Fact Checked

Ativan: What is it? Uses, Costs, Benefits, Doses

More than 40 million adults in the United States are diagnosed with an anxiety disorder, making it the most common mental illness in the country. Nearly 20 percent of the population struggles with anxiety! While anxiety disorders can be easily treated, less than 40 percent of those struggling receive treatment. Ativan is a powerful drug used to treat anxiety, among other conditions, on a short term basis. While slightly less well known than its cousin, Xanax, Ativan has been popularized through pop culture in the form of numerous references in songs from mega stars like Fall Out Boy and Post Malone. More than 12 million prescriptions were written for the drug in 2017.

What is Ativan?

Ativan is a tranquilizing medication, also referred to as a sedative-hypnotic or anxiolytic medication. Ativan belongs to a family of drugs called benzodiazepines, which also includes medications like Xanax, Klonopin, and Valium. The generic form of Ativan is called lorazepam, which is found in breast milk, and the drug comes in the form of both tablets and intravenous injections; the form in which a patient receives Ativan depends on the condition being treated. 

What is Ativan used to treat?

Ativan is FDA-approved for the treatment of three different conditions: anxiety, insomnia, and seizures. 

Anxiety

Ativan is most commonly prescribed to manage anxiety. The drug is FDA-approved for short term anxiety treatment, with typical prescription drugs written for periods of two to four weeks. Ativan is not used for long term treatment of anxiety due to its habit-forming and addictive nature, so it is more appropriate for use as an “emergency” or “rescue” medication during a particularly stressful or anxious time, such as following the death of a loved one. Ativan can also be used to treat panic attacks on an acute basis. Long term use of the drug can increase your risk of certain side effects, especially physical and psychological dependence, and can lead to withdrawal symptoms when the medication is stopped.

Insomnia

Ativan can also be used to treat insomnia for short periods of time. Insomnia, or trouble sleeping, can be caused by a variety of factors, but when caused by extreme anxiety or stress, Ativan may be an appropriate treatment option. Due to its tendency to be habit forming and addictive, Ativan should only be used to treat for short periods of time, such as two to four weeks. Long term use of the drug can increase your risk of certain side effects, especially physical and psychological dependence, and can lead to withdrawal symptoms when the medication is stopped.

Seizures

In its IV form, Ativan is used to treat a severe type of seizure called status epilepticus. Status epilepticus can take two different forms: the first is a single seizure that lasts longer than five minutes, while the second is two or more seizures within a five-minute period without the person recovering in between.

What is anxiety and what causes it?

Before we talk about how Ativan works to treat anxiety, let’s learn about the condition that Ativan is most commonly used to treat: anxiety. Anxiety is the body’s natural response to stress and is defined by fear or apprehension about what is to come. Everyone will experience anxiety at some point in their lives, but anxiety becomes a health problem and is described as an anxiety disorder when the feelings are extreme, last longer than six months, and interfere with your life. There are eight main types of anxiety disorders, including:

  • Generalized anxiety disorder
  • Panic disorderPhobia
  • Social anxiety disorder
  • Obsessive-compulsive disorder
  • Separation anxiety disorder
  • Illness anxiety disorder
  • Post-traumatic stress disorder.

Symptoms of generalized anxiety can include an increased heart rate, rapid breathing, restlessness, trouble concentrating, and difficulty falling asleep. A more acute form of anxiety, called an anxiety attack, has symptoms that include feeling faint or dizzy, shortness of breath, dry mouth, sweating, chills or hot flashes, apprehension and worry, restlessness, distress, fear, numbness or tingling.

How does Ativan treat anxiety?

Ativan works on neurotransmitters in the brain called gamma-aminobutyric acid (GABA), which are partially responsible for the regulation of sleep and feelings of both relaxation and anxiety. When a patient takes Ativan, the medication acts on the GABA receptors to slow down the central nervous system, which decreases agitation, excitement, and excess activity in the brain, producing a calming effect.  Ativan takes effect immediately, which is what makes it so effective in treating acute symptoms of anxiety and panic symptoms. The medication reaches its full effect in approximately an hour to an hour and a half and generally lasts around six to eight hours. Therefore, the medication may need to be taken several times per day.

How much does Ativan cost?

As is the case with any prescription medication, the brand name medication for Ativan costs considerably more than the generic form of lorazepam. Patients can save considerably by choosing the generic form of the drug.

Approximate Costs of Ativan and Lorazepam (in Dollars)

 

Ativan

Lorazepam

 

Per Pill

30 Day Supply

Per Pill

30 Day Supply

0.5 mg oral tablet

$27.94

$838.20

$0.56

$16.81

1 mg oral tablet

$37.29

$1,118.70

$0.65

$19.40

2 mg oral tablet

$59.37

$1,781.10

$0.58

$17.26

What are the benefits of using Ativan?

Although there are some serious drawbacks to using Ativan, the medication also has many benefits. Ativan is capable of producing anti-anxiety effects very quickly and can provide noticeable results within the first week of treatment. Slower-acting anti-anxiety medications, such as Zoloft, may take several weeks for patients to experience relief. For acute anxiety symptoms or particularly severe symptoms requiring rapid relief, Ativan is an excellent choice. Ativan is sometimes prescribed in conjunction with a slower-acting antidepressant or anti-anxiety medication, such as Zoloft, in order to provide relief more quickly while the long-term medication begins to work.

How do I know which dose of Ativan I should take?

The dose of Ativan that will be right for you varies depending on the condition being treated, food and drug administration recommendations, your age, the form of Ativan taken, other medical conditions you may have, and other medications you may be taking. Both Ativan and its generic form, lorazepam, come in tablets of 0.5 mg, 1 mg, and 2 mg strengths. The intravenous form of Ativan is offered in room temperature dosages of 2 mg per ml or 4 mg per ml; however, the intravenous form of Ativan is only used in a clinical setting. 
When taken to manage anxiety symptoms, just like alprazolam, the typical dosage of Ativan is 1 mg to 2 mg daily divided into two to three high doses. When used to treat insomnia, approximately 2 mg to 4 mg is taken at bedtime. 

Regardless of the size of your dosage, Ativan should not be stopped abruptly if you have been using it regularly for more than two weeks. Withdrawal symptoms may occur if the medication is stopped cold turkey. Instead, your healthcare provider will help you to gradually lower your daily dose by approximately 0.5 mg every few days until you have been weaned off the medication.

How do I use Ativan to treat anxiety?

Ativan is an important and powerful tool to treat anxiety, just like diazepam, but it can also be easily abused. When using Ativan to treat anxiety, the medication should be taken for short term use only, as it can be habit-forming. Ativan will work to provide immediate relief to your anxiety symptoms while a more appropriate long term medication, such as Zoloft, takes effect. 

Are there any side effects I should be aware of?

Side effects for Ativan are generally divided into three categories and include common, less common, and serious side effects. Common side effects include:

  • Drowsiness
  • Dizziness
  • Weakness

Less common side effects include:

  • Confusion
  • Lack of coordination
  • Depression
  • Fatigue
  • Headaches
  • Restlessness

Serious side effects include:

  • Slowed breathing
  • Respiratory failure
  • Psychological and physical dependence
  • Serious allergic reaction (antihistamines may be needed)
  • Suicidal thoughts

Be on the lookout for signs of psychological and/or physical dependence on Ativan. Symptoms of dependence may include:

  • Anxiety
  • Depression 
  • Muscle weakness
  • Nightmares
  • Body aches
  • Sweating
  • Nausea
  • Vomiting 

If you experience an allergic reaction to Ativan, you should seek medical attention immediately. Symptoms of an allergic reaction include:

  • Rash or hives
  • Trouble breathing or swallowing
  • Swelling of lips, tongue, or face
  • Rapid heartbeat

Does Ativan come with any warnings for use?

Unfortunately, due to the potential for Ativan to be habit-forming and cause psychological and physical dependence, the medication comes with several warnings for use. First, Ativan has a higher risk of drug abuse among patients with a history of drug or alcohol abuse or alcohol withdrawal. If you have suffered from addictive tendencies in the past, Ativan may not be right for you. Patients with existing depression may notice a worsening of their symptoms with the use of Ativan, so make sure to tell someone if you notice your depression worsening or begin experiencing suicidal thoughts. When used in combination with other central nervous system depressants, Ativan can be fatal due to respiratory depression, so drug interaction is crucial. So, it is imperative that you tell your doctor about any prescriptions, over-the-counter medications, supplements, vitamins, or herbs you are taking for appropriate medical advice. Generally, Ativan should only be prescribed for short periods of time (no longer than four months). Continuous long term use is not recommended due to the potential for abuse, so any extension of use should be carefully considered by a medical professional. Ativan should not be used by pregnant or breastfeeding mothers due to the potential for serious birth defects and life-threatening withdrawal symptoms for the infant.

Are there any withdrawal symptoms associated with Ativan?

Because Ativan is habit-forming and can lead to dependence and addiction, psychological and physical withdrawal symptoms can occur if the medication is stopped abruptly. If you’ve been taking Ativan regularly for more than two weeks, it is imperative that you gradually wean off the medication under the supervision of a doctor to prevent withdrawal symptoms from occurring. The longer you have taken Ativan, the more likely you are to experience withdrawal. Common withdrawal symptoms include:

  • Headache
  • Anxiety
  • Trouble sleeping
  • Irritability
  • Sweating
  • Dizziness 

If you are severely dependent on Ativan, you could experience more serious symptoms, especially if the medication is stopped abruptly. These include:

  • Hallucinations
  • Seizures
  • Tremors
  • Panic attacks

Is it possible to overdose on Ativan?

It is possible to overdose on Ativan, and it has happened before. Individuals who become dependent on the drug may find themselves taking more and more of the medication to produce the same calming effect. Eventually, this can lead to overdose, which is one of the reasons it is so important to take Ativan only as prescribed and only for short periods of time. Signs of an overdose include: 

  • Extreme drowsiness
  • Confusion
  • Slurred speech
  • Feeling restless
  • Muscle weakness
  • Loss of balance or coordination
  • Feeling light-headed
  • Slow heartbeats
  • Weak or shallow breathing 
  • Coma

Medical attention should immediately be sought in the event of an overdose or possible overdose of Ativan.

Who should not take Ativan?

Due to the long list of adverse effects and the possibility for psychological and physical dependence, some groups of people should not take Ativan. These groups include:
People with untreated depression. Ativan can cause suicidal thoughts in individuals who are depressed.
Children under age 12. Ativan is not approved by the FDA for use in children under the age of 12, although it is sometimes used off-label under a doctor’s care. Children are more likely to experience side effects from Ativan than adults, so they must be monitored carefully when taking the medication. 
Senior citizens. Senior citizens are more likely to experience side effects like drowsiness or dizziness, which can increase their risk of suffering from a fall, leading to bone fractures. Senior citizens may require a substantially lower dose of Ativan.  
Pregnant women and breastfeeding mothers. Ativan can cause serious birth defects or life-threatening withdrawal symptoms in newborn babies. Pregnant and nursing women should not take Ativan.

Additionally, some people with certain medical conditions should not take Ativan. Make sure to tell your doctor if you have experienced any of the following:

  • Narrow-angle glaucoma
  • History of allergic reaction to any benzodiazepine
  • Breathing problems, sleep apnea, drug or alcohol addiction, depression, mood problems, suicidal thoughts or behavior, kidney/liver disease, seizures, glaucoma

Finally, due to its depressive effects, you should not drink alcohol when taking Ativan.