lorazepam
Lorazepam (Ativan) is a benzodiazepine used for short-term treatment of anxiety. The oral tablets and solution are taken by mouth, typically 1 to 3 times daily, depending on the formulation. Lorazepam is also available as an injectable medication that's given by healthcare professionals in a hospital setting to control seizures. Sleepiness and dizziness are the most common side effects of lorazepam (Ativan).
What is Lorazepam (Ativan)?
What is Lorazepam (Ativan) used for?
- Anxiety disorders
- Anxiety associated with depressive symptoms
- Short-term relief of anxiety
- Seizures lasting longer than 5 minutes - injection only
- Surgery-related anxiety, usually given shortly before anesthesia - injection only
How Lorazepam (Ativan) works
Lorazepam (Ativan) is a fast-acting benzodiazepine. It slows down activity in your brain, to help control anxiety) and stop seizures.
Drug facts
Risks and warnings for Lorazepam (Ativan)
Lorazepam (Ativan) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Sedation and difficulty breathing
- Risk factors: Taking with opioid pain medications or alcohol | Taking for a longer time and at higher doses than prescribed
Taking lorazepam (Ativan) with opioid pain medications or alcohol can cause severe drowsiness, tiredness, and difficulty breathing, which can be life-threatening.
Some people with long-term pain might already be taking opioid medications. If this applies to you, let your care team know. The combination of lorazepam (Ativan) with opioid medication should be avoided because this raises the chance of overdose. Ask your care team if safer medication options are available. If you or a loved one notices that you're having trouble breathing or waking up easily, get medical help right away.
Misuse, dependence, and withdrawal
- Risk factors: Taking higher doses of lorazepam (Ativan) over a longer period of time | Stopping lorazepam (Ativan) suddenly
Taking lorazepam (Ativan) can raise the risk of misuse (using it for reasons other than prescribed) or addiction. This can happen even at the recommended dose of this medication. Misuse and addiction are serious concerns because they can lead to overdose, which can be life-threatening.
Additionally, taking lorazepam (Ativan) over longer periods of time can raise the risk for physical dependence. If so, suddenly stopping lorazepam (Ativan) can lead to withdrawal symptoms, including hallucinations, a change in behavior, and trouble sleeping. Sometimes, withdrawal symptoms can last weeks to years. Don't stop taking lorazepam (Ativan) without first talking to your HCP. Take lorazepam (Ativan) only as instructed to lower the risk of dependence and overdose.
Depression and suicidal thoughts or behaviors
- Risk factors: Severe depression | Psychosis
Taking benzodiazepines, like lorazepam (Ativan), can make depression worse. Watch for new or worsening signs of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior while taking lorazepam (Ativan). Get medical help right away if you notice any of these changes. Your care team will likely ask you to consider other medications for your anxiety.
Effect on driving and concentration
- Risk factors: Drinking alcohol | Also taking other medications that cause drowsiness | Older adult
Lorazepam (Ativan) can make you feel sleepy and affect your concentration and focus. Drinking alcohol while taking lorazepam (Ativan) and taking additional medications that make you feel drowsy can make this effect worse. Avoid activities that require you to be alert, like driving or operating machinery, until you know how the medication affects you.
Trouble breathing
- Risk factors: Ages 65 years or older | Liver problems | Medical conditions that affect breathing
If you're over the age of 65, you might be more likely to experience side effects from lorazepam (Ativan). Too high of a dose can cause you to have trouble breathing. Your HCP will most likely start you on a very low dose of lorazepam (Ativan). This will help prevent more dangerous side effects. Let your HCP know if you've trouble breathing after taking lorazepam (Ativan).
This medication should also be used with caution in people with certain breathing problems like chronic obstructive pulmonary disease (COPD) or sleep apnea. Lorazepam (Ativan) can affect your breathing, so it can be more dangerous for people with already existing breathing problems.
Risk of agitation and restlessness
- Risk factors: Ages 65 years or older In some rare cases, taking medications like lorazepam (Ativan) have led to side effects such as agitation, feeling irritable, violent behavior, confusion, and excitement. If you experience these side effects, let your healthcare team know right away because they'll need to help you stop this medication safely.
Harm to babies
- Risk factors: Taking lorazepam (Ativan) while pregnant
Lorazepam (Ativan) can cause harm to your baby if you take the medication while you're pregnant. Newborn babies whose parent took lorazepam (Ativan) during pregnancy have experienced serious issues like breathing problems, excessive drowsiness, irritability, and feeding difficulties. If you're planning to have a baby or are currently pregnant, speak with your HCP about the best options for your anxiety or panic disorder.
Serious allergic reaction (Loreev XR only)
Loreev XR capsules contain FD&C Yellow No. 5 (tartrazine). Don't take this medication if you're allergic to this ingredient. Doing so can trigger a serious allergic reaction.
More on Lorazepam (Ativan) warnings
Side effects of Lorazepam (Ativan)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Sleepiness (16%)
- Dizziness (7%)
- Weakness (4%)
- Unsteadiness (3%)
Less Common Side Effects
- Confusion
- Depression
- Mood changes
- Trouble speaking
- Headache
- Blurred vision
- Changes in behavior and sleep
Lorazepam (Ativan) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Suicidal thoughts and behaviors
- Trouble breathing
- Extreme sleepiness: drowsiness, confusion, disorientation, memory problems, slurred speech, slowed breathing, loss of consciousness
- Withdrawal symptoms: uncontrolled movements, anxiety, blurred vision, depression, dizziness, nausea, vomiting, diarrhea, weight loss, headache, irritability, trouble with sleep or memory, muscle pain and stiffness, panic attacks, convulsions, depression, hallucinations, seizures, suicidal thoughts
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The following Lorazepam (Ativan) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Drowsiness
relaxed and calm
sleepiness
Incidence not known
Aggressive, angry
agitation
attack, assault, or force
black, tarry stools
bleeding gums
blood in the urine or stools
bluish lips or skin
blurred vision
change in consciousness
chills
coma
confusion
confusion about identity, place, and time
cough or hoarseness
dark urine
decreased urine output
difficulty with breathing or swallowing
difficulty with speaking
discouragement
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
excitation
false or unusual sense of well-being
fast or irregular heartbeat
feeling sad or empty
fever with or without chills
general feeling of tiredness or weakness
headache
hyperventilation
increased thirst
irregular, fast or slow, or shallow breathing
irritability
loss of appetite
loss of balance control
loss of consciousness
loss of interest or pleasure
loss of memory
lower back or side pain
muscle pain, cramps, trembling, jerking, or stiffness
nausea or vomiting
not breathing
painful or difficult urination
pale or blue lips, fingernails, or skin
pinpoint red spots on the skin
problems with memory
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
reddening of the skin, especially around ears
restlessness
seeing, hearing, or feeling things that are not there
seizures
shaking
shuffling walk
sores, ulcers, or white spots on the lips or in the mouth
stiffness of the limbs
stomach pain
sweating
swelling of the eyes or inside of the nose
swelling of the face, ankles, or hands
swollen glands
thoughts or attempts at killing oneself
tightness in the chest
trouble concentrating
trouble sleeping
twisting movements of body
uncontrolled movements, especially of the face, neck, and back
unexplained bleeding or bruising
unpleasant breath odor
unusual bleeding or bruising
unusual tiredness or weakness
vomiting of blood
yellow eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Changes in patterns and rhythms of speech
increased sweating
loss of strength or energy
nightmares
shakiness and unsteady walk
slurred speech
trouble speaking
unsteadiness, trembling, or other problems with muscle control or coordination
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
unusual excitement, nervousness, restlessness, or irritability
unusual paleness
unusual weak feeling
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence not known
Being forgetful
clumsiness
decreased interest in sexual intercourse
disturbed color perception
dizziness or lightheadedness
double vision
drowsiness
feeling of constant movement of self or surroundings
hair loss or thinning of the hair
halos around lights
inability to have or keep an erection
increased in sexual ability, desire, drive, or performance
increased interest in sexual intercourse
lack or loss of self-control
lethargy
loss in sexual ability, desire, drive, or performance
muscle aches, twitching, or weakness
night blindness
overbright appearance of lights
rapid weight gain
sensation of spinning
shakiness in the legs, arms, hands, or feet
shivering
stupor
trembling or shaking of the hands or feet
tunnel vision
weak or feeble pulse
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Lorazepam (Ativan)
Pros
- Taken by mouth
- Might start to work within 30 minutes to manage anxiety symptoms
- Available as oral solution, good option for those who can't swallow tablets
- Some forms available as a lower-cost generic
Cons
- Short-term use only because risk of dependence and memory problems
- Can drowsiness, and dizziness
- Can cause withdrawal symptoms if stopped suddenly
- Can't take with alcohol
Pharmacist tips for Lorazepam (Ativan)
- Taking lorazepam (Ativan) with opioid pain medications is very dangerous and should be avoided, if possible. The combination can lead to life-threatening side effects, such as slowed breathing and coma.
- Lorazepam (Ativan) is only meant for short-term treatment of anxiety symptoms. Taking it over a longer period of time can raise the risk for dependence and memory problems. Talk with you care team to see how long you should take lorazepam (Ativan). Also, discuss with them about safer, long-term treatment options for anxiety.
- Don't drink alcohol with lorazepam (Ativan). This combination can intensify side effects which can lead to an overdose.
- Lorazepam (Ativan) causes dizziness and drowsiness. Avoid activities that require you to be alert (like driving) until you know how it affects you.
- If you've been taking lorazepam (Ativan) every day for a while, don't stop taking this medication suddenly because you might get withdrawal symptoms. Examples of withdrawal symptoms include headache, nausea, heart palpitations, and anxiety.
- If you're taking the oral solution version of lorazepam (Ativan), be sure to only use the dropper in the package to measure out your dose. Don't use other tools, like household spoons, to measure your dose because doing so might cause you to measure the wrong dose.
- It's recommended to mix your dose of lorazepam (Ativan) oral solution with a beverage or semi-solid food, such as water, juice, soda, applesauce, or pudding. Eat or drink the mixture right away and don't try to save it for later.
- Store the oral solution in the refrigerator, and discard the bottle after it's been open for 3 months.
- If you're taking extended-release lorazepam (Loreev XR) and have trouble swallowing the capsule, you can open it up and sprinkle the contents inside over a tablespoon of applesauce. Eat this mixture whole without chewing, then drink some water afterwards to help you wash it down. Make sure to eat this mixture within 2 hours of mixing and don't save it for later.
Common questions about Lorazepam (Ativan)
If you're taking lorazepam (Ativan) by mouth, you can start to feel its effects within 30 minutes. But some people might not feel a more noticeable effect until closer to 2 hours after a dose. If you're getting an injection of this medication from an HCP to stop a seizure, it can start to work even quicker (within 15 minutes).
Yes. As with all benzodiazepines, lorazepam (Ativan) can be habit-forming and has a risk for being misused or causing dependence. This is why lorazepam (Ativan) is a controlled medication. To lower the risk of addiction or dependence, your care team will prescribe the lowest dose of lorazepam (Ativan) needed to treat your symptoms. Talk with them if you have any concerns about taking lorazepam (Ativan).
Yes. The Drug Enforcement Administration (DEA) classifies lorazepam (Ativan) as a schedule IV controlled substance. This means that lorazepam (Ativan) has the potential for misuse and dependence. There are stricter rules regarding how your healthcare professional (HCP) prescribes lorazepam (Ativan) and how your pharmacy dispenses it. Because this medication can be habit-forming, you should only take it specifically as instructed by your HCP. Don't take more of it than you need, and never share this medication with anyone else.
Sleepiness is one of the most common side effects of lorazepam (Ativan). It's best to avoid taking other medications that can also cause drowsiness while you're taking lorazepam (Ativan). If you're starting lorazepam (Ativan) for the first time, don't drive or do anything that needs a lot of focus or attention until you know how this medication affects you. If lorazepam (Ativan) is making you feel too sleepy to go about your day, let your care team know. They might need to lower your dose of lorazepam (Ativan) or recommend other medications to help with your medical condition.
Sometimes, having anxiety can lead to temporary spikes in blood pressure. If you have high blood pressure because of anxiety, you might notice a slight drop in blood pressure after starting lorazepam (Ativan). A small study showed that some people noticed a slight improvement in their blood pressure when their anxiety symptoms were eased by lorazepam (Ativan). Talk with your care team if you have more questions of how lorazepam (Ativan) might affect blood pressure.
Avoid drinking alcohol with lorazepam (Ativan). Doing so can worsen the side effects of both alcohol and lorazepam (Ativan). This might lead to breathing problems, dizziness, and even a loss of consciousness. It's best to wait a few days after your last lorazepam (Ativan) dose before having an alcoholic beverage.
Yes, you might experience withdrawal symptoms, such as tremor or nausea, if you suddenly stop taking lorazepam (Ativan). This is more likely if you've been taking higher doses for a longer period of time, but it can also happen with the recommended doses. Typically, you might notice withdrawal symptoms within 2 days after stopping this medication. Symptoms can last months, and rarely, even years. Talk with your care team if you've been taking lorazepam (Ativan) for a while and want to stop. They can help you do so safely by lowering your dose slowly over time.
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Lorazepam (Ativan) dosage
Typical dosage for Lorazepam (Ativan)
The typical dose of lorazepam (Ativan) varies based on the response to the medication and the condition that's being treated.
Immediate-release tablets and oral liquid:
- Anxiety (people ages 12 years and older): The typical starting dose is 2 mg to 3 mg, split up into two to three doses, by mouth throughout the day. Your dose might be lower if you're an older adult.
Extended release capsules (Loreev XR):
Loreev XR is only for people who are stable on immediate-release lorazepam (Ativan) three times daily in evenly divided doses.
- Anxiety (adults): The typical dose of Loreev XR is equal to the total daily dose of lorazepam (Ativan), taken by mouth once daily in the morning.
Lorazepam (Ativan) is also available as an intravenous (IV) injection or intramuscular (IM) that's given by a healthcare professional (HCP) to treat seizure(s) or to ease anxiety before surgery.
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Interactions between Lorazepam (Ativan) and other drugs
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Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Flumazenil
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alfentanil
- Alprazolam
- Amobarbital
- Anileridine
- Benzhydrocodone
- Bromazepam
- Bromopride
- Buprenorphine
- Butabarbital
- Butalbital
- Butorphanol
- Calcifediol
- Calcium Oxybate
- Cannabidiol
- Carbinoxamine
- Carisoprodol
- Cetirizine
- Chloral Hydrate
- Chlorzoxazone
- Clobazam
- Codeine
- Dantrolene
- Dezocine
- Diacetylmorphine
- Difenoxin
- Dihydrocodeine
- Diphenoxylate
- Doxylamine
- Esketamine
- Ethchlorvynol
- Ethylmorphine
- Fentanyl
- Flibanserin
- Fospropofol
- Gabapentin
- Gabapentin Enacarbil
- Hydrocodone
- Hydromorphone
- Ketamine
- Ketobemidone
- Lemborexant
- Levocetirizine
- Levorphanol
- Lofexidine
- Loxapine
- Magnesium Oxybate
- Meclizine
- Meperidine
- Mephenesin
- Mephobarbital
- Meprobamate
- Meptazinol
- Metaxalone
- Methadone
- Methocarbamol
- Methohexital
- Metoclopramide
- Midazolam
- Mirtazapine
- Morphine
- Morphine Sulfate Liposome
- Nalbuphine
- Nicomorphine
- Opium
- Opium Alkaloids
- Orlistat
- Oxycodone
- Oxymorphone
- Papaveretum
- Paregoric
- Pentazocine
- Pentobarbital
- Periciazine
- Phenobarbital
- Piritramide
- Potassium Oxybate
- Pregabalin
- Primidone
- Propofol
- Remifentanil
- Remimazolam
- Scopolamine
- Secobarbital
- Sodium Oxybate
- Sufentanil
- Tapentadol
- Thiopental
- Tilidine
- Tramadol
- Trazodone
- Zolpidem
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Desogestrel
- Dienogest
- Drospirenone
- Estradiol
- Ethinyl Estradiol
- Ethynodiol
- Gestodene
- Levonorgestrel
- Mestranol
- Nomegestrol
- Norethindrone
- Norgestimate
- Norgestrel
- Posaconazole
- Probenecid
- Pyrimethamine
- Rifapentine
- St John's Wort
- Theophylline
- Valproic Acid
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Lorazepam (Ativan) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Lorazepam (Ativan) will not be safe for you to take.
- Acute narrow-angle glaucoma
What are alternatives to Lorazepam (Ativan)?
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