Ativan (lorazepam) is a prescription drug used for the short-term treatment of anxiety disorders and anxiety symptoms. It belongs to a class of drugs called benzodiazepines that bind to gamma-aminobutyric acid (GABA) receptors in the brain, slowing down the central nervous system (CNS) , causing drowsiness or a sedative effect.
Ativan comes in pill form and is available in generic form. Injectable Ativan is another form of medication used in health care settings to treat status epilepticus (prolonged seizures ) or as a pre-anesthetic medication to calm and calm the patient before surgery and anesthesia . Ativan for injection is injected into a vein or muscle.
There is also the Lorazepam Intensol brand of lorazepam, which comes in an oral concentrate that is mixed with liquids and drinks.
Oral ativan (lorazepam) is approved for the short-term treatment of anxiety disorders, such as generalized anxiety disorder (GAD), or the immediate relief of anxiety symptoms in adults and children 12 years of age and older.
It may also be prescribed short-term for anxiety-related insomnia or depression-related anxiety.
Ativan, like other benzodiazepines, carries a serious risk of abuse, misuse, and dependence, even when taken as directed. Due to the risk of overdose and death, Ativan is not considered a long-term remedy for anxiety and should not be taken for everyday stress and stress.
In a hospital setting, Ativan injection can be used to treat life-threatening seizures and is often used to alleviate status epilepticus or prevent seizures in a patient who has had multiple seizures during hospitalization. For seizures, injection into a vein is preferable. Injection into the muscle is only recommended if intravenous access is not available and medication must be administered.
Ativan injection is also approved as a sedative before general anesthesia and surgery. It can be injected into a muscle or injected intravenously for this purpose.
However, studies show that the use of Ativan before surgery cannot significantly improve the patient's condition and prolong recovery.
A randomized controlled trial comparing patients who received lorazepam before elective surgery with those who received placebo or no medication concluded that lorazepam did not improve the patient experience. Drug use was also associated with longer ventilation times and cognitive recovery.
Use not indicated on the label
Ativan is also sometimes prescribed for withdrawal symptoms and to reduce complications, which can include seizures.
It can also be used to treat schizophrenic symptoms such as agitation and to reduce nausea and vomiting during chemotherapy .
In hospitals, Ativan can also be used after surgery to improve sleep, reduce arousal, improve postoperative delirium symptoms, and enhance relaxation.
In intensive care units, Ativan may be prescribed to help a patient with a ventilator or bedside procedure. In this case, the drug can be administered intermittently as an intravenous injection or continuously as a dropper.
The first-line treatment for anxiety disorders is psychotherapy, long-term medication, or both.
Cognitive behavioral therapy is a form of psychotherapy that is often used to treat anxiety. It includes helping the patient explore and analyze their thoughts and feelings, especially those related to the appearance or reduction of anxiety. It can also include practicing techniques that can be used in scenarios that tend to trigger anxiety.
Selective serotonin reuptake inhibitors (SSRIs), such as Zoloft (sertraline) or Paxil (paroxetine), or serotonin norepinephrine reuptake inhibitors (SNRIs), such as Cymbalta (duloxetine) or Effexor (first-line venlafaxine) are available. ). SSRIs and SNRIs target the neurotransmitter serotonin, making it more available in the body and reducing feelings of anxiety.
Benzodiazepines, such as ativan or Xanax (alprazolam) , are considered second-line or adjunctive drugs for the treatment of GAD and other anxiety disorders when initial treatment is neither sufficient nor sufficient .
Benzodiazepines quickly relieve symptoms such as muscle tension and anxiety, so they can be prescribed for use in specific situations (such as air travel) or as add-on drugs until first-line therapy is effective.
For example, it can take several months for an SSRI to be fully effective. If you have been prescribed Ativan when you start taking an SSRI, you will be gradually withdrawn from Ativan as the SSRI takes effect.
Talk to your doctor about all the medications, supplements, and vitamins that you are currently taking. While some medications have a lower risk of interaction, others may directly contraindicate the use of Ativan or encourage careful consideration of whether the benefits of treatment outweigh the disadvantages in your case.
Precautions and contraindications.
Ativan is a federally controlled substance because it can be abused or addicted. Because of these and other health risks, your healthcare provider will want to perform a complete physical and mental health analysis before prescribing Ativan.
Medical circumstances that could make taking Ativan risky or prohibit its use include:
- Allergies or hypersensitivity: Do not take Ativan if you have a known allergy or hypersensitivity to benzodiazepines or any of the inactive ingredients of the medicine.
- Acute narrow-angle glaucoma: Do not take benzodiazepines if you have an urgent vision problem, as there may be a risk of increased pressure in the eye.
- Pregnancy: there is evidence that Ativan can harm the fetus. Your healthcare professional can help you evaluate the benefits and risks of its use. Long-term use during pregnancy can cause the baby to have withdrawal symptoms after birth.
- Breastfeeding: Do not take Ativan while breastfeeding as it can be passed to the baby through breast milk, which can lead to sedation and respiratory distress.
- Personal or family history of substance abuse or addiction: The risk of addiction, abuse and misuse increases for people prone to drug addiction. Your healthcare provider may refuse to prescribe Ativan due to these additional risks, or consultation and close monitoring may be required during treatment.
- History of depression or suicidal thoughts: Pre-existing depression can occur or worsen while taking benzodiazepines. Your healthcare provider may refuse to prescribe Ativan due to these risks, or you may need close monitoring and antidepressant therapy while taking this drug.
- Respiratory failure: Patients with conditions such as chronic obstructive pulmonary disease (COPD) or sleep apnea may be at increased risk of serious respiratory side effects when taking Ativan.
Lorazepam can interact with other medications, which can cause serious or life-threatening adverse reactions. Always discuss all medications with your doctor.
Other common types of benzodiazepines that may be prescribed for anxiety include:
- Xanax (alprazolam)
- Klonopin (clonazepam)
- Valium (diazepam)
- Librium (chlordiazepoxide)
Your healthcare professional can help you determine which benzodiazepine may be the best option for you.
Ativan can be taken every day at a specific time or as needed (subject to daily dosing). It is usually prescribed for two to four weeks at a time and is not approved for use for more than four months. Take this medicine as directed by your doctor.
Ativan is available as 0.5, 1 and 2 mg tablets. Typical doses are 2 to 6 mg per day in two or three divided doses, but doses can range from 0.5 mg per day to a maximum of 10 mg per day. Due to the risk of dependence and addiction, Ativan is prescribed at the lowest effective dose for the shortest period of time possible.
For anxiety disorders, most patients receive a starting dose of 2 to 3 mg per day, divided into two or three doses. The highest dose is usually taken at bedtime.
For insomnia caused by anxiety or situational stress in the short term, a single daily dose of 2 to 4 mg can be taken before bedtime.
Oral doses are usually higher than the injection doses prescribed by your doctor. A person who requires 0.5 mg for the intravenous form of the drug can receive 1 mg or more if they need to take the drug by mouth.
All indicated doses are indicated by the manufacturer of the drug. Check your prescription and talk to your doctor to make sure you are taking the correct dose.
Adolescents and older adults are more likely to be sensitive to the drug or have paradoxical reactions, meaning that Ativan causes, rather than relieves, anxiety and anxiety. In these groups, the drug must be given in very low starting doses.
How to take and store
Ativan can be taken with or without food. If you miss an appointment, take it as soon as you remember. If it is time for your next dose, skip the missed dose. Do not take two doses or more than the prescribed daily dose.
Store the medicine at room temperature (ideally 77 degrees Fahrenheit). If necessary, Ativan can be taken with you on excursions if stored in temperatures between 59 and 86 degrees Fahrenheit.
If you take more than the prescribed dose, consult your doctor as you run the risk of overdose or dependence. Seek emergency medical attention if you notice any signs of an overdose, such as:
- Slow reflexes
- Difficulty breathing
Ativan is generally well tolerated, but can sometimes cause serious side effects.
The most common side effect associated with taking Ativan is sedation. While this can be problematic in some ways, it is often the desired effect given the symptoms the drug is treating.
Other common side effects include:
- Soft spot
Sedation and instability are more common in older people taking Ativan .
This drug can also cause amnesia, especially at higher doses. When administered in a medical setting prior to the procedure, the patient may have little or no memory of the time immediately after dosing.
In rare cases, Ativan can cause paradoxical effects that increase anxiety or cause very serious and life-threatening side effects, such as respiratory depression and allergic reactions, especially at high doses.
Seek emergency medical attention if you experience any of the following side effects:
- Difficulty breathing
- Speak slurred
- Increased irritability
- Feeling depressed / lack of interest in life (pre-existing depression may appear or worsen when taking Ativan)
- Suicidal thoughts
- Swelling of the face, tongue, or throat
- Changes in eye function or visual impairment.
- Memory impairment
Warnings and interactions
Ativan is not a long-term solution. Your healthcare provider can help you explore other ways to manage your anxiety. If you suspect that you are becoming addicted to ativan or taking more than you should to get the desired effect, contact your doctor immediately.
Do not stop taking Ativan suddenly. Withdrawal symptoms such as headaches and irritability can occur (even if you stop taking the drug just a week after taking it). Seizures can be a more serious and life-threatening withdrawal symptom. Always consult your doctor before decreasing (or increasing) your dose of ativan. Your dose may be lowered gradually so that you can safely stop taking the medicine.
Some people taking Ativan may develop leukopenia , a low white blood cell count that makes it harder for the immune system to fight infection. An elevated level of lactate dehydrogenase (LDH), an enzyme that can indicate tissue damage in the liver and other important organs, can also be produced.
While you are taking ativan, your healthcare provider may ask you to keep several appointments to assess your dose and have blood tests, for example, to check your white blood cell count and LDH levels.
Close monitoring is necessary in patients with liver disease and hepatic encephalopathy , which can manifest as confusion or difficulty processing thoughts while taking benzodiazepines.
Older people and those taking Ativan for long periods may also need frequent monitoring for signs of upper gastrointestinal problems, as preliminary studies indicate that lorazepam may affect the esophagus .
Ativan can cause sedation, so you should not drive or operate machinery after taking the medicine.
Due to the risk of impaired breathing, Ativan should not be administered with other central nervous system (CNS) depressants without proper supervision from a healthcare provider or in a hospital. The combination can increase the risk of breathing problems, coma, and death. Other CNS depressants include:
Alcohol also depresses the central nervous system and should not be taken with Ativan.
Other drugs that can interact with Ativan include:
- Clozaril (clozapine): Taking Ativan with this antipsychotic medicine used for schizophrenia can cause excessive sedation, excessive salivation, hypotension (low blood pressure) , poor coordination, delirium and respiratory arrest in rare cases. Close monitoring is necessary and dosage adjustments of any medication may be required.
- Valproate anticonvulsants: These medications used for seizures or bipolar disorder, such as Depacon (sodium valproate), Depakote (divalproex sodium) , or Depaken (valproic acid) , can increase blood levels of ativan and reduce the elimination of the drug from the body . The dose of Ativan should be reduced by approximately 50%.
- Probalan (probenecid): Taking this medicine for gout with Ativan may result in a faster onset or a longer effect of Ativan. The dose of Ativan should be reduced by about half.
- Teolair (theophylline) or aminophylline: These medications, used for asthma and other lung conditions, can reduce the sedative effects of benzodiazepines.