Lorazepam

Common Brand Names: Ativan, Lorazepam Intensol, Temesta, Tavor

Lorazepam is an anxiolytic and sedative medication that works by binding to benzodiazepine receptors on post-synaptic GABA-A ligand-gated chloride ion channels within the central nervous system. Because of its low potential for abuse, it is listed as a Schedule IV drug under the federal drug scheduling system.

Due to the calming effect Lorazepam can produce, some patients misuse the drug in order to prolong or amplify this effect. In some cases, it can lead to lorazepam use disorder, particularly among individuals with a history of substance use disorder.

What Is Lorazepam Prescribed For?

Lorazepam is FDA-approved as a sedative or amnesic drug, and is typically prescribed for the treatment of the following conditions:

• Anxiety disorder
• Anxiety-associated insomnia
• Relief of pre-operative anxiety
• Status epilepticus

Off-label uses of lorazepam include:

• Chronic insomnia
• Panic disorder
• Delirium (including alcohol withdrawal delirium)
• Control of agitation
• Alcohol withdrawal syndrome
• Chemotherapy-induced nausea and vomiting
• Psychogenic catatonia

Contraindications to lorazepam use include documented hypersensitivity to the drug or any of its components, severe respiratory illness, and acute narrow-angle glaucoma. Patients in the first and third trimester of pregnancy must also not take lorazepam as first-line agents for anxiety.

How Lorazepam Is Abused

Though lorazepam does not have a high potential for abuse compared to other benzodiazepines, it is still possible to misuse it. Some common ways in which lorazepam is abused include:

• Taking larger or more frequent doses than prescribed
• Taking the medication for a longer period than prescribed
• Taking it in combination with other substances, such as alcohol or opioids
• Crushing the tablet form of the medication and snorting it
• Injecting the concentrate directly into the veins
• Taking the medication using any other methods that are not recommended by physicians

Lorazepam Drug Interactions

Patients may experience adverse effects if taking lorazepam with other substances, such as:

• Probenecid: When combined with lorazepam, probenecid may decrease total clearance and increase the half-life of lorazepam. This can lead to a more prolonged effect or rapid onset of lorazepam’s effects.
• Valproate: Taking this with lorazepam may lead to reduced clearance of lorazepam and an increase in plasma concentrations.
• Opioid medications or other benzodiazepines: The use of lorazepam in combination with other benzodiazepines or opioids is potentially fatal as it can result in severe respiratory depression.
• Central nervous system (CNS) depressants: When taken with these, lorazepam can amplify CNS depressant effects. Examples of such depressants include:
  • Arbituates
  • Antidepressants
  • Anesthetics
  • Anticonvulsants
  • Alcohol
  • Antipsychotics
  • Hypnotics or sedatives
  • Narcotic analgesics
  • Sedative antihistamines
  • Anticonvulsants

Side Effects of Lorazepam Use

Some of the common adverse effects of lorazepam are:

• Dizziness
• Double vision
• Urinary retention or incontinence
• Fatigue
• Confusion
• Amnesia
• Irritability
• Menstrual irregularities
• Inflammation at the injection site
• Respiratory depression
• Decreased blood pressure

There are also several paradoxical reactions linked to lorazepam use (i.e. any effect of a drug or substance that is opposite of what might be expected). Some of these are:

• Anxiety
• Excitation
• Agitation
• Hostility
• Aggression or rage
• Sleep disturbances (including insomnia)
• Sexual arousal
• Hallucinations

Some people may experience more serious side effects when taking lorazepam. Should you notice any of the side effects listed below, contact your doctor or 911 immediately:

• restlessness or an inability to sit still
• an uneven heartbeat
• tremors or involuntary and persistent shaking
• shuffling gait
• fever
• rashes on or yellowing of the skin
• yellowing of the whites of the eyes

Benzodiazepines may also exacerbate pre-existing depression and are associated with increased suicidal ideation. Patients clinically diagnosed with primary depressive disorder or psychosis are advised against taking lorazepam without concomitant adequate antidepressant therapy.

Long-Term Effects of Lorazepam

Presently, lorazepam is only indicated for short-term use (e.g. 2 to 4 weeks). The effectiveness of lorazepam in long-term use (i.e. longer than 4 months) has not been adequately studied and is thus not recommended.

It is important to note that long-term use of benzodiazepines like lorazepam may cause a patient to become over-reliant on the drug. They may also experience a loss of self-confidence and potentially develop drug-seeking behaviors.

Signs of Lorazepam Overdose

As with any other medication, it is possible to overdose on lorazepam. Do not hesitate to contact 911 or local emergency services should you notice any of the following symptoms in yourself or someone else:

• Mental confusion
• Lethargy
• Drowsiness
• Slurred speech or difficulty talking
• Paradoxical reactions, such as:
  • Excitation
  • Agitation
  • Hostility
  • Rage
  • Aggression
  • Anxiety
  • Insomnia or Sleep Disturbances
  • Hallucinations
  • Sexual Arousal

Some signs of more serious cases of lorazepam overdose, especially when taken with other substances, include the following:

• Being in a hypnotic or trance-like mental state
• Low blood pressure
• A decrease in muscle tone
• Cardiovascular depression
• Respiratory depression
• Difficulty speaking, swallowing, walking, or maintaining balance
• Coma

Symptoms of Lorazepam Addiction

Though lorazepam is considered to be less addictive than certain other drugs, long-term use of lorazepam can cause a person to develop an addiction to the substance.  Additionally, patients with a history of substance or alcohol abuse or those with significant personality disorders are at an increased risk for benzodiazepine use disorder.

The Fifth Edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) has listed specific criteria for the diagnosis of substance use disorder. These behavioral patterns also apply to chronic abuse or misuse of lorazepam. Some signs of lorazepam addiction include the following:

• Taking lorazepam in greater amounts or for longer than prescribed
• Being unsuccessful in reducing or stopping the use of lorazepam
• Spending a significant amount of time to get, use, or recover from using lorazepam
• Feeling cravings or intense urges to use lorazepam
• Becoming unable to fulfill school, work, or family obligations
• Continuing to use lorazepam despite having it cause interpersonal or relationship problems
• Letting go of important social, occupational, or recreational activities because of lorazepam use
• Continuing to use lorazepam even if it means being in danger
• Continuing to use lorazepam despite exacerbation of physical and psychological problems
• Increasing the amount of lorazepam taken to achieve the desired effect (tolerance)
• Development of withdrawal symptoms

Lorazepam Withdrawal Symptoms

Abrupt cessation of lorazepam use may cause withdrawal symptoms such as:

• Headache
• Tension
• Depression
• Anxiety
• Restlessness or irritability
• Tremors
• Seizures
• Confusion
• Insomnia
• Increased sweating, heart rate, and temperature
• Dizziness
• Numbness of extremities
• Nausea and vomiting
• Diarrhea
• Involuntary movements
• Panic attacks

Experiencing the above-mentioned withdrawal symptoms after stopping the use of lorazepam may indicate that you have developed a dependence on the substance. However, this does not necessarily mean that you have become addicted to the drug. Rather, your body just needs time to adjust to the absence of lorazepam. This can be done by following a tapering schedule as prescribed by a medical professional.

Lorazepam Detox

Should a patient wish to wean themselves off of lorazepam, they should not suddenly stop taking the drug, as this could cause mild, moderate, or severe withdrawal symptoms. Instead, they must go through an appropriate detoxification program to gradually eliminate the substance from the body. Here’s some of what you can expect when going through a lorazepam detoxification regimen:

• You will be provided with a tapering schedule to help you safely and comfortably wean yourself off of the drug.
• A team of professionals will provide you with assistance for the duration of your stay at the detox facility.
• If found to be clinically appropriate, your team may recommend that you switch to a benzodiazepine with a longer half-life to help reduce withdrawal symptoms.

Treatment for Lorazepam Use Disorder

The abuse potential of lorazepam can be attributed to its mood-altering properties, rapid onset of action, high potency, and brief duration of action. This can result in dependence, tolerance, or addiction to the drug. Those struggling with lorazepam use disorder may benefit from professional addiction treatment programs. Depending on the individual’s preferences or specific needs, they can undergo a lorazepam treatment program on an outpatient or inpatient basis.

• Outpatient lorazepam addiction treatment: This type of treatment program is recommended for lower-risk individuals with a milder form of substance use disorder. This is because outpatient treatment only requires a person to regularly attend therapy and counseling sessions at a treatment center while allowing the patient to stay at home and continue their regular day-to-day activities.
• Inpatient lorazepam addiction treatment: Patients who are considered to be high-risk due to exhibiting moderate to severe symptoms of substance use disorder may require 24/7 supervision at an inpatient rehab facility. Individuals will receive only the best quality of care from a team of medical professionals, and patients may undergo various treatment modalities with the goal of helping them recover from their lorazepam addiction.

Psychosocial and behavioral interventions may be instituted to help the patient achieve complete abstinence. Various forms of psychotherapy can help individuals struggling with lorazepam use disorder. Such psychotherapy methods include:

• Cognitive-behavioral therapy (CBT). In CBT, patients are professionally guided to explore and recognize their maladaptive behaviors that predispose them to substance abuse. The aim of CBT is to correct these behavioral patterns to decrease the risk of relapse episodes and help the patient achieve a drug-free state.
• Counselling. Much like CBT, counseling aims to help the patient achieve lifetime abstinence from drugs by teaching them healthy ways to cope with relapse triggers. Counselors also help patients identify possible difficulties in their treatment journey and come up with acceptable resolutions.
• Motivational Interviewing. Motivational interviewing is a client-centered approach that focuses on resolving the patient’s ambivalent feelings that would lead to a positive behavioral change.

Get the Help You Need

Overcoming lorazepam addiction can be difficult, but with the right help, it’s not impossible. If you’re looking for treatment or trying to help a loved one get the help they need, the good news is that many insurance plans cover addiction treatment services. Additionally, there are many ways to get financial assistance, which means you can still get treatment even if you may not have insurance.

For more information, give us a call at (800) 429-7690. One of our recovery support advisors will be there to guide you on finding the best treatment program for your needs. They can also confirm whether your insurance plan covers addiction treatment programs and help you find alternative ways to finance it.

A Brief History of Lorazepam

Lorazepam was developed by DJ Richards. It was patented in 1963 and was first marketed by Wyeth Pharmaceuticals in the United States in 1977. Lorazepam received its first FDA approval in 1985 by the Mutual Pharm company.

In 2018, lorazepam ranked 58th in the list of most commonly prescribed medications in the United States, with over 13 million documented prescriptions.