Ativan Withdrawal: Symptoms, Timeline, and Treatment

Published March 1st, 2021 by Erik Rivera
Fact Checked by
Camille Freking
Medically Reviewed:
Dr. Gerardo Sison
Updated Date: Mar 23rd, 2021

Lorazepam is a popular anti-anxiety medication sold under the brand name Ativan that belongs to a class of drugs called benzodiazepines. Commonly used to treat anxiety disorders, insomnia, and certain types of seizures, Ativan carries a risk of dependence and addiction based on the sedating and relaxing effects it provides. 

This powerful medication is one of the most commonly prescribed benzodiazepines in the United States, with about 26.4 million prescriptions for the drug written in 2017 alone. Ativan is classified by the U.S. Drug Enforcement Administration (DEA) as a Schedule IV controlled substance due to its potential for abuse and addiction. 

People who become addicted to or dependent on Ativan due to abuse or prolonged use of the drug may experience Ativan withdrawal symptoms if they attempt to stop taking the medication or drastically reduce their dose within a short amount of time.

Who is likely to experience symptoms of Ativan withdrawal?

Ativan has the tendency to cause withdrawal symptoms even in patients who use the drug as prescribed. The medication is intended for short-term use of four months or less, but taking the drug for as little as three to six weeks can still produce physical dependence on the drug that can cause withdrawal symptoms. These include withdrawal phases including acute withdrawal symptoms and post-acute withdrawal syndrome. 

Studies show that of people who take Ativan or other benzodiazepines for a period of six months or more, 40 percent will have moderate to severe withdrawal symptoms if they discontinue their substance use abruptly, while the remaining 60 percent will experience mild withdrawal symptoms. How severe your benzodiazepine withdrawal symptoms are will vary depending on your dose of the medication and whether you use Ativan with other benzodiazepines.

If you’ve been taking Ativan regularly for more than two weeks, it’s important you gradually wean off the medication under the guidance of a healthcare professional in order to prevent or minimize withdrawal symptoms. 

What are the symptoms of Ativan withdrawal?

The symptoms most commonly associated with Ativan withdrawal include extreme feelings of anxiousness and irritability. Although many patients take Ativan to treat anxiety, withdrawal symptoms of the drug can make your anxiety and mental health worse than it was before you started taking Ativan. Severe headaches, aching muscles, insomnia, and hand tremors are also common. 

Other common withdrawal symptoms include:

  • Sweating

  • Dizziness 

  • Difficulty concentrating

  • Mood swings

  • Panic attacks

  • Rapid heart rate

  • Nausea

  • Restlessness

Patients who have been taking Ativan at a very high dose or who are severely dependent on Ativan may experience more serious side effects, especially if the medication is stopped abruptly. These include:

  • Hallucinations

  • Grand mal seizures

  • Delirium

  • Visual disturbances

What is the timeline for Ativan withdrawal?

Each person experiences the symptoms of Ativan withdrawal differently. Research has not conclusively established a timeline for withdrawal symptoms due to the differences in patient experiences. Some studies find that the acute symptoms of Ativan withdrawal feel the worst on the second day of withdrawal and begin to improve by the fourth or fifth day. 

However, other research has found that acute symptoms last longer, with an estimated duration of one to four weeks in most patients. 

While some patients will experience withdrawal symptoms for several weeks and then no longer experience symptoms, up to one-quarter of people who use Ativan for an extended period of time will experience a condition known as protracted withdrawal. 

People who experience protracted withdrawal experience more mild symptoms that may come and go inconsistently over the course of several months. Most patients who experience protracted withdrawal will completely recover within 12 months.

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What treatment is available for Ativan withdrawal?

The best way to minimize and prevent symptoms of Ativan withdrawal is to consult your doctor before reducing or stopping your use of the medication. 

Your doctor will help you gradually taper down the dose over a period of several weeks or months, which can keep withdrawal symptoms at bay. Your doctor may also help by prescribing a longer-acting benzodiazepine that can help keep your anxiety stable and prevent acute symptoms of anxiety, irritability, and panic attacks.

Reductions in the daily dose of Ativan should be no more than 10 to 20 percent per week, so stopping use of the medication takes planning and time. Patients should never stop taking Ativan “cold turkey,” as it can cause dangerous symptoms. Patients who have a history of severe mental illness, seizures, or complicated withdrawal may need to stop using Ativan in an inpatient setting, but most people do not need to undergo detox as long as they follow the guidance of their doctor. 

Working with a therapist or counselor may help to reduce psychological symptoms. Ativan addiction, substance abuse, and drug cravings can occur in patients who have been taking Ativan for long periods of time. 

Your healthcare provider can discuss addiction treatment options, treatment programs, and treatment facilities for patients who have developed Ativan use dependencies. Ativan detox can be difficult, as can any medical detox following extended periods of drug abuse, and the withdrawal process can be potentially life-threatening if not aided by a medical professional. 

Summary

Ativan is a serious medication that has significant effects on your brain chemistry. As a result, quitting use of the medication can cause significant withdrawal symptoms and should not be done abruptly. 

Patients should work closely with their doctor, gradually tapering their dose of their medication over time through their last dose in order to minimize the symptoms of withdrawal, which can last for up to one year. 

Sources:

https://www.deadiversion.usdoj.gov/drug_chem_info/benzo.pdf 

https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.12023 

https://www.webmd.com/drugs/2/drug-6685/ativan-oral/details

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