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Lorazepam long term side effects


Ativan Side Effects of Long-term Use

Ativan is the brand name for lorazepam, a benzodiazepine primarily prescribed for the short-term relief of anxiety.1 As with any medication, there are side effects that can occur when taking Ativan, even when taking it as prescribed. And like other benzodiazepines, there is potential for misuse, the development of physical dependence, and, in some cases, addiction.2

Keep reading to better understand lorazepam, the short- and long-term side effects and risks associated with its use, and how to get help if you’re concerned about your misuse or that of a loved one.

What Is Ativan?

Ativan (lorazepam) is a central nervous system (CNS) depressant that falls in the benzodiazepine class of medications. 2 It is approved by the U.S. Food and Drug Administration (FDA) for the management of anxiety disorders, anxiety symptoms, and anxiety associated with depressive symptoms.1 That’s because as a CNS depressant, or sedative-hypnotic, lorazepam works to calm an overexcited nervous system, resulting in a sedate, relaxed, calming effect. 2,3

Ativan Side Effects

As with any prescription medication, lorazepam may cause side effects. As a fast-acting benzodiazepine, lorazepam’s effects—both desired and undesired—may be felt within minutes, depending on its route of administration.2 These effects vary from one individual to the next and range from mild to severe. More severe side effects are associated with higher doses of lorazepam or taking it in combination with opioids or alcohol, as well as other CNS depressing drugs.2 Chronic use over a prolonged period increases the risk of certain long-term consequences as well.2

Short-Term Side Effects of Ativan

Some of the most common lorazepam side effects include:1

  • Sedation.
  • Experiencing dizziness.
  • Feeling weak.
  • Feeling unsteady.

Several factors can impact the specific side effects an individual may experience and the severity with which they experience them. These factors include the amount of lorazepam taken, the frequency and duration of use, the person’s overall physical and mental health, and whether lorazepam was taken with other substances—such as alcohol, opioids, and other sedatives.1,2

Additionally, mixing lorazepam with opioids, alcohol, or other sedatives can lead to a drug overdose, which can produce serious, even life-threatening side effects, including slowed, shallow, or stopped breathing.1

What Are the Effects and Risks of Long-Term Ativan Use?

The use of benzodiazepines, including lorazepam, can lead some individuals to develop a physical dependence to the drug. Physical dependence refers to the body’s adaptation of having the drug present to function normally. Thus, when an individual abruptly stops taking the drug or drastically cuts back their dose, withdrawal symptoms can emerge.1

The risk of dependence increases with higher doses and longer-term use, which is why it’s advised that individuals only take lorazepam for 2 to 4 weeks, though signs of dependence can appear after even 1 week of using a benzodiazepine. 1

Additionally, individuals with a history of substance use disorders or personality disorders may be more susceptible to developing a physical dependence to lorazepam.1

It’s important to note that just because an individual may have become physically dependent on lorazepam, it does not mean that they have developed an addiction to it.4 Physical dependence is a neurological adaptation. Addiction—or substance use disorder—is a treatable medical disease characterized by the compulsive use of a drug despite negative consequences.4

Ativan Overdose

Overdose from Ativan—without the presence of other substances—usually results in varying degrees of CNS depression, including drowsiness, mental confusion, and lethargy.1 However, as previously mentioned, life-threatening and even fatal overdoses involving lorazepam typically occur in conjunction with alcohol, opioids, or other CNS depressing drugs.1

In a report from the Centers for Disease Control and Prevention (CDC), 92. 7% of benzodiazepine-involved deaths also involved opioids in the first 6 months of 2020.5

Concurrent use of lorazepam and opioids may result in dangerous symptoms and can be fatal. Symptoms can include:2

  • Extreme sedation.
  • Dangerously slowed or stopped breathing.
  • Coma.

If you suspect that you or someone else is experiencing an overdose, call 911 immediately.

Ativan Withdrawal

Individuals who develop a physical dependence to lorazepam will likely experience withdrawal symptoms when they stop taking the drug or drastically cut back on their use.1 Symptoms may surface in as quickly as 6 to 8 hours after the last dose and usually last between 4 and 5 days, peaking on day 2.4

Symptoms of withdrawal may include:1

  • Headache.
  • Anxiety.
  • Muscle tension.
  • Depressive symptoms.
  • Sleep difficulties.
  • Feeling restless.
  • Confusion.
  • Increased irritability.
  • Sweating.
  • Increased sensitivity to light and sound.
  • Nausea.
  • Vomiting.
  • Diarrhea.
  • Tremors.
  • Elevated heart rate.
  • Panic attacks.
  • Seizures.

It is important to notify your doctor if you wish to stop taking lorazepam, as withdrawal symptoms can be severe and life-threatening. Severity of symptoms is typically increased when taken at higher doses for longer periods of time.1 While not every individual experiences each of these withdrawal symptoms, studies indicate that 20% to 30% of untreated patients with benzodiazepine withdrawal syndrome experience seizures.4

Ativan Addiction and Polysubstance Use

Ativan misuse commonly occurs in conjunction with other substance use, also known as polysubstance use.6 Research indicates that misuse of benzodiazepines, like lorazepam, is most often associated with the misuse of opioids, stimulants, and alcohol. 7

Individuals who engage in polysubstance use may take lorazepam to enhance the euphoric effects of opioids or alcohol or to temper the high from stimulants like cocaine.6 Others may mix substances unintentionally. For instance, those who buy lorazepam and other counterfeit prescription benzodiazepines on the street, risk unknowingly taking drugs that have been mixed or cut with other substances, like fentanyl.8

Whether intentional or not, mixing substances is never safe; the effects can be unpredictable, dangerous, even lethal.8

If you or a loved one misuse Ativan alone or in conjunction with other substances, seeking help to quit the use of lorazepam and other drugs can save your life. The most effective treatment plans are tailored to your specific needs, but most programs offer different interventions, which may include:9,10

  • Detoxification. Medically managed detox cleanses your body of the drug safely. In a treatment center, healthcare providers can prescribe a benzodiazepine taper, or other medications, to alleviate symptoms and keep you as safe and comfortable as possible.
  • Inpatient treatment. Inpatient rehab consists of 24/7 care in a hospital or residential setting. It can be long-term for up to 12 months or more, or short-term, depending on your treatment needs.
  • Outpatient treatment. Outpatient programs allow you to live at home or in a sober living environment during treatment and vary widely in intensity, depending on your needs. Some may require several hours of treatment each day, most days per week; others may mandate a couple of hours a day a few days each week.
  • Behavioral therapy. Behavioral therapies such as motivational interviewing or cognitive-behavioral therapy (CBT) may take place in individual or group settings. These interventions address the underlying issues of substance misuse, teach you coping skills to help prevent relapse, and provide you with psychoeducation about addiction and substance use.
  • Aftercare. Also known as continuing care, aftercare starts after formal treatment ends and assists you in your long-term recovery. Programs may include participation in a 12-step or other mutual-help group, ongoing counseling, or helping you secure sober living.

American Addiction Centers (AAC) has accredited treatment facilities across the United States with the ability to treat lorazepam addiction, polysubstance addiction, and other co-occurring mental health disorders. Let us create an individualized treatment plan that addresses all of your needs. Call today to speak with one of our Admissions Navigators. They can answer your questions and help you find the treatment center that might be right for you.

SAMHSA’s National Helpline | SAMHSA

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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

  • Suggested Resources

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    It's Not Your Fault (NACoA) (PDF | 12 KB)
    Assures teens with parents who abuse alcohol or drugs that, "It's not your fault!" and that they are not alone. Encourages teens to seek emotional support from other adults, school counselors, and youth support groups such as Alateen, and provides a resource list.

    After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
    Aids family members in coping with the aftermath of a relative's suicide attempt. Describes the emergency department treatment process, lists questions to ask about follow-up treatment, and describes how to reduce risk and ensure safety at home.

    Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
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    For additional resources, please visit the SAMHSA Store.

Last Updated: 08/30/2022

Lorazepam - description of the substance, pharmacology, use, contraindications, formula

Contents

  • Structural formula
  • Russian name
  • English name
  • Latin name of the substance Lorazepam
  • Chemical name
  • Gross formula
  • Pharmacological group of the substance Lorazepam
  • Nosological classification
  • CAS code
  • Pharmacological action
  • Characteristic
  • Pharmacology
  • Use of the substance Lorazepam
  • Contraindications
  • Restrictions for use
  • Use in pregnancy and lactation
  • Side effects of the substance Lorazepam
  • Interaction
  • Overdose
  • Route of administration and doses
  • Precautions
  • Special instructions
  • Trade names with the active substance Lorazepam

Structural formula

Russian name

Lorazepam

English name

Lorazepam

Latin name of the substance Lorazepam

Lorazepamum ( genus Lorazepami)

Chemical name

7-Chloro-5-(2-chlorophenyl)-1,3-dihydro-3-hydroxy-2H-1,4-benzodiazepin-2-one

Gross formula

C 15 H 10 Cl 2 N 2 O 2

Pharmacological group of the substance Lorazepam 9004 9002 Anxiolytics

Nosological classification

ICD-10 code list

  • R45. 1 Restlessness and agitation
  • F51.0 Insomnia of non-organic etiology
  • G47.0 Disorders of falling asleep and maintaining sleep [insomnia]
  • F10.5 Alcoholic psychosis
  • F91 Conduct disorders
  • F30 Manic episode
  • F42 Obsessive-compulsive disorder
  • F25 Schizoaffective disorders
  • F41.0 Panic disorder [episodic paroxysmal anxiety]
  • Z100* CLASS XXII Surgical practice
  • F60 Specific personality disorders
  • G44. 2 Tension headache type
  • R45.0 Nervousness
  • R45.7 State of emotional shock and stress, unspecified
  • F32 Depressive episode
  • F43.1 Post-traumatic stress disorder
  • F40.0 Agoraphobia
  • F43.2 Adjustment disorder
  • F34.1 Dysthymia
  • F41.1 Generalized anxiety disorder
  • F43.0 Acute stress reaction
  • G40 Epilepsy
  • F10.3 Withdrawal state

CAS code

846-49-1

Pharmacological action

Pharmacological action - anxiolytic , muscle relaxant , anticonvulsant , sedative , hypnotic , central .

Characteristics

Anxiolytic, benzodiazepine derivative.

Almost white powder, very slightly soluble in water.

Pharmacology

Interacts with specific benzodiazepine receptors of the GABA-benzodiazepine receptor complex, increases the sensitivity of GABA receptors to GABA. As a result, the frequency of opening of transmembrane channels for chloride ions increases, the postsynaptic membrane of the neuron is hyperpolarized, neuronal activity is inhibited, and interneuronal transmission to the CNS is inhibited. The effects are due to the influence on various parts of the central nervous system: the amygdala complex of the limbic system (anxiolytic), the reticular formation of the brain stem and nonspecific nuclei of the thalamus, hypothalamus (sedative and hypnotic), spinal cord (muscle relaxant), hippocampus (anticonvulsant). It reduces the excitability of subcortical formations (limbic system, thalamus, hypothalamus) responsible for the implementation of emotional reactions, and inhibits the interaction of these structures with the cerebral cortex. Stabilizes vegetative functions.

Suppresses anxiety, fear, reduces psychomotor agitation, emotional stress. It has anti-panic and amnestic (mainly for parenteral use) action. It is effective for insomnia caused by anxiety or a short-term stressful situation: it facilitates the onset of sleep (shortens the period of falling asleep), reduces the number of night awakenings, and increases the duration of sleep. It inhibits polysynaptic spinal reflexes and lowers the tone of skeletal muscles.

Lorazepam has low toxicity and wide therapeutic range.

An animal reproduction study showed that administration of lorazepam at doses of 40 mg/kg orally and 4 mg/kg or more IV to rabbits resulted in fetal resorption and an increased incidence of fetal death. Causes developmental anomalies in rabbits, regardless of dose. In an 18-month study in rats, no carcinogenic activity was found.

Good but slowly absorbed from the gastrointestinal tract when taken orally, bioavailability is 90%. max "> C max is achieved within 2 hours and is dose dependent: at a dose of 2 mg max"> C max is 20 ng / ml. About 85% binds to plasma proteins. The equilibrium concentration in the blood is usually reached after 2-3 days. Passes through the BBB and the placental barrier. It is rapidly metabolized in the liver by conjugation to form the main inactive metabolite, lorazepam glucuronide. 1/2 "> T 1/2 unconjugated lorazepam - about 12 hours, the main metabolite - 18 hours. Excreted mainly by the kidneys, mainly in the form of glucuronide.

When administered intramuscularly, max "> C max is achieved in 60–90 minutes. 1/2"> T 1/2 when administered parenterally is 16 hours. When used for 6 months, no cumulation phenomena are observed. The pharmacokinetic parameters of lorazepam do not change in the elderly.

Use of the substance Lorazepam

Neuroses accompanied by anxiety, agitation, incl. generalized anxiety disorder, post-traumatic stress disorder, phobias, obsessive-compulsive disorder, psychoreactive states, emotional reactive disorders, anxiety in depressive states of various origins (usually in combination with antidepressants), insomnia, psychosomatic disorders (including heart - vascular, gastrointestinal and other diseases), premedication before surgical and diagnostic manipulations (in combination with analgesics), tension headache; nausea and vomiting caused by chemotherapy, epilepsy (as part of combination therapy), alcoholic delirium and withdrawal syndrome in chronic alcoholism (as part of combination therapy).

Contraindications

Hypersensitivity, incl. to other benzodiazepines, myasthenia gravis, angle-closure glaucoma, acute intoxication with CNS depressants, respiratory depression, liver failure, pregnancy (especially the first trimester), breast-feeding, age up to 18 years.

Restrictions on use

Chronic respiratory failure, sleep apnea syndrome, open-angle glaucoma, drug and alcohol dependence, depression (see "Precautions"), psychosis, severe renal impairment.

Use during pregnancy and lactation

Contraindicated during pregnancy (especially in the first trimester). At the time of treatment should stop breastfeeding.

Side effects of the substance Lorazepam

From the nervous system and sensory organs: lethargy, fatigue, drowsiness, disorientation, headache, dizziness, depression, ataxia, sleep disturbance, agitation, visual impairment, amnesia episodes.

From the digestive tract: dry mouth, nausea, vomiting, diarrhea, change in appetite.

On the part of the skin: erythema, urticaria.

Others: changes in blood composition (leukopenia), increased LDH activity.

May develop addiction, drug dependence, withdrawal syndrome, rebound syndrome (see "Precautions").

Interaction

Lorazepam enhances the effect of CNS depressants, incl. phenothiazines, narcotic analgesics, barbiturates, antidepressants, hypnotics, anticonvulsants, antihistamines with a sedative effect. Potentiates the action of general and local anesthetics, enhances the action of curare-like drugs. With simultaneous use with alcohol, in addition to increasing the inhibitory effect on the central nervous system, paradoxical reactions are possible (psychomotor agitation, aggressive behavior, a state of pathological intoxication). Nicotine inhibits the activity of lorazepam (accelerates its metabolism).

Overdose

Symptoms: drowsiness, arterial hypotension, confusion, depression of reflexes, coma.

Treatment: induction of vomiting, gastric lavage, intravenous administration of norepinephrine to increase blood pressure, symptomatic therapy, monitoring of vital functions. The introduction of a specific antidote - an antagonist of benzodiazepine receptors flumazenil (in a hospital setting).

Dosage and administration

Inside. The dosage regimen and the duration of the course of treatment are set strictly individually.

In neurological practice - 1 mg 2-3 times a day; in psychiatric practice - 4-6 mg / day; with insomnia - 1-2 mg 30 minutes before bedtime. In elderly and debilitated patients, the dose should not exceed 2 mg / day (in divided doses). In patients with liver and / or kidney disease, as well as in patients with cerebral sclerosis, hypotension, heart failure, underweight, dose adjustment is recommended.

Precautions

Use with caution in depressed patients due to suicidal tendencies. In patients with drug and alcohol dependence, use under close medical supervision.

Side effects are usually observed at the beginning of therapy. The possibility of a more frequent occurrence of side effects in elderly and debilitated patients should be taken into account.

During treatment and for 2 days after its completion, it is necessary to exclude the intake of alcoholic beverages; drivers of vehicles and people whose work requires a quick mental and physical reaction, and is also associated with increased concentration of attention, should not engage in professional activities during this period.

With prolonged use, addiction and drug dependence may occur (especially when taking high doses). In this regard, lorazepam should not be used for longer than 4-6 weeks. If long-term treatment is necessary, weekly breaks in taking the drug should be periodically taken. With a sharp cessation of treatment, a withdrawal syndrome may occur (tremor, convulsions, abdominal or muscle cramps, vomiting, perspiration), and symptoms similar to those of the disease (anxiety, agitation, irritability, emotional stress, insomnia, convulsions) may also occur.

With prolonged use, it is necessary to periodically monitor the picture of peripheral blood, liver and kidney function.

Special instructions

Note that anxiety or tension associated with everyday stress does not usually require treatment with anxiolytics.

Trade names with active substance Lorazepam

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Lek. form All lek. dragee forms substance-powder tablets, coated tablets, film-coated

Dosage All dosages 1 mg 2.5 mg No dosage

Manufacturer All manufacturers of Cambrex Propharmaco Milan S.r.L. Moscow Endocrine Plant Federal State Unitary Enterprise Tarkhominsk Pharmaceutical Plant Polfa, JSC

The use of lorazepam in the treatment of children with cancer

Supportive care

Trademarks:

Ativan®

Other names:

Lorazepam Intensol

Often used for:

treatment of seizures, nausea and vomiting, anxiety

Lorazepam is a benzodiazepine. Drugs of this type are aimed at slowing down the activity of the central nervous system (CNS). Lorazepam helps to manage seizures, relieve symptoms of nausea and vomiting in cancer treatment, reduce anxiety levels, and help calm the patient before medical procedures.

Long-term use of this drug may cause addiction. Follow dosage instructions carefully.

Administered intravenously (by drip or injection) in liquid form

IM administration in liquid form

Oral tablets

Oral liquid form

Nasal injection (intranasal)

  • Drowsiness
  • Increased fatigue or general weakness
  • Dizziness
  • Reduced respiratory rate
  • Loss of clarity of vision
  • Diarrhea
  • Constipation
  • Headache
  • Dry mouth
  • Problems with urination

The listed side effects are not observed in all patients who are prescribed lorazepam. The most common side effects are highlighted in bold, but others are not excluded. Report all possible side effects to your doctor or pharmacist.

With long-term use, some patients develop drug resistance or dependence.

In young children, frequent use of the drug before medical procedures may lead to long-term brain damage.

Be sure to discuss these and other recommendations with your doctor or pharmacist.

  • After prolonged use of lorazepam, it is possible to stop taking it only under medical supervision. The doctor may gradually reduce the dosage to prevent the negative consequences associated with discontinuing the drug.
  • Alcoholic beverages should be avoided while taking this drug.
  • Patients of reproductive age who have been prescribed lorazepam should consult their physician before planning pregnancy.
  • Pregnant or breastfeeding patients should notify their physician.
Lorazepam home use: