DESCRIPTION / DEFINITIONS: Ativan® (lorazepam) is a benzodiazepine prescribed for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms. According to its label, “Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic. The effectiveness of Ativan (lorazepam) in long-term use, that is, more than 4 months, has not been assessed by systematic clinical studies.”
ABUSE: According to its label, ” The use of benzodiazepines, including lorazepam, may lead to physical and psychological dependence. The risk of dependence increases with higher doses and longer term use and is further increased in patients with a history of alcoholism or drug abuse or in patients with significant personality disorders… In general, benzodiazepines should be prescribed for short periods only (e.g. 2- 4 weeks).”
ADDICTION / DEPENDENCE: Half life and metabolism.
SIDE EFFECTS: Confusion, suicide ideation/attempt, impotence (see list below).
WITHDRAWAL SYMPTOMS: Nausea, insomnia, electric shock like sensations (see list below).
TREATMENT: Medical detoxification.
Ativan® (lorazepam) is a benzodiazepine. It is prescribed for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms. The exact mechanism of Ativan is not known.
According to its label, “The use of benzodiazepines, including lorazepam, may lead to physical and psychological dependence. The risk of dependence increases with higher doses and longer term use and is further increased in patients with a history of alcoholism or drug abuse or in patients with significant personality disorders. In general, benzodiazepines should be prescribed for short periods only (e.g. 2- 4 weeks).”
HALF LIFE AND METABOLISM
The biological half life of a substance is the time it takes for a drug to lose half of its pharmacologic activity. This is significant because it affects how soon withdrawal symptoms may appear.
The half life of Ativan is between 12-18 hours.
Ativan is mainly metabolized through the P450 pathway in the liver and the enzyme primarily handling the metabolism is CYP3A4 but it is not clear how much of the metabolism is done by other enzymes.
The CYP enzymes are the major enzymes involved in drug metabolism, and since many drugs may increase or decrease the activity of various CYP isozymes, this is a major source of adverse drug interactions, since changes in CYP enzyme activity may affect the metabolism and clearance of various drugs. For example, if one drug inhibits the CYP-mediated metabolism of another drug, the second drug may accumulate within the body to toxic levels, possibly causing an overdose.
The following information is taken from the Ativan label:
- allergic skin reactions
- anaphylactic/oid reactions
- autonomic manifestations
- blurred vision
- change in appetite
- change in libido
- CNS effects
- decreased orgasm
- dermatological symptoms
- extrapyramidal symptoms
- eye-function/visual disturbance
- hypersensitivity reactions
- increase in alkaline phosphatase
- increase in bilirubin
- increase in liver transaminases
- memory impairment
- respiratory depression
- sexual arousal
- sleep disturbances/insomnia
- slurred speech
- small decreases in blood pressure
- suicidal ideation/attempt
- worsening of obstructive pulmonary disease
- worsening of sleep apnea
Ativan can be a very difficult drug to stop taking. Here are some of the Ativan withdrawal symptoms:
- digestive problems
- hypersensitivity to light, noise, and physical contact/perceptual changes
- loss of appetite
- muscle aches
- numbness/tingling of extremities
- panic attacks
- sleeplessness, nightmares
Withdrawal from Ativan should only be done under the care of a health practitioner. The safest way is to withdraw at an inpatient medical detox facility with a protocol that includes hydration, vitamins and supplements for biological balancing. Call us to talk to a Detox Advisor.