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Ativan Withdrawal Symptoms

Ativan withdrawal can cause symptoms like anxiety, tremors, and nausea, with severe risks including seizures and delirium. Acute and protracted stages of Ativan withdrawal require careful management for health and safety.

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If you are dependent on or addicted to Ativan (lorazepam) and suddenly quit taking it, you will experience Ativan withdrawal symptoms like anxiety, tremors, and nausea or vomiting.

Emergency Guidance

Lorazepam withdrawal can be potentially life-threatening. Some symptoms are so severe that they’re considered a medical emergency that requires treatment in an emergency room.

Those dangerous symptoms include the following:

  • Seizures
  • Hallucinations
  • Delirium

Symptoms like these can be treated in the hospital with medications like anticonvulsants and anti-seizure medications.[3] Doctors monitor their patients carefully in hospital settings, and they can provide additional treatment (like airway management) if symptoms get worse.

In general, everyone who has used Ativan for a long time should ask for help before trying to quit. If someone you love has tried to quit alone and you notice these symptoms, call 911 and ask for immediate help.

Acute vs. Protracted Ativan Withdrawal Symptoms

AcuteProtracted
Anxiety and panicAnxiety
Heart palpitationsDepression
Nausea and vomitingConcentration issues
SweatingApathy
Rapid pulseIrritability
Tremors and shakinessAtivan cravings
Rapid, purposeless movementsSleep disturbances
Hallucinations
Seizures

What Is Ativan Withdrawal?

Ativan (lorazepam) is a type of benzodiazepine, a powerful medication used to treat anxiety, sleep disorders, and seizures. Doctors use the medication to treat acute but short-term problems. 

The U.S. Food and Drug Administration (FDA) doesn’t recommend using the drug for longer than about 4 weeks because you can develop a physiological dependence. Dependence means that a person’s brain and body have become accustomed to the presence of Ativan and need it to function optimally.

You shouldn’t take lorazepam for longer than 4 weeks because of the risk of physiological dependence.

If someone who is dependent on lorazepam suddenly stops taking it, they’ll experience unpleasant and potentially life-threatening symptoms known as Ativan withdrawal syndrome. These symptoms may include tremors, sweating, heart palpitations, and more. [1],[2],[5]

People who use their medication as directed can become dependent on Ativan, which is a normal adaptation and doesn’t indicate an addiction. In this case, the withdrawal symptoms will likely be milder than if someone were abusing Ativan. Ativan misuse and abuse can speed up the development of dependence and lead to addiction, a compulsive pattern of use despite negative consequences.

Why Does Ativan Cause Dependency?

The neurotransmitter gamma-aminobutyric acid (GABA) helps nerve cells to communicate with other nerve cells. It’s a critical part of remaining awake and aware, but when levels are too low, people can feel anxious and upset. 

Conditions like depression are closely tied to low GABA levels. Ativan helps, as it boosts GABA levels.[8] That same function can make Ativan a target of drug abuse.

Researchers say benzodiazepines working on GABA receptors also trigger the release of dopamine, which stimulates the brain’s reward system.[9] As the brain becomes accustomed to drug-influenced dopamine highs, it produces less naturally. If someone quits drugs suddenly, the brain doesn’t produce enough dopamine naturally, so withdrawal symptoms begin.

Ativan’s work on GABA contributes to dependency too. As the drug use continues, the brain adjusts its GABA production accordingly. In time, the person only feels healthy and normal when drugs are present. Trying to quit them or reduce the dosage can cause extreme feelings of sickness.

Stages of Ativan Withdrawal

Ativan withdrawal is variable, and few time frames are exactly the same. Measuring withdrawal timeframes is difficult too, as most people taper their doses instead of quitting cold turkey. However, researchers have identified what a typical withdrawal process might look like in an average person.

A typical benzodiazepine withdrawal process looks like the following:

  • Acute: Symptoms begin within one to two days after the last dose and include anxiety, insomnia, restlessness, and agitation.[3]
  • Intermediate: Symptoms continue for two to four weeks and might involve the same symptoms as those in the acute stage.[3]
  • Protracted: Symptoms like anxiety appear and may last until another form of treatment begins.[10]

Acute Withdrawal Symptoms for Lorazepam

Acute withdrawal begins in the days following abrupt cessation of Ativan use. Those symptoms can include the following:[1-3]

  • Anxiety and panic attacks
  • Irritability and agitation
  • Cravings
  • Heart palpitations
  • Rapid pulse
  • Headaches
  • Dizziness
  • Nausea
  • Vomiting
  • Weight loss
  • Blurred vision
  • Irregular sleep patterns
  • Poor concentration
  • Confusion
  • Rapid, purposeless movements like pacing
  • Tremors
  • Sweating
  • Paranoia
  • Hallucinations and delirium
  • Grand mal seizures

Some people develop seizures when they stop taking Ativan suddenly. This problem is most common in people with pre-existing seizure disorders and those taking antidepressants and other seizure-causing drugs, although it can happen if you have a severe addiction.[2]

Protracted Withdrawal Symptoms

When the acute stage passes, your brain cells need more time to heal. You can develop a long-lasting withdrawal syndrome as your brain cells adjust to sobriety. Symptoms include the following:[4]

  • Anxiety
  • Insomnia
  • Poor concentration, problem-solving, and memory
  • Feelings of unreality or depersonalization 
  • Depression
  • Irritability
  • Apathy
  • Ativan cravings

Your Ativan withdrawal experience can vary based on the following factors:

  • Your age and health
  • How much Ativan you took 
  • How long you took Ativan
  • Whether or not you took other drugs

What Are the Most Dangerous Ativan Withdrawal Symptoms?

The most dangerous symptoms associated with Ativan withdrawal are seizures, which can be life-threatening without emergency care or preventative treatment.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), between 20% and 30% of people withdrawing from sedatives like Ativan may experience a grand mal seizure.[2] And grand mal seizures have been reported in people taking therapeutic doses of benzodiazepines for fewer than 15 days.[7]

Hallucinations and withdrawal delirium can also be hazardous because people may be at an increased risk of accidents. People who are hallucinating may also make impulsive or dangerous decisions because of delirium.

These risks are why seeking professional detox is so important. A team of nurses and doctors can keep you safe while you go through withdrawal.

What Is the Safest Way to Manage Lorazepam Withdrawal Symptoms?

The safest way to manage withdrawal from lorazepam is a medical detox setting, which can occur in environments, such as these:

  • Acute care unit
  • Psychiatric hospital
  • A freestanding detox program that offers medical care
  • Inpatient treatment center that offers medical detox

During medical detox, you receive 24/7 care, supervision, and monitoring to manage Ativan withdrawal symptoms, address complications or medical emergencies like seizures, and ensure your comfort.

Replacement Benzodiazepines for Withdrawal

During medical detox, the treatment team will likely administer a long-acting benzodiazepine that can relieve your symptoms and reduce the risk of seizures. These may include the following:[6]

  • Chlordiazepoxide (Librium)
  • Diazepam (Valium)
  • Oxazepam 

These long-acting benzos need to be administered less frequently than intermediate-acting ones and are cross-tolerant with Ativan since it is a benzo as well.

Professional Medical Care

Aside from administering benzodiazepines, the medical team will also provide the following:

  • Supportive care like IV fluids
  • Additional medications, if needed, such as anticonvulsants
  • Monitoring of your vital signs
  • Counseling
  • Case management and wraparound services

Once you complete acute withdrawal and are medically stable, the best course of action is to transition into a comprehensive addiction treatment program where you can receive therapy and individualized treatment planning to help you recover.

How to Find Care

It’s critical to get help to quit benzodiazepines like Ativan. Where to get that help can vary.

If you’ve been taking a high dose of Ativan for a long period, you might be safest in an inpatient clinic. Your team can watch your progress around the clock and step in if something goes wrong. If you’ve been taking other drugs with Ativan, inpatient care might be best.[11]

However, if you’ve been taking a low dose of Ativan for a short period, and you have plenty of help and support, you could complete a taper at home.

Talk with your doctor about your Ativan use. Ask what setting is best for your treatment program and recovery. If inpatient care is best, your program might take place in a hospital or acute care clinic. You might also enter a detox clinic attached to a rehab center. Your doctor can help you find the setting that’s right for you.

Frequently Asked Questions About Ativan Withdrawal Symptoms

Can I Quit Ativan Cold Turkey?

No. You should not quit Ativan cold turkey, as the risk of seizures is too great.

What Does Ativan Withdrawal Feel Like?

Ativan withdrawal symptoms can range from mildly uncomfortable to severe and life-threatening. Some mild symptoms may include anxiety and nausea while more serious symptoms include seizures, tremors, and hallucinations.

Can You Die from Ativan Withdrawal?

Yes, it’s possible to die from Ativan withdrawal, due to the risk of grand mal seizures. The people most at risk have a severe Ativan addiction, a history of seizures, and a history of withdrawal delirium. However, withdrawal seizures have been reported in people taking benzodiazepines for two weeks at therapeutic doses.[7]

Updated January 22, 2024
Resources
  1. Ativan (Lorazepam) Tablets. U.S. Food and Drug Administration. (September 2016)
  2. Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. (2013).
  3. Management of Benzodiazepine Misuse and Dependence. (October 2015). Australian Prescriber.
  4. Post-Acute Withdrawal Syndrome (PAWS). SEMEL Institute for Neuroscience and Human Behavior. (n.d.).
  5. Challenges of the Pharmacological Management of Benzodiazepine Withdrawal, Dependence, and Discontinuation. (May 2019). Therapeutic Advances in Psychopharmacology.
  6. Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. Journal of Clinical & Diagnostic Research. (September 2015.)
  7. Benzodiazepine withdrawal seizures and management. The Journal of the Oklahoma State Medical Association, 104(2), 62–65. Hu X. (2011).
  8. GABA Receptor. (February 2023). StatPearls.
  9. Hooked on Benzodiazepines: GABA Receptor Subtypes and Addiction. (May 2014). Trends in Neuroscience.
  10. The Benzodiazepine Withdrawal Syndrome. (November 1994). Addiction.
  11. Benzodiazepine Withdrawal Management. Government of South Australia.
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