What Is Ativan Withdrawal?
Ativan (lorazepam) is a benzodiazepine drug typically prescribed to relieve anxiety, and it may also be administered intravenously in hospital settings to halt seizures.1,4
Withdrawal may occur when someone who is physically dependent on Ativan stops using it or takes a lower dose.
Withdrawal symptoms can vary from one person to the next. How long the substance was used, in addition to the quantity and dose, will usually determine the intensity of withdrawal symptoms.
Symptoms may include:
- Panic attacks.
- Nausea or vomiting.
- Increased pulse and blood pressure.
- Hand tremors.
- Trouble with memory and concentration.
Risks of Withdrawal
Generally, Ativan withdrawal symptoms are not fatal. However, in severe cases, hallucinations, seizure, blackout, and even death have resulted from unmanaged detox.6
Of additional concern is something known as the Rebound effect, or the recurrence of symptoms for which Ativan was prescribed, such as sudden insomnia.2,5
Detoxing under the supervision of a health care professional is the safest way to undergo the withdrawal process. A person can be monitored and any complications can be dealt with.
- 6-8 hours after last dose. Withdrawal symptoms begin to appear. Early symptoms may include increased pulse and blood pressure, anxiety, panic attacks, restlessness, and upset stomach.
- 48 hours after last dose. Symptoms peak in intensity and may include tremors, fever, insomnia, and diarrhea.
- Days 4-5. Symptoms begin to improve. If symptoms are left untreated, they may worsen and include hallucinations, agitation, and seizures.6,10
Protracted withdrawal symptoms or post-acute withdrawal symptoms are symptoms that persist for weeks or months after quitting Ativan. These symptoms can appear, go away, and reappear without warning. They are thought to be caused by changes that take place in the brain as a result of substance abuse. 7,9
Symptoms of post-acute withdrawal include:
- Preoccupation or obsessive compulsiveness.
- Sleep disturbance.
- Drug cravings.
- Poor concentration and memory.7,9
Causes of Ativan Withdrawal
Withdrawal symptoms include anxiety, insomnia, tremors, and nausea.
People who regularly use benzodiazepines such as Ativan can develop tolerance to the drug and require larger doses to experience the same effects as before. These users are at risk of developing a physical and psychological dependence on the drug. Even users who take Ativan as prescribed can develop physical dependence.3,6
Once a person has developed a dependence on a substance, they will likely experience withdrawal symptoms when they stop taking the drug or reduce the dose too quickly. Many people continue to take the drug to avoid experiencing these symptoms.
Because of the risk for developing tolerance and dependence, the National Library of Medicine does not recommend using Ativan for more than 4 months or stopping its use without medical supervision.4
A number of treatment options are available to assist those struggling with Ativan withdrawal, as well as for family members and friends. Following detox, a person recovering from Ativan addiction should seek out group or individual therapy, or some other form of support, such as Pills Anonymous or Narcotics Anonymous (NA), to work through the issues that led to the addiction.
Behavioral therapies, such as cognitive behavioral therapy (CBT), have been shown to improve recovery outcomes. One study found a 76% success rate of CBT plus tapering compared to 25% for tapering alone.8
The following is a list of treatment options available:
- Residential and inpatient treatment. Inpatient treatment can last from 28 days to 90 days or longer. Some programs will include detox, while others accept people after they have detoxed at another facility. Treatment usually includes individual and group therapy, medical supervision, and aftercare preparation. Inpatient programs can be a way for people to take time away from environments that may promote drug use. Treatment facilities range from hospitals to destination retreats, but all are created with recovery in mind.
- Detox center. A detox center is designed to help a user safely withdraw from Ativan and other substances. Medical staff oversee the process, monitoring the user for any complications and providing medication as needed. These programs typically do not include services beyond the detox process.
- Outpatient treatment. Outpatient programs allow individuals to live at home and maintain job and family responsibilities while in treatment. The programs may combine individual, group, and pharmaceutical therapies. Outpatient treatment varies in length and intensity, but usually requires the person to attend treatment at least a few hours at a time on a few days of the week. Some programs help people detox who have mild withdrawal symptoms.
- Dual diagnosis. Many people who develop problems with Ativan use are struggling with anxiety and possibly depression. Dual diagnosis programs are designed to treat mental health and substance abuse problems simultaneously, so that the person does not relapse when they become sober and experience anxiety symptoms again. These programs may or may not offer detox.
Medications for Ativan Withdrawal
Tapering is a method of slowly reducing the dose of Ativan to lessen the intensity of withdrawal symptoms and prevent cravings.
In some cases, a physician may prescribe a person a similar drug with a longer half-life, such as diazepam or clonazepam, to better manage Ativan withdrawal symptoms. The dose is then gradually reduced over a period of several weeks.8
- How to Stop Ativan Cravings, Prevent Relapse, and Find Help
- What You Should Know About Quitting Ativan
- Drug Enforcement Agency. (n.d.). Drug Fact Sheet: Benzodiazepines.
- Johnson, B. (2013). Risks Associated with Long-Term Benzodiazepine Use. American Family Physician 88(4), 225–226.
- Drug Enforcement Agency (2013). Benzodiazepines.
- National Library of Medicine, Medline Plus. (2010). Lorazepam.
- Mehdi, T. (2012) Benzodiazepines Revisited. British Journal of Medical Practitioners, 5(1), 501.
- Federal Bureau of Prisons. (2014). Detoxification of Chemically Dependent Inmates.
- Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal. Substance Abuse Treatment Advisory, 9(1), 1–6.
- National Center for PTSD. (2013). Helping Patients Taper from Benzodiazepines.
- UCLA Dual Diagnosis Program. (2016). Post-Acute Withdrawal Syndrome (PAWS).
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.