Ativan (Lorazepam) Addiction and Abuse | Recovery Option
Ativan (lorazepam) such medication is a member of the benzodiazepine family. It is primarily meant to cure anxiety, sleep problems, severe agitation, and seizures. It is also effective for treating alcohol withdrawal suffering, nausea from chemotherapy, and relaxation before surgery. Most emergency doctors and staff treat patients on ventilators or in emergency cases related to cocaine use with Ativan. Ativan is available as a pill, topical skin patch or gel, or injection into one vein or muscle. When injected, it acts for a few minutes and can last up to a day.
This drug was initially patented in 1963 and became available in the United States in 1977. According to the World Health Organization, it is considered an essential medicine, and it is market available as a generic. It is one of the most frequently prescribed drugs in the United States in 2022, with over 8 million prescriptions written.
Medical Uses of Ativan (Lorazepam)
Anxiety
Ativan is a good drug for short-term alleviation of serious anxiousness. In the guidelines of the United States for the purposes of use by medical professionals, Ativan and other benzodiazepines are not to be prescribed for more than four weeks. It acts quickly, and so it is quite effective for sudden bouts of severe anxiety or panic attacks.
Ativan is both sedating and tranquilizing due to its short duration of action. Thus, it has potential use in short-term treatment of insomnia, particularly when associated with anxiety or nightmares. However, an abrupt stopping of Ativan after one week of use may produce withdrawal symptoms including anxiety and sleeplessness.
Epileptic Seizures
First-line drugs for the management of seizure control include Ativan especially in cases of status epilepticus (a category of seizures that are serious and continue without stopping). The results obtained are more effective than with diazepam and have a lower threshold for the need for other drugs. However, phenobarbital may be a much stronger candidate in older people.
Ativan is one of the preventive drugs from seizure attacks, though with time the body gets less responsive to it. Since swallowing is usually difficult during a seizure, giving Ativan orally may not always be the best option.
This drug is particularly useful in the treatment of alcohol withdrawal symptoms, since it can control seizures and quiets the nervous system down. It is especially safe for people with liver problems because it does not need to be broken down with the use of the liver.
Sedation and Preparation for Surgery
Ativan is sometimes used for patients on ventilators to cause sedation and comfort. Propofol is frequently the mainstay as it is more effective and is cost efficient.
It is a drug that is frequently administered before surgery or any medical procedure such as a dental procedure or endoscopy to allay anxiety and cause relaxation in patients. It also makes it more difficult for the patient to remember the entire procedure, which is sometimes a helpful effect. The oral form of the drug is given from 90 to 120 minutes prior to the procedure, while the injectable form can often be given as close to 10 minutes before the procedure
Agitation or Restive Activity
Sometimes Ativan is used to rapidly calm highly agitated or aggressive individuals, although another combination of drugs (haloperidol and promethazine) is preferred because it works better with fewer correlated effects on breathing.
For acute confusion (delirium), Ativan may be combined with haloperidol, although in some people, it may have an opposite effect and increase agitation.
Other Usage
- Catatonia (a state when the person cannot move or speak) – Ativan will help but symptoms may recur needing treatment for a few days.
- Appendage to anti-nausea medications – At times, Ativan is availed together with other anti-puking agents in treating nausea and vomiting associated with chemotherapeutic procedures.
In summary, Ativan is a quite broad medication: it covers anxiety, seizures, sedation, among other indications but should be used cautiously because it has the possibility of dependence and side effects.
Side Effects of Lorazepam
Despite the many valuable effects of lorazepam like relieving anxiety, relaxing muscles, and promoting sleep, it is attended by the adverse effects.
Most common effects:
- Drowsiness or sleep
- Dizziness
- Weakness or Faintness
- Unsteadiness
- Hypotension
These effects are enhanced when lorazepam is taken with other drugs such as alcohol or pain-killers that potentially depress the nervous system.
Memory and Thinking Problems:
- Using this drug makes it hard to have new memories.
- Long-term use may give rise to thinking problems which may last for months.
- Older people are more sensitive to the effects and may fall higher than the normal population.
Mood Changes and Paradoxical Effects:
Some people find themself being the other person than expected, being more aggressive, angry, or restless. This is more common in old adults and children, or people who abused alcohol in the past, or people having mental health problems. Most of these symptoms are cleared when the dose is lowered or the drug is withdrawn.
Risk of the Disease called Depression and Suicide:
- Lorazepam and its kin may worsen depression.
- Higher doses may bring suicidal thoughts.
Sleep and Amnesia Problems:
- In general, lorazepam has a very robust memory-inhibiting effect.
- Those taking high doses (e.g., 4 mg at night) have reported that they, in fact, do forget some parts of the next day.
- With time one may develop a bit of tolerance to the effect.
Serious Risks:
- Respiratory depression occurs, especially at high doses or in combination with other sedatives.
- A rare but serious complication from high-dose continuous intravenous lorazepam is propylene glycol toxicity.
FDA Warning:
There is a very strong warning attached by the FDA to benzodiazepines like lorazepam about abuse, addiction, dependence, and withdrawal as at the year 2020.
There is no doubt that lessening the side effects can be achieved if the minimum effective dose is taken for as little time as possible.
Who should avoid lorazepam?
There are some conditions where lorazepam would not be prescribed to an individual. Such a case would be the following:
- Allergy or Sensitivity
Should there be an allergy to lorazepam, for instance, to other benzodiazepines or to any of their components, then one should not take lorazepam.
- Breathing Problems
Given lorazepam’s capability to slow down breathing mechanisms, persons suffering from serious problems of breathing, such as respiratory failure, should therefore never take it; that is also a contraindication to its use in relieving anxiety in an asthmatic patient going through an acute attack. However, lorazepam might have its applications as deep sedation for the person on a ventilator.
- Alcohol or Drug Intoxication
Do not administer lorazepam if the patient is intoxicated or under the influence of drugs, as it may greatly intensify the effects.
- Movement and Balance Problems (Ataxia)
Ataxia refers to the problem of balance and coordination in muscle movements. As lorazepam could aggravate these conditions, it should be withheld in such individuals.
- Eye Condition (Eyes are Acutely Narrow-Angle Glaucoma)-Narrow
The drug would relax pupillary muscles and thereby facilitate worsened upsurging pressure in the eye in cases of this type of glaucoma.
- Sleep Apnea
This indicates a dangerous enhancement in the slowing of breathing that occurs in these patients due to the presence of lorazepam.
- Muscle Weakness Disorder (Myasthenia Gravis)
Myasthenia gravis symptoms can be aggravated by lorazepam since it provides muscle relaxation.
- Pregnancy and Breastfeeding
The use of lorazepam in pregnancy poses a hazard to the child, especially if taken in the first trimester. Floppy infant syndrome is one possible consequence, in which the new-born experiences muscle weakness and difficulty breathing. Withdrawal symptoms in the infant could occur if lorazepam is taken on a daily basis during the last trimester, including weak muscle tone, poor feeding, breathing difficulties, and regulation of body temperature. This medication could also result in jaundice in a new-born if it affects liver function. Due to the secretion of lorazepam in breast milk, nursing mothers should avoid it unless absolutely necessary.
Interactions with Ativan
Substance/Drug | Effect When Taken with Lorazepam |
|---|---|
Alcohol | Heightens the risk of respiratory depression, amnesia, and loss of control, which may lead to embarrassing or criminal actions. |
Opioids | Increases sedative effects, leading to drowsiness, breathing impairment, and possible overdose. |
Other Hypnotics (sleep medications) | Causes increased sedation, potentially leading to excessive sleep. |
Rifabutin | May alter the effects of lorazepam. |
Valproate | Slows lorazepam metabolism, enhancing its effects and prolonging its duration. |
Carbamazepine, Lamotrigine, Phenobarbital, Phenytoin, Rifampin | Increase lorazepam metabolism, reducing its effects. |
Certain Antidepressants | May increase drowsiness and other side effects. |
Sedating Antihistamines | Have additive sedative effects, leading to increased drowsiness. |
Opiates | Increases the risk of severe drowsiness and respiratory depression. |
Antipsychotic Medicines | May enhance sedation and increase side effects. |
Overdose
- A lorazepam overdose can occur when large doses of this drug-and especially in combination with alcohol or other drugs-are administered. Symptoms include confusion, slurred speech, extreme sleepiness, muscle weakness, low blood pressure, walking problems, coma, and very rarely, death.
In the Events of an Overdose:
- Check for Other Agents: Whether other agents were used can affect the type of medical care the person receives.
Symptoms: Extreme drowsiness, difficulty breathing, loss of coordination, and confusion must all be assessed.
Treatment:
- For awakened patients, vomiting should be induced, stomach pumping may be performed, or activated charcoal could be administered.
- Supportive care should include the monitoring of vital signs and comfort measures for the person.
- In severe intoxication, flumazenil may be administered to reverse the effects, but it should be done with extreme caution.
Environment: Allow the person to stay still and calm, as high doses may induce aggressive behavior or confusion.
History of Lorazepam
Lorazepam is classed among “classical” benzodiazepines: alongside diazepam, clonazepam, oxazepam, and et cetera. The drug was first marketed in 1977 through Wyeth Pharmaceuticals under the brand names Ativan and Temesta. It was developed by D.J. Richards, who headed research at Wyeth.
