Chemically, Ativan (lorazepam) is a short-acting anxiolytic belonging to a group of drugs known as benzodiazepines. It is usually prescribed to treat anxiety associated with mental health conditions such as depression and insomnia, panic, muscle spasm pain, and seizures. In some cases, it has also been used to manage symptoms associated with the acute phase of schizophrenia.

How Does Ativan Work?

Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter—meaning it does not cause excitement in the brain—produced in the central nervous system. It can help the body calm the nervous system and promote balanced activity within a person’s brain. To put it very simply, Ativan acts on GABA receptors and causes a release and enhancement of the GABA neurotransmitter, which promotes a relaxing, calming effect throughout the body.

Dosage FAQs

  • What is a safe dose of this drug?
    • Anxiety: Ativan is used for short-term relief of severe anxiety in a 1 mg to 4 mg divided dose. It is not recommended for long-term use.
    • Panic: A 3 mg to 5 mg divided dose may be administered for panic, but it is not without risk and should only be used when alternative measures have failed (such as antidepressant therapy).
    • Insomnia: A dose of 1 mg to 2 mg at bedtime is indicated for insomnia with anxiety.
    • For pain relief: A dose of 0.5 mg to 2 mg in divided doses can be used to relieve pain that is complicated by anxiety or muscular spasm.
    • Status epilepticus (epileptic seizures):  A slow IV dose of 4 mg is used for status epilepticus and, if necessary, the dose is repeated after 10 minutes. In children under 10, an IV dose of 4 mg is administered and repeated only if necessary
       
  • Is it safe to use this drug if I am pregnant?
    During pregnancy, this drug should only be used if there is a clear indication, for example seizure control. High doses during pregnancy can cause neonatal hypothermia and respiratory depression. It can also cause neonatal hypotonia (low muscle tone). It is classified by the U.S. Food and Drug Administration (FDA) as a pregnancy schedule D drug, which means there is evidence of a risk to the fetus for pregnant mothers.
     
  • How is this drug processed in my body?
    This medication has a moderate rate of absorption with the peak concentration reached in one to six hours and a half-life of 10 to 20 hours. After metabolization, it has no active metabolites that are excreted through the urine.
  • If I am prescribed this medication for anxiety or panic, how do I get the most out of my treatment?
    Anxiety and panic-related mental health conditions are often treated with success with various types of psychotherapy. Finding a therapist or counselor to work with may help complement your treatment with psychotropic medication. A therapist can help you better understand if there are underlying conditions associated with what you are experiencing, help you work on developing a self-care routine to keep anxiety levels low, and help you develop coping strategies in case symptoms arise or become triggered.

Possible Side Effects

The possible side effects of Ativan include drowsiness and lightheadedness the day after administration. Depending on dose, it may also cause an anterograde amnesic effect, which leads to difficulty forming new memories. For people who are elderly, confusion and ataxia (loss of muscle coordination) are common due to the sedative properties of anxiolytics. The sedative effect of Ativan can also lead to hypotension, headache, vertigo, and muscle weakness. Changes in libido and urinary retention are also reported in some cases.

Drug Interactions of Ativan

Ativan can interact with various drugs and can lead to various effects. Some of the drug interactions of this medication include:

  • Antihistamines (drugs commonly used for hay fever and different allergies/hypersensitivities): An interaction occurs because most antihistamines have sedative properties too. This can cause an increased level of sedation.
  • Sedatives and hypnotics: When taking with other sedatives, caution must be taken as it may cause an increased level of sedation.
  • Antifungals and antibacterials: Antifungals and antibacterials can decrease or increase the hepatic (liver) metabolism of drugs, which can alter the effects of Ativan.   
  • Antidepressants and antipsychotics: These drugs may cause increased sedation when taken together with Ativan.
  • Beta blockers and other antihypertensives: These drugs may cause a decrease in blood pressure when administered with Ativan.
  • Calcium channel blockers: These drugs can alter the metabolism of Ativan.
  • Muscle relaxants: These drugs may cause an increased level of sedation when co-administered.
  • Ulcer healing drugs: Proton pump inhibitors can increase plasma concentration of Ativan due to decreased metabolism, leading to increased or prolonged sedation.

Precautions

Ativan is both a sedative that reduces anxiety and a hypnotic that produces drowsiness. After administration of this medication, activities requiring motor coordination should be avoided, such as driving, operating heavy machinery, or climbing.

In doses greater than the recommended dose, Ativan can cause excessive sedation and partial airway obstruction.

During IV administration, the monitoring of respiratory and cardiac function is required. For individuals experiencing hepatic (liver) and renal (kidney) failure, this drug is not recommended as it is metabolized by the liver.

Do not consume grapefruit or products containing grapefruit as they may increase the plasma concentration of benzodiazepines.

Safe Withdrawal of Ativan

Most benzodiazepines are meant to be used short term. Long-term use increases the occurrence and severity of withdrawal symptoms when the treatment must be stopped. In order to avoid the uncomfortable, sometimes debilitating symptoms associated with withdrawal, make a safe plan to taper your dosage down with your doctor. 

References:

  1. Cloos, J.M. and Ferreira, V. (2009). Current use of benzodiazepines in anxiety disorders. Current Opinion in Psychiatry, 22, 90.
  2. Da Settimo, F. et al. (2007). GABA A/Bz receptor subtypes as targets for selective drugs. Current Medicinal Chemistry, 14, 2680.
  3. Ibqual, M.M., Sobhan, T., and Ryals, T. (2002). Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant. Psychiatric Services, 53, 39–49.
  4. Wang, P.S., Bohn, R.L., Glynn, R.J., et al. (2001). Hazardous benzodiazepine regimens in the elderly: Effects of half-life, dosage, and duration on risk of hip fracture. American Journal of Psychiatry, 158, 892–898.

Page content reviewed by James Pendleton, ND.