Ativan Withdrawal Dangers

Ativan is the trade name for lorazepam, a benzodiazepine medication prescribed to treat anxiety disorders and certain types of seizures. It is also indicated for use as a pre-surgical sedative and to manage stress- or anxiety-related sleep problems (insomnia).1

How Does Someone Become Addicted to Ativan?

Like other benzodiazepines, Ativan interacts with GABA receptors to increase the activity of that inhibitory neurotransmitter. At prescription doses (and when used in the short-term), Ativan’s sedative properties can help a person manage their anxiety as well as reduce seizure activity. However, increased GABA activity is also linked with the disinhibition of certain dopamine-releasing brain cells that, in a cascade of neurochemical events, increases the reinforcing or rewarding properties of using such a drug.2 It is this accompanying increase in dopamine that contributes to the abuse liability of benzodiazepines like Ativan.

So, despite its legitimate therapeutic uses (and as a Schedule IV controlled substance), Ativan has known abuse and dependence liability.3,4 This is one reason why many benzodiazepines like Ativan are indicated for relatively short-term use. People should be careful to adhere to prescription guidelines, as use that exceeds recommended doses may increase the likelihood of addiction development.

Unfortunately, nonmedical misuse of Ativan is quite prevalent.People who use benzodiazepines for extended periods of time, as well as those who intentionally misuse them for nonmedical use, may develop physiological dependence and be at risk of experiencing significant and, in some cases, potentially life-threatening withdrawal effects when attempting to quit or cut back on use.1

What Is Ativan Withdrawal?

Physiological substance dependence develops as a person undergoes what’s known as “neuroadaptation” to the consistent presence of a substance—in this case, Ativan. Once the body acclimates to the sedative influence of Ativan, quitting or slowing use is likely to lead to a syndrome of abstinence, or acute withdrawal.5

Though some symptoms of withdrawal may appear even with therapeutic use, significantly troublesome withdrawal syndromes are most likely to develop after the discontinuation of a dose-appropriate therapeutic regimen that has persisted for months to years (~4-6 months, for example), or after a shorter time at higher dose misuse.5,6

Symptoms of acute Ativan withdrawal may include:1,5,7

  • Headache.
  • Insomnia.
  • Depression.
  • Anxiety.
  • Agitation.
  • Irritability.
  • Restlessness.
  • Increased heart rate.
  • Changes in blood pressure.
  • Increased body temperature.
  • Sweating.
  • Abdominal cramps, nausea, vomiting.
  • Muscle aches and/or tension.
  • Involuntary movements.
  • Tremor.
  • Seizure activity (may be more common in those with pre-existing seizure disorders or have otherwise lowered seizure thresholds—such as in association with other medications or concurrent substance use).

The Time Course for Ativan Withdrawal

It is generally accepted that benzodiazepine discontinuation or tapering should take place over a period of several weeks to best prevent seizures and avoid some of the more unpleasant or troublesome withdrawal symptoms.6 A small proportion of patients who have engaged in long-term benzodiazepine use may be at risk of experiencing a relatively prolonged or protracted withdrawal syndrome. This syndrome—which may persist for several weeks to months beyond the more typical acute withdrawal period associated with acute discontinuation of the drug—may include a somewhat unpredictable pattern of symptoms such as anxiety, insomnia, sensory hypersensitivity, and perceptual disturbances which can complicate the course of early recovery and increase relapse risks for some individuals.5

 

Medical Detox and Withdrawal Management

Because of the risks, abruptly quitting Ativan should be avoided after an extended period of use; instead, a gradual tapering of the medication may be needed to keep a person as safe and comfortable as possible.7,8 Benzodiazepine withdrawal management frequently necessitates some form of medical supervision, even if the person has been taking this medication as prescribed.

Medical detoxification protocols can help mitigate some of the withdrawal risks. Relatively intensive detox settings—either in a hospital or those that might be available in an inpatient or residential treatment center—can help facilitate medical interventions, when needed, to decrease certain complication risks and minimize the discomfort of withdrawal.8,9

In some cases, Ativan will first be substituted for a longer-acting benzodiazepine—such as Librium or Valium—prior to starting the tapered schedule.6,9

The Need for Additional Treatment

Successful benzodiazepine withdrawal management takes considerable effort—and can be relatively time-intensive, as the tapering schedules may be carried out for several weeks. Though this detox period is a necessary and important start to recovery, it is not a substitute for more comprehensive substance abuse treatment efforts. Once withdrawal management is well underway, those recovering from compulsive benzodiazepine use may benefit from ongoing rehabilitation

Counseling and therapy—whether inpatient or outpatient—can help people navigate the dicey withdrawal period;9 however, they are also a fundamental part of any formal rehabilitation program. Inpatient, residential, and outpatient rehab programs may all utilize a combination of behavioral therapies (e.g., cognitive-behavioral therapy) to help people better understand the root causes of their addiction or substance abuse issues and to develop better coping mechanisms for stress or triggers in the person’s environment.6,8,9 People who began taking Ativan as part of a prescribed course of treatment (for anxiety or sleep issues, for example) may also benefit from behavioral and other non-pharmacologic techniques for anxiety management as part of their recovery plan.9

References

  1. National Alliance on Mental Illness. (2019). Lorazepam (Ativan).
  2. National Institute on Drug Abuse—NIDA Notes Archives. (2012). Well-Known Mechanism Underlies Benzodiazepines’ Addictive Properties.
  3. United States Drug Enforcement Administration—Diversion Control Division. (2019). Controlled Substances Schedules.
  4. United States Drug Enforcement Administration—Diversion Control Division. (2019). Benzodiazepines.
  5. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  6. Soyka, M. (2017). Treatment of Benzodiazepine Dependence. N Engl J Med 2017; 376:1147-1157.
  7. United States Department of Health and Human Services—Food & Drug Administration. (2016). Labeling-Medication Guide—Ativan.
  8. National Institute on Drug Abuse. (2018). Misuse of Prescription Drugs—How can prescription drug addiction be treated.
  9. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
About The Contributor
Scot Thomas, M.D.
Senior Medical Editor, American Addiction Centers
Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating... Read More
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