What is Ativan Withdrawal?
In 2019, nearly 700,000 Americans aged 12 and older were diagnosed with a sedative or tranquilizer use disorder.1 Approximately 4.8 million Americans aged 12 or older had misused benzodiazepines in the past year.1
Ativan (lorazepam) belongs to a class of prescription medications known as benzodiazepines.1 Benzodiazepines (also known as “benzos”) are central nervous system depressants and can be prescribed to treat anxiety, panic disorder, or insomnia.2,3 Ativan is a potent, short-acting medication that’s intended for short-term use. Taking Ativan for long periods of time can lead to physical and psychological dependence as well as addiction.3 Dependence describes a state where a person experiences uncomfortable and potentially severe withdrawal symptoms should they cease or significantly reduce their use of Ativan.4
This page will provide an overview of the Ativan withdrawal syndrome, including the symptoms associated with benzodiazepine withdrawal, various options that are available to ease withdrawal symptoms, and also discuss how to avoid relapse and begin long-term recovery for a substance use disorder.
The Cause of Ativan Withdrawal
Regular use of benzodiazepines such as Ativan, alters the interaction of neurotransmitters in normal brain function.4 Specifically, benzodiazepines increase inhibitory brain signaling, producing a calming effect on the central nervous system that helps reduce anxiety or induce sleep. With regular use of the drug, the body begins to adapt to this interruption of its normal function, and the result is diminishment of the desired effects of the drug. This adaptation is called “tolerance” and sets the stage for a person to eventually experience withdrawal symptoms.5,6
When Ativan is stopped, the adaptations that were made to counteract for the drug’s presence are suddenly exposed, resulting in the brain having to rebound without the drug. This state of dependence manifests as a withdrawal syndrome that consists of effects that are, in general, opposite of the desired effects of the drug.4,6 A person who takes Ativan regularly can experience withdrawal quickly after Ativan use is stopped or dramatically reduced.5
Ativan Withdrawal Symptoms
The timeline for withdrawal from Ativan can be highly variable from person to person and some people may experience a post-acute withdrawal syndrome in addition to acute withdrawal.5
Acute Ativan withdrawal can begin as quickly as 6 to 8 hours from the last dose, and may worsen for a few days before they begin to resolve, usually this takes about a week.5 The acute withdrawal symptoms typically subside completely within 2 to 4 weeks.6 Physical withdrawal symptoms can be distressing, on a continuum from minor and uncomfortable to severe and life-threatening.3-5
Mild Ativan withdrawal symptoms can include achy or twitching muscles, headache, having a metallic taste in the mouth, loss of appetite, mild dizziness, restlessness, sleep difficulties, sweating, and changes in sensory perception, including becoming more sensitive to light, smells, sounds, and touch.3,4,6 More severe symptoms of acute withdrawal include a pins and needles feeling in the arms and legs, hand tremors, uncontrollable movements, nausea, vomiting, diarrhea, stomach cramps, severe dizziness, increased body temperature, rapid heart rate, raised blood pressure, and heart palpitations.3-6
Some people experience lingering lower intensity withdrawal symptoms which can last for months or even years after quitting Ativan.5-7 These post-acute withdrawal symptoms may include persistent physical symptoms such as twitching muscles, numbness or tingling in the arms and legs, ringing in the ears, changes in sensory perception, stomach issues, and trouble sleeping.4,6,7 Lingering emotional and mental symptoms may be extremely distressing, potentially severe enough that they interfere with the ability to function.5 These can include ongoing anxiety, depression, difficulty remembering things, and psychosis.4,6,7 Depression associated with post-acute withdrawal can be severe and contribute to suicidal thoughts or behaviors.6
Is Ativan Withdrawal Dangerous?
The severity of withdrawal symptoms is difficult to predict because the symptoms an individual will experience as well as their severity are influenced by a wide variety of factors. These include: How long you have been taking Ativan, the dose taken, and the frequency taken.3,5,6 Longer duration, as well as higher and/or more frequent doses may cause dependency to develop faster and lead to more severe withdrawal symptoms.3-5
Taking Ativan while also using alcohol or other drugs, including certain medications, can increase the risk of developing a substance use disorder and can also influence withdrawal symptoms.3,4 Alcohol withdrawal is very similar to benzodiazepine withdrawal.5 The presence of medical and/or mental health issues can also have an impact on dependency and withdrawal symptoms.3,8
Extremely severe benzodiazepine withdrawal symptoms may be accompanied by life-threatening medical complications; however, they are not commonly experienced and it’s rare that they are fatal.5Experiencing any of these symptoms, however, should prompt quick medical attention:
- Difficulty regulating body processes, including body temperature, blood pressure, breathing rate, and heart rate, which should be monitored by a medical professional to prevent complications from occurring.5
- Psychotic symptoms, such as a loss of touch with reality and a feeling of being disconnected from your body or thoughts.3,5,6
- Perceptual disturbances, such as visual, auditory, and/or tactile hallucinations, resulting in severe confusion that resembles delirium.3,6
Seizures are perhaps the most potentially life-threatening symptom of severe Ativan withdrawal, and they can appear quickly without notice.3,5,6,8 The severity can vary from a single seizure to multiple seizures, leading to severe and potentially fatal complications.9 People who have a seizure disorder or who drink alcohol or take other substances that can increase the risk for seizures, such as other benzodiazepines or antidepressants, are at greater risk for having seizures during Ativan withdrawal.3
Can I Detox from Ativan Safely at Home?
It may be appealing to consider trying to detox from Ativan at home, since it doesn’t involve a large financial commitment or require taking time away from work or any other responsibilities the way attending a detox facility would. However, you should discuss at-home withdrawal with your doctor or a trusted medical professional before trying to quit Ativan on your own or making any major decisions about what to do.8
It is strongly suggested that you do not attempt to quit taking Ativan without medical supervision.8 A medical professional can help you to assess your risks of experiencing more severe withdrawal symptoms and determine the appropriate level of detox or rehab care that will meet your needs while keeping you safe and comfortable. Your doctor should work with you to take not only your medical needs into account, but also your preferences. Ideally, your doctor should recommend you to the least restrictive level of care, meaning that you would receive treatment at the lowest level of intensity that is likely to be effective while allowing you the most freedom to engage in life activities.8
As noted above, some of the symptoms of withdrawal can come with medical complications and may even be life-threatening.5,6 If you have been taking high doses of Ativan, have been taking it for a long time, have other physical or mental health conditions that put you at greater risk for severe symptoms of withdrawal, or have experienced severe withdrawal symptoms in the past, you may be at greater risk for experiencing severe withdrawal symptoms and complications.5,9 Difficulties in regulating the body’s processes, psychosis, delirium tremens, and seizures can quickly become fatal, especially if untreated.5,6,9
When you are considering detoxing from Ativan, it is important to be aware that these severe and potentially fatal symptoms and complications can arise rapidly and need to be treated immediately.5,9 Seizures are especially concerning symptoms and require medical attention to avoid further progression and potentially fatal outcomes.5,9
Seeking help for Ativan withdrawal treatment doesn’t necessarily mean that you will be required to attend an inpatient detoxification facility.8 In some cases, especially for people who are likely to experience mild symptoms of withdrawal, it could be possible to undergo outpatient detoxification under the supervision of a doctor.8 No matter what route you are thinking of taking, it is important to discuss your plans with a medical professional before taking any action toward detoxing from Ativan on your own.
Ativan Withdrawal Treatment
Since withdrawal from Ativan can may warrant attention from a nurse or physician, medical detox is recommended for anyone who is likely to experience severe withdrawal symptoms.8 Medical detox refers to inpatient treatment where medical staff is available 24 hours a day to monitor your condition and provide medication to manage and treat symptoms of Ativan withdrawal to ensure your comfort and safety as best as possible.8 Medical detox facilities have a doctor available on-call in case of emergencies and have licensed and certified therapists available for pre-existing or any new mental health issues and to transition you into recovery.8
During medical detox, two medications may be used to treat and manage the symptoms of Ativan withdrawal.8 Since Ativan is a very potent, short-acting benzodiazepine, the first option is to substitute a less intense and long-acting benzodiazepine, such as Librium (chlordiazepoxide) or Klonopin (clonazepam).4,8 After the medication has been switched, the dose is slowly tapered to reduce the severity of withdrawal symptoms and lower the risk of experiencing severe symptoms and potential complications.3,8 The tapering schedule can be adjusted to meet the needs of each patient and can take weeks or months if needed.8
The other option is to taper off of Ativan using phenobarbital instead of another type of benzodiazepine medication.8 Regardless of which option is chosen, the dosing should be flexible and responsive to symptoms, with significant increases in symptoms corresponding to an adjustment in dose.8 In some cases, if withdrawal is especially severe, other medications may be added to help control symptoms and ensure your safety.8
The primary goal of detox is to help manage symptoms of withdrawal and ensure your safety while doing so.8 For many people who use or abuse Ativan, attending detox is the first step they take toward sobriety. However, detox alone is not sufficient addiction treatment and does little to address the underlying causes that contributed to Ativan misuse in the first place.8,10 Since detox is generally the starting point in the treatment journey, it is a good opportunity to make a connection to further care.8 Before discharge from detox, your treatment team will discuss your plans and help connect you to the next step in the recovery journey to make the transition as easy and seamless as possible.8,10
Post-detox follow-up rehabilitation treatment is a longer-term commitment that is intended to set the stage to create lasting change.8,10 Inpatient and outpatient treatment offer variable periods of treatment, allowing time to address the underlying causes of addiction as well as the physical, mental, emotional, social, financial, behavioral, legal, and occupational consequences associated with it.8,10 This is accomplished through a combination of individual and group therapy sessions, where different behavioral therapy techniques are used to help improve coping and communication skills, teach relapse prevention techniques, and encourage participation in mutual-support groups, which is likely to also be incorporated in your aftercare plan.10 If desired, marital and family counseling sessions can be provided as well.10 Psychiatric care is provided in many facilities as needed.10
|Ativan Information at a Glance|
|Medication Name, Costs||Class of Medicine|
|Generic Name: Lorazepam
Brand Name: Ativan
Cost/Price: $1- $3 1
|Function or Use at Low Dose: Anxiolytic
Function or Use at High Dose: Sedative, hypnotic, anticonvulsant
Type of drug: Central nervous system (CNS) depressant/benzodiazepine
|Form, Intake, and Dose||Interactions and Complications|
|Drug Forms: pill or liquid 1
Administration Routes: oral, intravenous
Dosage: varies from 1mg to 10mg 2
Overdose: usually occurs in combination with alcohol or other drugs 2
Overdose symptoms: drowsiness, mental confusion, lethargy, loss of control over body movements, low blood pressure, cardiovascular depression, respiratory depression, coma, death 2
|Alcohol interaction: can produce increased CNS depressant effects (lower breathing rate and blood pressure) with alcohol and lead to overdose 2
Prescription medication interactions: increased CNS depressant effects when combined with clozapine, barbiturates, antipsychotics, sedative/hypnotics, anxiolytics, antidepressants, narcotic analgesics, sedative antihistamines, anticonvulsants, and anesthetics 2
Contraindications: In patients with hypersensitivity to benzodiazepines or to any components of the formulation and/or patients with acute narrow-angle glaucoma 1
|Effects and Adverse Reactions||Substance Abuse|
|Short-Term: Sedation, weakness, unsteadiness, amnesia, disorientation, vertigo, headache 2
Long-Term: change in appetite, change in libido, memory impairment, tolerance, dependence, addiction 2
|Risk of Substance Abuse: Yes 2
Signs of Abuse: Cravings, preoccupation with the medication, poor performance at school, general apathy, financial problems because money is spent on pills
|Signs and Symptoms of Withdrawal||Dependence and Addiction Issues|
|Withdrawal Syndrome Onset: 6 to 8 hours 4
Withdrawal Symptoms: headache, anxiety, tension, insomnia, convulsions, tremors, abdominal and muscle cramps, rapid heart rate, anxiety, hallucinations, vomiting, sweating, seizures 2
|Physical Dependence: Yes 2
Psychological Dependence: Yes 2
|DEA Drug Scheduling|
|Controlled Substances Act Classification: Schedule IV 3|
1. Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
2. Drug Enforcement Administration. (2017). Drugs of abuse: A DEA resource guide.
3. U.S. Food and Drug Administration. (2016). Ativan.
4. Longo, L.P., & Johnson, B. (2000). Addiction: Part I. Benzodiazepines — Side effects, abuse risk and alternatives. American Family Physician, 61(7), 2121-2128.
5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
6. Lerner, A., & Klein, M. (2019). Dependence, withdrawal and rebound of CNS drugs: An update and regulatory considerations for new drugs development. Brain Communications, 1-23.
7. Ashton, H. (1995). Protracted withdrawal from benzodiazepines: The post-withdrawal syndrome. Psychiatric Annals, 25(3), 174-179.
8. Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series 45, DHHS Publication No. (SMA) 06-4131. Rockville, MD: Substance Abuse and Mental Health Services Administration.
9. Hu, X. (2011). Benzodiazepine withdrawal seizures and management. Journal of the Oklahoma State Medical Association, 104(2), 62-5.
10. National Institute on Drug Abuse. (2020). Principles of drug addiction treatment: A research-based guide (Third edition).
Ativan Information at a Glance Sources
. DrugBank. (2016). Lorazepam.
. Food and Drug Administration. (2011). Ativan.
. Drug Enforcement Administration. (n.d.). Drug Schedules.
. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ). Washington, D.C: American Psychiatric Association.