Did your doctor cover these items BEFORE prescribing lorazepam?
Lorazepam, sold under the brand name Ativan, is a potent, tranquilizer that induces sedation and muscle relaxation. Ativan, like all benzo drugs, is recommended for short-term use only, to avoid dependence, which can develop quickly. Despite the recommendations, many doctors continue to prescribe Ativan or lorazepam far longer than the recommended time frame without advising of the potential consequences of Ativan withdrawal, which can have disastrous consequences for their patients. Benzo prescriptions have continued to soar, despite cautions given by drug regulators and clinical researchers.38
Prescribing Best Practices
Before prescribing, physicians are encouraged to employ guidelines that they have been directed to follow, which include the following prescribing best practices: 1,15
- Take full history including alcohol or other drug use, licit and illicit.
- The patient must be informed of the potential adverse effects of benzodiazepines.
- Search for and treat underlying causes before prescribing.
- Explore and discuss referrals to other therapies or types of services.
- Explore and discuss alternative types of therapies or treatments.
- Explore, discuss, and consider the possibility of the patient delaying the prescription until the next visit.
- Benzodiazepines should not be prescribed for more than a few weeks.
Ativan is 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.
Ativan is short-acting benzo. If someone takes it 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 lorazepam 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.16
What Is Ativan (lorazepam) Used For?
Ativan has been FDA approved for the treatment of anxiety and anxiety-related conditions.5 A number of off-label uses have also developed, which are described in more detail below.
As Ativan is highly addictive, it has also developed a street presence as a drug of abuse, which carries a high liability of being contaminated with additives such as deadly fentanyl and other unknowns. This is especially problematic for this population as benzos do not respond to opioid reversal agents such as Narcan or Naloxone in the case of overdose.38
Medical Uses for Ativan
Ativan is primarily prescribed as a relatively fast-acting sedative. Lorazepam may prevent seizures during alcohol detox, and reduce discomfort during opiate withdrawal, and before surgery or dental work. Doctors prescribe Ativan “off label” to treat insomnia.17
Physicians also prescribe Ativan off-label to help with nausea, a common reaction to chemotherapy, and for a condition called psychogenic catatonia. Catatonia is a broad diagnostic term affecting up to 20% of psychotic persons in inpatient treatment settings. Catatonia patients may exhibit multiple symptoms such as mutism, stupor, grimacing, posturing, and other unusual symptoms. In this set of persons, benzodiazepines do not have a sedative effect, but paradoxically, 60-80% of these patients if given benzodiazepines through IV become more alert, and more interactive.18,19
Lorazepam and Opiates – Deadly Duo
Lorazepam 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 lorazepam or 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.20,21
What is a Natural Substitute for Ativan?
There are many natural nutritional and herbal remedies that have been found to have similar properties to Ativan, which improve sleep and provide relief from stress, depression, and anxiety, but without negative characteristics or harsh reactions.
Some examples of these aids can include:
- Nutritional GABA 28
- Amino acids such as taurine, glycine, L-lysine, L-theanine, 5-HTP, etc. 29,30
- Magnesium 31
- Diet modification includes fermented foods, probiotics, and prebiotics to support microbiome health, which in turn supports mental and physical health.32
Our Ativan alternatives page describes more examples in greater detail.
How Habit-Forming Is Ativan?
Ativan is classified by the DEA as a Schedule IV drug, described as having a lower risk for abuse than Schedule II or III drugs such as opioids or ketamine, but more addictive than cough syrup with codeine, or antidiarrhea drugs.34
However, it is well-established that benzodiazepines are highly addictive and according to clinical research published in the Journal of Addiction Medicine, benzodiazepines should not be prescribed to anyone who has a history of drug or alcohol use disorder.33
Additional research out of Germany showed that between 35% and 40% of chronic benzodiazepine users become drug-dependent. As underscored in the DEA schedule, populations that have a history of turning to drugs or alcohol are at high risk if taking lorazepam and similar benzos.35
Ativan Alternative Names and Slang
Lorazepam is a generic drug that is sold under the brand name Ativan. It is often referred to in street slang 22 where the drug is used in non-clinical settings for getting high or for self-medicating. Here are some of the drug’s nicknames:
- Tranks
- Benzos
- Nerve Pills
- Downers
Strategies to Quit Ativan (lorazepam)
Withdrawal from Ativan is safest when done slowly; giving the body a chance to stabilize and adjust to incremental reductions over adequate time.
As mentioned earlier, benzodiazepines should be prescribed for 2-4 weeks maximum, but long-term use is still prevalent. Long-term use of benzodiazepines may require inpatient treatment for withdrawal. When the time comes to begin the detox process, a clinic or setting that can provide close and careful medical monitoring is recommended.
Handling Ativan’s Short Half-life in Withdrawal
Lorazepam or Ativan discontinuation may manifest a certain complication; due to the drug’s short half-life. This means withdrawal can come on 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. Speak to your prescriber about using a stair-step-down dosing strategy, to gradually reduce the dosage.
An example of this approach you can discuss with your prescriber might be:
- 1mg Ativan daily, split into 4x.25mg dosings throughout the day. Dropping one of the doses to .125 (half) would be a reasonable approach to discuss with your doctor.
- Once stabilized, continue to drop each of the dosings to .125mg, one step at a time.
- Over the course of four reductions, the person would be at .5mg total daily.
- Once stabilized, then consider dropping the mid-day dose.
- For the next dosage adjustment, pick another dose to eliminate, and continue this process until medication-free.
In some cases, temporary bridge drugs like Trileptal or Gabapentin can soften the Ativan discontinuation process.
Another much different approach might be switching to Valium, as it is longer acting. Not everyone reacts to these two drugs equally, and there may be a crossover reaction so requires attentive monitoring.
Discuss these suggestions with your treating physician. The above information does not in any way represent what you should do in your case but does provide possible talking points between you and your doctor. Each person’s situation brings unique challenges and so requires the guidance of an experienced and trusted medical professional to determine the correct strategy.
These problems may challenge the entire family. Consider residential treatment for Ativan withdrawal, as it may significantly ease what you and your family may go through during this difficult time.