long it takes to clear from your body.
Common Ativan Side Effects: Dizziness, poor coordination,
sedation, and weakness, are the most common lorazepam side effects.
These effects are usually mild, but you may want to speak to your
doctor if they bother you or persist.
Mild Ativan Side Effects: Altered appetite, amnesia, blurred
vision, confusion, constipation, decreased hearing, depression,
slurred speech, and sweating occur rarely to infrequently. While
these side effects are not generally serious, you should discuss
them with your doctor to determine the best course of action. Hives
or rash caused by Ativan treatment indicate an allergy to the medication,
and possibly to all benzodiazepines. You should inform your doctor
and discuss discontinuing treatment.
Serious Ativan Side Effects: Difficulty breathing,
hallucinations, low blood pressure, low white blood cell count,
excitement or anger, porphyria, and seizure or tremor are
all rare but serious symptoms and you should contact your
doctor or seek medical treatment. Yellow skin and eyes or
a feeling of whole body discomfort and nausea, while rare,
indicate a severe allergic reaction and liver damage. Treatment
should be discontinued immediately.
Withdrawal: If you take Ativan for longer than four weeks,
or at higher dosages, physical withdrawal symptoms are a possible
result. Ativan treatment should never be stopped abruptly; instead,
you should gradually decrease your dose according to the advice
of your doctor. Possible effects include insomnia, ringing in the
ears, shaking, tremors, sweating, and nausea, depending on the dosage
and length of use before withdrawal. These effects are not generally
dangerous, but their likelihood and severity can be greatly decreased
by following your doctor's advice.
Overdose: An overdose is possible with Ativan, though
is much more likely in combination with alcohol or other central
nervous system depressants. Symptoms range from drowsiness,
weakness, or an unsteady walk, to depressed breathing, stupor,
and various levels of coma. Liver damage may occur in such
cases. Very rarely, death is a possible outcome.
Cautions: Only a doctor can determine whether or not Ativan
treatment is safe for you. Always discuss your full medical history
with your prescribing physician so that they can give you the safest,
most effective treatment.
Because some conditions are contraindications for Ativan treatment,
and others may require careful monitoring or a dosage adjustment,
inform your doctor if you have any of the following conditions or
a history of them.
- Alcohol or drug abuse - may increase likelihood of Ativan dependence
- Allergic reaction to Ativan, or other benzodiazepine. Always
tell your doctor about any allergies before starting a medication.
An allergic reaction to this medication, or a related medication,
indicates that you should use a different treatment.
- Borderline personality disorder or a history of violent behavior.
- Brain disease - may increase likelihood of side effects from
Ativan
- Breathing difficulties such as asthma, bronchitis, emphysema,
or any other chronic lung disease - Ativan may worsen this condition.
- Glaucoma - Ativan should not be prescribed to patients with
acute narrow-angle glaucoma. Patients receiving treatment for
open angle glaucoma should consult their doctor, as Klonopin may
be an acceptable treatment for them.
- Kidney or liver problems - In isolated cases, Ativan has been
reported to cause jaundice. If you experience yellowing of the
skin or eyes, seek medical treatment immediately. More Ativan
may end up in your bloodstream if you have a pre-existing kidney
or liver condition, increasing the likelihood of side effects.
- Major Depression - You should not use Ativan.
- Myasthenia gravis - This autoimmune disorder characterized by
muscle weakness may be aggravated by Ativan treatment.
- Porphyria - Ativan (lorazepam) may potentially cause reactions
in individuals with acute intermittent porphyria, and any previous
sensitivity to benzodiazepines would indicate that another treatment
should be chosen.
- Psychosis or other serious mental illness - Ativan has not proved
to be an effective treatment for these conditions, and is not
recommended.
- Sleep apnea (temporary suspension of breathing during sleep)
- Ativan may worsen this condition. Individuals with sleep apnea
should not generally use sedatives as sleep aids. (See Sleep
Disorders)
Ativan Interactions
Ativan (lorazepam) is a central nervous system depressant, and
should not generally be mixed with other drugs that may cause drowsiness,
unless specifically recommended by your doctor. Stimulant medications
may reduce the effectiveness of Ativan treatment, and should generally
be avoided.
You should speak to your doctor about any other prescription, over
the counter, or herbal medication you may take in order to avoid
the possibility of undesirable or dangerous drug interactions. Always
ask your doctor or pharmacist about the advisiability of starting
a new prescription or over the counter medication during Ativan
treatment. Always give your prescribing physician an update on any
other medications you may have started taking since your last visit,
especially if you see more than one medical professional.
The following medications should be used either with caution, under
the advice of your doctor, or not at all during Ativan treatment.
- Alcohol - Do not use alcohol while you are being treated
with Ativan, as the possibility of oversedation or overdose
is greatly increased. Lower alcohol tolerance has been reported
up to 24 hours after using Ativan.
- Any medication which may cause drowsiness
- Antibiotics (macrolide antibiotics) like azithromycin,
biaxin, clarythromycin, or erythromycin
- Antihistamines like Tavist or Benadryl
- Antiseizure medication like Cerebyx (fosphenytoin), Dilantin
(phenytoin), or Tegretol
(carbamazepine) - these medications may decrease each
other's effectiveness.
- Benemid (probenecid) - May decrease Ativan's effectiveness
by lowering its levels in the body.
- Benzodiazepines of any other type, such as Valium
(diazepam), Halcion
(triazolam), Restoril
(temazepam), Librium(chlordiazepoxide),
Tranxene-SD (clorazepate), Paxipam (halazepam), Klonopin
(clonazepam), ProSom (estazolam), Xanax
(alprazolam) - These medications should not be mixed.
- Bronchodilators of the xanthine (thioxanthine) class (Aminophylline,
Dyphylline, Oxtriphylline, Somophyllin, Theo-Dur,
etc...) - May increase the effects of Ativan.
- BuSpar (buspirone)
- Can result in oversedation.
- Clozaril (clozapine) - Oversedation and lack of muscle
coordination may result from combining these medications.
- Desyrel (trazodone) - Risk
of additive CNS depression.
- Heparin - Might cause a build up of Ativan in the body.
- Kava kava - Do not use this herb while taking Ativan.
- Lithium (Lithobid, etc.) -
May cause a drop in temperature.
- Muscle relaxants such as Flexeril
(cyclobenzaprine), Skelaxin
(metaxalone), Soma
(carisoprodol), or Robaxin
(methocarbamol) may cause oversedation in combination
with this medication.
- Narcotic analgesics of any kind, like Darvon (propoxyphene),
Darvocet (propoxyphene, acetaminophen), Demerol
(meperidine), Codeine, Percocet
(oxycodone, acetaminophen), Vicodin
(hydrocodone, acetaminophen), Vicoprofen
(hydrocodone and ibuprofen) or OxyContin
(oxycodone) should likely be taken in much lower doses
when taken with Ativan, especially if you have a history
of respiratory depression.
- Norflex (orphenadrine)
- Risk of oversedation.
- Oral contraceptives - May increase the effects of Ativan.
- Phenobarbitol, Fioricet
(butalbital, acetaminophen, and caffeine), Fiorinal,
Seconal, or other barbiturates
- Seroquel (quetiapine) - Can cause Ativan to build up in
the body, potentially increasing the likelihood of side
effects like drowsiness or poor coordination.
- Sleep medication like Ambien
(zolpidem), Sonata
(zaleplon), or over the counter sleeping pills should
be used with Ativan only as, and if, advised by your doctor.
Most likely, they should not be used concurrently.
- Street drugs - Marijuana may increase sedative effects
from Ativan. You should refrain from using any illegal drugs
while taking prescription medication, as it greatly increases
the risk of adverse side effects and overdose.
- St. John's Wort - Do not use this herb while taking Ativan.
- Tranquilizers such as Haldol (haloperidol), Mellaril (thioridazine),
or Thorazine (chlorpromazine) may cause oversedation.
- Tricyclic antidepressants such as Elavil
(amitriptyline), Asendin (amoxapine), Anafranil (clomipramine),
Pertofrane or Norpramin (desipramine), Sinequan
(doxepin), Tofranil (imipramine), Aventyl or Pamelor
(nortriptyline),
Vivactil (protriptyline), and Surmontil (trimipramine),
may potentially interact with benzodiazepines.
- Valerian - Do not use this herb while taking Ativan.
- Valproic acid, also Depakote, Depakene, divalproex, increases
the risk of continuous absence seizures in combination with
Ativan.
Ativan Dosages
Ativan (lorazepam) starting dosages in adults being treated for
anxiety are usually 1-3 mg daily, divided into 2-3 doses. A typical
maintenance dose is 2-6 mg daily, taken in divided doses, with a
maximum dose of 10 mg per day. The usual amounts prescribed for
insomnia are 2-4 mg taken at bedtime.
This medication is available in the following forms:
- Lorazepam oral solution - 2 mg/ml
- Lorazepam sublingual tablets - 0.5 mg, 1mg, 2 mg
- Lorazepam tablets - 0.5 mg, 1mg, 2 mg
Ativan Directions
Do not increase your dose of Ativan without instructions from your
doctor. If you miss a dose, take it as soon as you remember, unless
it is almost time for your next dose. Skip the missed dose of Ativan
and resume your regular schedule. Do not take double doses of this
medication.
Ativan tablets may be crushed and can be taken with or without
food or a beverage.
Do not discontinue treatment abruptly, or without the advice of
your doctor. Withdrawal symptoms may range from mild insomnia, to
cramps, sweating, and tremor, depending on the length of use and
dosage taken. Gradual withdrawal under the guidance of your physician is recommended.
Inform your doctor, dentist, or anesthesiologist that you are taking
Ativan before any kind of surgery or medical test. This medication
may interfere with certain test results. Ativan should not be combined
with certain medications given during surgery.
Store Ativan away from direct light and heat. Store in a dry location;
avoid storing it in the bathroom, near sinks, or other areas where
it may become damp. Do not use after the expiration date. Do not
allow the liquid form of this medication to freeze.
Keep Ativan away from children; both when storing it, and when
discarding any unused medication.
Ativan may cause drowsiness or disorientation. Be cautious if you
plan to drive or operate heavy machinery, avoid these activities
if you find yourself feeling tired or experience slowed reactions.
Ativan and Pregnancy
Use of lorazepam early in pregnancy has been seen to produce an
increased risk of birth defects in animal studies. Use during late
pregnancy may cause muscle weakness and respiratory depression in
newborns. This drug is not advised for use during pregnancy, or
during nursing, as it would pass through breast milk.
Ativan and Children
Lorazepam has not been fully studied for use and safety in individuals
under the age of 18. Its only approved use in children is a dose
of 1 mg - 4 mg taken under the tongue (sublingual form) to treat
serial seizure.
Ativan and Seniors
Lower doses are recommended to decrease the risk of side effects.
Starting doses are usually 0.5 mg - 1 mg twice daily, not to exceed
a total of 2 mg per day. Watch carefully for signs of oversedation
like fatigue, low motivation, or weakness, and signs of adverse
reaction like anger, excitement, or irritability.
There is some concern that problems with the esophagus may develop
in older patients, and they are advised to have their doctors monitor
their condition. This rare condition is reversible if the medication
is stopped within two months of the initial problem.
Other than a greater likelihood of side effects and slower metabolism
of the medication, Ativan does not affect seniors differently than
the general population.
Ativan is a trademark of Wyeth Ayerst Pharmaceuticals
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This document is provided for information only. It is not a substitute for consultation with a physician, either to diagnose symptoms or prescribe treatment. Any dosages mentioned are general guidelines only, please follow the directions of your doctor or pharmacist exactly when taking medication. We have made every effort to ensure that this information is accurate, but only your doctor can say if a medication, or drug combination, is safe for you. Information intended for US residents only.
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