Before prescribing, physicians employ guidelines that they have been directed to follow, which includes the following prescribing best practices (1):
Benzodiazepine drugs such as Ativan are used as a potent short term tranquilizer for a variety of purposes. The drug is fast acting and produces a drowsy, calming and mildly euphoric effect as a result of depression of the central nervous system.
One of the considering factors regarding Ativan is that it is short acting. If someone takes Ativan at night, it can be that by morning they are no longer feeling the sedating effects. Especially for people who experience daytime anxiety, this can create a rollercoastering effect of inter-dosing withdrawal manifestations. Should this be occurring, the tendency may be for the practitioner to include daytime dosing. It is for this reason that Ativan is a poor choice for long-standing pre-existing anxiety. The person with pre-existing anxiety could quickly find themselves in a spot where they are taking the medication 3 or 4 times a day, and no clear way out of this situation.
Uses for the drug include the treatment of anxiety, in depressed persons with anxiety, to avoid seizures during alcohol detox, to reduce discomfort during opiate withdrawal, for panic disorders, as a muscle relaxant, and to treat insomnia.
Ativan is used for pre-surgical anesthesia, or pre-dental anesthesia.
Lorazepam is sometimes prescribed to help with nausea, a common side effect of cancer-related chemotherapy.
Ativan is sometimes abused by opiate users because combining these two drugs augments the euphoric effects, although the practice is dangerous and often leads to overdose, coma or death.
Another form of abuse is using Ativan on a victim of “date rape” or even robbery, due to the drug’s ability to induce a trance-like state of non-resistance, and amnesia.
Ativan is often referred to in street slang where the drug is used in non-clinical settings for getting high or for medicating symptoms of addiction or withdrawal. Here are some of the nick-names for Ativan:
The tranquilizing effects of Ativan (lorazepam) taken orally in pill form come on quickly, within approximately 30 minutes and peaking at about the two hour mark. The drug also comes in an injectable form, producing effects within 15 to 20 minutes, which effects last from 6 to 8 hours.
Side effects include:
Less common side effects include:
Ativan is a CNS depressant, and should never be mixed with alcohol, or other depressants such as opiates or barbiturates. When two or more depressants are taken together, the effects become more potent, and can become life-threatening, leading to coma, stopped breathing, stopped heartbeat and death.
The number of ER visits for adverse events involving benzodiazepines tripled from 1998 to 2008, which demonstrates clearly the dangers that can be linked with benzodiazepines.
Ativan is recommended for short-term use only. Medical regulators in the US, UK, and other countries have reduced the recommended window for Ativan prescription to last not longer than one month. This is due to the risk of becoming drug dependent after one month. (1)
Withdrawal symptoms from Ativan include the following:
In general, the shorter the drug was used, the milder the withdrawal symptoms will likely be. However, cases have occurred where severe withdrawals presented after only a few days or weeks of using Ativan or similar drugs.
Unless medically as directed by a hospital, never abruptly stop benzodiazepines that have been in regular use, but do a gentle taper off the drug under medical supervision. Abruptly stopping benzodiazepines may result in seizure or death, especially if they have acclimated to using it over a longer duration.
Benzodiazepines are also known to have a number of PAWS, or post-acute withdrawal symptoms that can linger long after the drug has been stopped, including:
Withdrawal from Ativan is safest when done slowly; giving the body a chance to stabilize and adjust to incrementally reduced presence of the drug in the system.
As mentioned earlier, benzodiazepines should not be prescribed for more than one month.
When the time comes to begin the detox or tapering process, a clinic or setting that can provide close and careful medical monitoring is recommended.
Ativan tapering may have a certain complication; due to the short half-life, a person can go into withdrawal quite rapidly. A pragmatic approach might be to spread the dosing out so that it is being administered three or four times over a day, to limit withdrawal effects between dosing. Then, use a stair-step down dosing strategy, attempting to maintain a somewhat consistent level. An example of this approach might be:
In some cases, temporary bridge drugs like Trileptal or gabapentin may be used to soften the tapering process.
Another much different approach may be switching to Valium, as it is longer acting. Not everyone reacts to these two drugs equally, and there may be a crossover reaction.
These are all options to discuss with your treating physician. This is not intended to represent what you should do in your case, but merely talking points for your doctor and you to discuss. Each person’s situation is highly specific to them and truly needs the guidance of an experienced an trusted medical professional to determine the correct strategy.
This process might additionally be challenging to your family. Consider residential treatment as it may significantly ease what you and your family may go through during this delicate time.
The following topics relate to the most searched for and frequently asked questions about Ativan (lorazepam).
For more information contact your primary or prescribing physician, or contact us for more information which we can supply on request.
The Alternative to Meds Center designs an appropriate and individualized withdrawal schedule, ample preparation steps and compassionate health-supportive programs that ensure the safety and comfort of the client.
Our center is staffed by over forty trained practitioners and caregivers who coordinate and assist the client to navigate through their Ativan withdrawal steps comfortably and safely.
Some of the steps include:
There has been success regarding the extraction of excitotoxins, like heavy metals, chemicals and pesticides that we have been commonly exposed to.
One type of pesticide, called organophosphates, kills pests by putting their nervous system into overdrive via overstimulation of its acetylcholine receptors.
There may be a similar action in the human body as well. Like the fate of the poisoned pest, this may lead to over-stimulating acetylcholine receptors in the human brain and CNS. (3)
A poison, or pesticide, is designed to kill pests by attacking the pest’s nervous system and leaving it in a state of twitches and uncontrolled movements as it begins to die. There may be a parallel for this possibly in humans, because, like the pest, we also have acetylcholine receptors. As we humans have livers for clearing some of this toxic burden, we typically experience a different outcome than a grasshopper or other pest. Yet, if our genetic dispositions become somehow compromised, we may be at risk of similar effects as are seen in the spasmodic movements and twitches or a poisoned, dying pest.
Two toxic substances in particular, Aspartame and MSG have been examined closely regarding causing synaptic over-firing.
According to one research group studying the over-firing phenomena,
“This is because aspartic acid (from aspartame) and glutamic acid (from MSG) can both stimulate a receptor in the brain called the NMDA receptor (n Methyl d aspartate). Chronic overstimulation of the NMDA receptor over time is neurotoxic.” (4)
The cumulative real effects of organophosphates and other environmental toxins are truly understudied as most of the instances of toxicity involve acute poisoning. For some, clearing out a body burden of neurotoxins may be the only way to find relief from anxiety and nervous system over-stimulation. These patients typically present as those who enjoyed a lifetime of balance, and then slowly began to degenerate into anxiety and/or insomnia.
Benzodiazepine withdrawal doesn’t have to be painful, torturous or unsustainable. Contact us at the Alternative to Meds Center for more information about the comprehensive set of therapies and protocols we implement to provide a much more likely path to achieving long term success.
Dr. Michael Loes is board-certified in Internal Medicine, Pain Management and Addiction Medicine. He holds a dual license in Homeopathic and Integrative Medicine. He obtained his medical doctorate at the University of Minnesota, Minneapolis, MN, 1978. Dr. Loes performed an externship at the National Institute of Health for Psychopharmacology. Additionally, he is a well-published author including Arthritis: The Doctor’s Cure, The Aspirin Alternative, The Healing Response, and Spirit Driven Health: The Psalmist’s Guide for Recovery. He has been awarded the Minnesota Medical Foundation’s “Excellence in Research” Award.