What Are the Side Effects of Ativan (Lorazepam)?

Ativan (lorazepam) is a benzodiazepine, which is a class of medications also known as central nervous system depressants. Other benzodiazepines include Librium (chlordiazepoxide), Klonopin (clonazepam), Valium (diazepam), and Xanax (alprazolam).

Ativan is used to treat anxiety, insomnia (during a short term period), and seizure.

In the United States, benzodiazepines are considered “controlled substances” that are federally regulated because of their potential for misuse. If you are taking Ativan, it's important to be aware of the potential side effects in case you begin to experience any. If you do, be sure to consult your doctor right away.

Common Side Effects of Ativan

It is important to use Ativan under the guidance of a healthcare provider, and to avoid driving or operating heavy machinery until you know how you are affected by the medication.

Severe Side Effects

In severe cases, Ativan can cause profound sedation, respiratory depression, coma, and, most severely, death because it dampens the signal from your brain that tells your body to breathe. These severe side effects can occur when:

• Ativan is taken in high doses
• Ativan is taken with other substances that also depress the central nervous system, such as other benzodiazepines, alcohol, opioid pain medication, barbiturates, and more
• Ativan is taken when you have other illnesses that affect your breathing, such as chronic obstructive pulmonary disease (COPD), sleep apnea, and more

Children and the Elderly

In some populations, such as the children and the elderly, Ativan can cause a “paradoxical effect.” Instead of having a calming effect, it may cause agitation and confusion. Elderly patients taking Ativan are also at a higher risk of falls.

Pregnancy, Breastfeeding, and Infants

Ativan can affect people who are pregnant and breastfeeding and their babies. Ativan can, in fact, cross the placenta and move into the breastmilk. In these cases, it is important to speak with your healthcare provider to weigh the risks and benefits of using this medication.

Physical Dependence and Tolerance

Long-term use of benzodiazepines such as Ativan can lead to physical dependence. This means that your body develops a tolerance for the medication. Over time, you might need higher doses of the medication to have the same effect.

In other words, if you use the same dose of medication over a long period of time, there is a decreased effect of that dose when compared to your previous, smaller dose.

People who use benzodiazepines for a long time might have a physical dependence, but it does not necessarily mean they are addicted to or abusing these medications.

Ativan Withdrawal 

Some people who suddenly stop taking Ativan can experience withdrawal symptoms.

This is why it is so important to talk to a healthcare provider before stopping a benzodiazepine. A healthcare provider can help you slowly taper, or reduce, the Ativan dose over time in order to prevent withdrawal.

Drug Abuse and Addiction

Benzodiazepines like Ativan have the potential for abuse and addiction. If you have a personal history of addiction or a family history of addiction, you should be especially careful when using these medications and be closely monitored by your healthcare provider.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), a substance use disorder is defined as a "problematic pattern of substance use leading to clinically significant impairment or distress," including two or more of the following criteria over a 12-month period:

1. The substance is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
4. Craving, or a strong desire or urge to use the substance.
5. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
7. Important social, occupational, or recreational activities are given up or reduced because of substance use.
8. Recurrent substance use in situations in which it is physically hazardous.
9. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. Tolerance, as defined by either a need for markedly increased amounts of the substance to achieve intoxication or desired effect, or markedly diminished effect with continued use of the same amount of the substance.
11. Withdrawal, as manifested by either characteristic withdrawal symptoms for the substance, or the substance is taken to relieve or avoid withdrawal symptoms.