Ativan

Medically Reviewed By University of Illinois Chicago Drug Information Group

Ativan at a glance

Key highlights to know about Ativan are:

  • Ativan (lorazepam) is used to treat anxiety disorders and symptoms of anxiety associated with depression.
  • Ativan tablet and liquid concentrate are administered by mouth. The tablet may be administered with or without food. The oral liquid concentrate should be mixed with at least 30 mL of water, juice, applesauce, pudding, or carbonated beverage.
  • Ativan should not be used with alcohol.
  • Ativan does not cause weight changes (gains or losses). When discontinuing Ativan, weight loss may be a sign of withdrawal.
  • Generic Ativan is typically a low-cost drug, defined in this article as costing less than $30/month.
  • Ativan tablets are available as both the brand-name and generic medication, called lorazepam. A liquid (concentrate) is available as the generic medication only.

Important safety warnings for Ativan

Ativan has a black box warning (also called a boxed warning), which is the Food and Drug Administration’s most serious warning for drugs. These warnings alert doctors and patients that a drug has serious or life-threatening risks.

  • Use with opioids warning: Using Ativan with opioid medications can cause excessive sedation, trouble breathing (respiratory depression), coma, or death. The use of Ativan with opioid medications should only occur when no other alternative options exist.
  • Abuse, misuse and addiction warning: Ativan may be habit-forming. This can result in overdose and lead to death, coma, and serious side effects (delirium, paranoia, suicidal thoughts and actions, seizures, trouble breathing). If you experience any of these side effects, call your doctor or go to the emergency room right away. It is possible to develop addiction, even if you take Ativan as directed by your healthcare provider. Take Ativan exactly as prescribed, do not share Ativan with others, and store Ativan away from children.
  • Physical dependence warning: Physical dependence can occur with Ativan, typically with higher doses and longer treatment duration. This may lead to withdrawal if Ativan is stopped suddenly or discontinued too quickly. Withdrawal may be fatal. Your healthcare provider will gradually decrease your Ativan dose prior to stopping it all together. Physical dependence is not the same as addiction.

Users of Ativan should be aware of these additional safety warnings:

  • Use in depression warning: Ativan should not be used in patients with depression who are not being treated with an antidepressant due to the risk for suicide.
  • Use with respiratory conditions: If you have a respiratory condition, such as chronic obstructive pulmonary disease (COPD) or sleep apnea, your risk of experiencing trouble breathing (respiratory depression) is higher while taking Ativan. Your healthcare provider should monitor your breathing status closely and adjust your dose to avoid side effects.
  • Use in elderly and debilitated patients warning: Elderly patients and patients that are debilitated are more likely to experience sedating side effects from Ativan (drowsiness, sleepiness). Your healthcare provider will monitor you for side effects and adjust your dose to avoid side effects. You may also be prescribed a lower starting dose to help avoid side effects.
  • Paradoxical reaction warning: Ativan may cause some patients to become talkative, agitated, hyperactive, restless, hostile, or aggressive, as well as cause difficulty sleeping. These side effects are called paradoxical reactions, because they are the opposite of what is typically expected from Ativan. They are more common in children and elderly patients. Tell your healthcare provider immediately for any of these effects, so that they can discontinue Ativan.
  • Esophageal dilation warning: In animal studies, Ativan caused widening of the esophagus (esophageal dilation). Esophageal dilation can lead to upper gastrointestinal conditions, such as heartburn (also known as gastroesophageal reflux disease [GERD]). This is more common when Ativan is used for long periods of time and in elderly patients. Tell your healthcare provider if you notice new or worsening symptoms of heartburn.

Talk with your doctor about these warnings in the context of your individual treatment plan and medical history.

What Ativan treats

This medication is used to treat:

  • Anxiety disorders
  • Symptoms of anxiety or anxiety associated with depression (short-term relief)

Ativan is typically not necessary to treat anxiety or stress associated with everyday life. Long-term use of Ativan, beyond four months, has not been studied.
Doctors sometimes prescribe medications for different uses. Ask your doctor or pharmacist for information about other uses of this medication.

How it works

Ativan is a prescription drug that belongs to a class of medications called benzodiazepines. It works in the brain by slowing down the brain’s activity. This allows for relaxation.

Ativan is available as a tablet and liquid (concentrate) that are administered by mouth. Ativan is also available as an injection medication, but the injection form is used only by healthcare professionals in a hospital or healthcare setting. Ativan is available as a brand-name product, as well as a generic medication called lorazepam. The generic form is more commonly dispensed. The oral concentrate liquid is only available as a generic medication.

Side effects of Ativan

Ativan side effects are possible and may go away with continued use. Serious side effects are rare.

Common side effects

The more common side effects that occur with Ativan include:

  • Dizziness
  • Sedation
  • Unsteadiness
  • Weakness

Serious side effects

Call your doctor right away if you have serious side effects. Seek emergency care (call 911) if you experience life-threatening symptoms, such as difficulty breathing; chest pain; loss of consciousness; sudden vision changes; or swelling of the face, mouth, tongue or throat.

Serious side effects and their symptoms can include the following:

  • Abuse, misuse and addiction that can lead to overdose and serious side effects. Symptoms can include:
    • Coma
    • Death
    • Delirium
    • Paranoia
    • Seizures
    • Suicidal thoughts and actions
    • Trouble breathing
  • Decreased brain function that may impair your ability to operate machinery. Symptoms can include:
    • Dizziness
    • Sleepiness
    • Slow thinking
  • Serious adverse events when used with opioid medications, alcohol, central nervous depressant medications, and street drugs, which can lead to coma and death. Symptoms can include:
    • Difficulty breathing
    • Drowsiness
    • Excessive sleepiness (sedation)
    • Slowed breathing
  • Worsening or new depression. Symptoms can include:
    • Changed appetite, sleep, energy, concentration or behavior
    • Loss of interest
    • Sadness
  • Withdrawal if Ativan is stopped too quickly. Symptoms can include:
    • Depression
    • Losing touch with reality (delirium)
    • Seeing or hearing things that others do not (hallucinations)
    • Seizures
    • Sudden and severe mental status changes
    • Suicidal thoughts or actions
    • Unusual movements, responses or expressions

Other side effects are possible. Talk to your doctor or pharmacist if you have any side effect that bothers you or that does not go away.

Costs of Ativan

Without insurance, the generic formulation of Ativan (lorazepam) is typically a low-cost drug (defined as costing less than $30/month). You can check the out-of-pocket cash pay price for Ativan on prescription drug discount websites.

With insurance, prices can vary considerably. Individual health plans may have preferred drugs with better pricing. If the price of Ativan on your health plan is too expensive, ask your doctor or pharmacist if there is an equivalent drug you can substitute.

How Ativan may interact with other medicines

Ativan may interact with other prescription and over-the-counter medications, vitamins, or herbal supplements you may be taking. To help avoid harmful interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbal supplements you are taking. To find out how this drug might interact with something else you are taking, talk to your doctor or pharmacist.

This is not a complete list of drugs that may interact with Ativan. However, examples of drugs that may interact with Ativan include:

Opioids

Taking Ativan with opioid pain medications can cause drowsiness and breathing problems (respiratory depression). This can be fatal. The use of opioids with Ativan should be limited to the lowest dose for the shortest duration possible. Examples of opioid medications include:

  • Buprenorphine (Belbuca, Buprenex, Butrans, Sublocade)
  • Fentanyl (Actiq, Duragesic, Fentora, Ionsys, Lazanda, Subsys)
  • Hydrocodone (Hysingla ER, Zohydro ER) and drugs that contain hydrocodone (Lortab, Norco, Vicodin, Vicoprofen)
  • Methadone (Dolophine, Methadose)
  • Morphine (MS Contin)
  • Oxycodone (Oxaydo, Oxycontin, Roxicodone) and drugs that contain oxycodone (Endocet, Percocet)

Drugs that cause drowsiness

Avoid use of other drugs that cause drowsiness if you are taking Ativan. Using these drugs together could cause drowsiness, breathing problems, or slowed muscle reactions that could impair your ability to drive a car. Examples of drugs that cause drowsiness include:

  • Antidepressants
  • Antihistamines, such as diphenhydramine (Benadryl)
  • Antipsychotics, such as clozapine (Clozaril)
  • Other sleep aid drugs

Drugs that increase exposure to Ativan

Be careful when taking drugs that can lead to higher exposure to Ativan in the body. This can lead to more drowsiness and other side effects. You may need a lower dose of Ativan. Examples of other drugs that can increase exposure to Ativan include:

  • Probenecid
  • Valproate

Disclaimer: Since drugs interact differently in each person, this information is not guaranteed to include all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbal supplements, and over-the-counter drugs that you are taking.

Other Ativan alerts

This drug comes with several alerts:

Anxiety with gastrointestinal or cardiovascular symptoms

Although Ativan is used to treat anxiety, it has not helped to improve certain symptoms associated with anxiety. This includes symptoms associated with the gastrointestinal tract (cramping, diarrhea) or the cardiovascular system (racing heartbeat).

Warnings for other groups

For children: Ativan has not been studied in children younger than 12 years of age.

For patients with liver disease, low liver function, and worsened brain function (encephalopathy) caused by liver disease: Ativan can worsen encephalopathy due to liver disease. Patients with liver disease or encephalopathy should receive lower doses to avoid side effects.

For decreased kidney function: Patients with lower kidney function may be more likely to experience Ativan side effects.

Call your doctor right away if you have serious side effects. Seek emergency care (call 911) if you experience life-threatening symptoms, such as difficulty breathing; chest pain; loss of consciousness; sudden vision changes; or swelling of the face, mouth, tongue or throat.

For pregnant and breastfeeding women

Can I take Ativan when pregnant?

Ativan may harm your unborn baby, particularly during the first trimester and for several weeks leading up to delivery. Taking Ativan in the several weeks prior to delivery can cause your baby to go through withdrawal once they are born. Talk with your healthcare provider to decide whether to continue Ativan during pregnancy.

Can I take Ativan when breastfeeding?

Ativan should not be taken when breastfeeding. Ativan passes into breast milk and can cause harm to your baby. Talk with your healthcare provider about how to feed your baby if you are taking Ativan.

How and when to take Ativan

This drug is administered by mouth. Your dose and how often you take Ativan will depend on:

  • Age
  • Other medications
  • Other medical conditions you have
  • How well you tolerate the medication

The starting dose of Ativan will be the lowest dose possible. To avoid side effects, your doctor may slowly increase the prescribed dose based on your response.

Drug forms and strengths

  • Tablet
    • 0.5 mg
    • 1 mg
    • 2 mg
  • Concentrate (liquid)
    • 2 mg/mL

Dosage for anxiety

  • Initial dose: 2 to 3 mg per day administered in divided doses 2 to 3 times per day

Dosage for insomnia due to anxiety

  • Single dose: 2 to 4 mg at bedtime

Dosage for elderly or debilitated patients

  • Initial dose: 1 to 2 mg per day administered in divided doses

If you miss a dose of Ativan

Ativan is typically prescribed several times a day for anxiety. If you are taking Ativan several times a day, skip the missed dose and continue your regular schedule with your next dose.

If you take too much Ativan

Overdose with Ativan is possible. The risk of overdose is higher if you are taking Ativan with certain medications, taking it with alcohol, or abusing Ativan (taking too much Ativan or for purposes other than its prescribed use).

Symptoms of overdose are drowsiness, confusion, paradoxical reactions (aggressiveness, talkativeness, etc.), low blood pressure, and trouble breathing or slowed breathing. Overdose can lead to coma or death. If you think you have taken too much of this drug or are experiencing these side effects, call your doctor or local poison control center at 1-800-222-1222 immediately.

Seek emergency care (call 911) if you experience life-threatening symptoms, such as difficulty breathing; chest pain; loss of consciousness; sudden vision changes; or swelling of the face, mouth, tongue or throat.

Helpful tips when taking Ativan

Keep these considerations in mind if your doctor prescribes Ativan for you.

General

  • Take Ativan exactly as your healthcare provider tells you to take it.
  • Ativan tablets may be administered with or without food.
  • Do not use alcohol if you are taking Ativan. This increases your risk of overdose, causes breathing problems (respiratory depression), or may lead to coma or death.

Oral liquid concentrate

  • Use the dropper supplied by the pharmacy to measure your dose.
  • Mix the required dose into approximately 30 mL (1 oz) of liquid (water, juice, soda) or semi-solid food (applesauce, pudding).
  • Consume the entire mixture immediately. Do not store it for future use.

Storage

  • Store Ativan tablets at room temperature, between 68°F to 77°F (20°C to 25°C). Store lorazepam liquid concentrate in the refrigerator between 36°F to 46°F (2°C to 8°C).
  • Bottles should be tightly closed.
  • Store Ativan out of reach of children.
  • Store the lorazepam concentrate away from light and keep in its original container. Any unused lorazepam concentrate should be thrown out 90 days after opening.

Alcohol

Do not consume alcohol while taking Ativan. Using alcohol with Ativan can lead to excessive sleepiness or dizziness. Alcohol can also increase your risk of overdose, cause breathing problems (respiratory depression), or lead to coma or death.

Refills

Your doctor will write the number of authorized refills on your prescription. Ativan is a federal controlled substance because it can be abused. This may limit the number of refills that a doctor can authorize on a single prescription. Because of this, you will need to get a new prescription from your healthcare provider more often than for other medications. Talk with your pharmacist if you have questions about refills.

Travel

When planning to travel, keep these tips in mind for packing your medication:

  • Bring enough medication for the full number of days of your trip, plus at least two days to be safe.
  • Keep your medication with you, in a purse or a carry-on bag if flying. Do not put it into a checked bag in case you are separated from your luggage.
  • Liquid medications are allowed through security when flying. They are also exempt from the 3-1-1 liquid rule.
  • Keep your medications in their original containers, if possible, to reduce delays during airport or security screening. Keep all your medications together to expedite the process.
  • Avoid leaving your medication in a parked car for extended periods to protect it from extreme temperatures (hot or cold).

Availability

Many pharmacies stock this drug. When filling your prescription, you can call ahead to make sure your pharmacy carries it and has it in stock.

Prior Authorization

Many insurance companies do not require a prior authorization for this drug. Health plans may prefer certain drugs within this medication class over others. If a prior authorization is needed, your doctor will need to get approval from your insurance company before your insurance company will pay for your prescription.

Medications similar to Ativan

Ativan is considered a benzodiazepine medication. In addition to anxiety, certain benzodiazepines are also used for seizures, trouble sleeping, and muscle spasms. Other medications in this class include: Xanax (alprazolam), chlordiazepoxide (Librium), clobazam (Onfi), Klonopin (clonazepam), clorazepate (Tranxene), Valium (diazepam), flurazepam, oxazepam, quazepam (Doral), temazepam (Restoril), and triazolam (Halcion).

Discontinuing use of Ativan

Ativan should not be stopped suddenly. This can cause withdrawal symptoms due to physical dependence. Physical dependence is different from addiction. Withdrawal from Ativan can be life-threatening. Suddenly discontinuing Ativan can cause symptoms that may last for weeks to over 12 months. These symptoms include anxiety, depression, memory problems, difficulty concentrating, problems sleeping, a feeling of bugs crawling under your skin, weakness, shaking, burning or prickling feeling, and ringing in your ears. Talk with your healthcare provider before discontinuing Ativan. They will provide you with a plan to discontinue the dose gradually.

Healthgrades Disclaimer:

This information is for educational purposes only. It should not be interpreted as medical advice, diagnosis or treatment. Healthgrades takes every effort to ensure this information is accurate and up to date. This content is not intended to cover all possible uses, side effects, warnings, precautions, allergic reactions, or drug interactions. Do not assume that the absence of such information means the medication is safe for your personal use. Always consult your doctor, pharmacist, or healthcare professional before taking or discontinuing any medication.

Medical Reviewer: University of Illinois Chicago Drug Information Group
Last Review Date: 2021 Sep 14
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.