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Ativan for Alcohol Withdrawal: Benefits and Dosage for Alcohol Detox

Written by Heather Lomax

& Medically Reviewed by Dr. Jessica Pyhtila, PharmD

Medically Reviewed

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This article was reviewed by a medical professional to guarantee the delivery of accurate and up-to- date information. View our research policy.
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Ativan (generic: lorazepam) one of the gold-standard drugs for alcohol withdrawal treatment. As such, it can help you safely detox and prepare you for further rehab treatment.

Benzodiazepines, or benzos, are widely considered to be the best drugs for managing alcohol withdrawal syndrome (AWS) symptoms. Benzos are versatile and can be prescribed to treat AWS in both inpatient and outpatient settings. One of the most common benzos used in AWS treatment is Ativan.

What Is Ativan?

Ativan is the brand name for lorazepam, a generic benzodiazepine. It is a Schedule IV controlled substance that is FDA-approved to treat anxiety and seizures. However, it is commonly prescribed off-label for other conditions. These include insomnia, agitation and AWS.

Ativan for Alcohol Withdrawal Symptoms

A person who drinks heavily often experiences changes in their brain. Drinking interferes with the body’s ability to balance certain chemicals (neurotransmitters).  The two main chemicals affected are gamma-aminobutyric acid (GABA) and glutamate. GABA is known as the calming chemical in the brain, while glutamate excites the cells. 

Heavy drinking depresses brain activity and enhances GABA. As a result, the brain becomes hypersensitive to glutamate. If someone suddenly stops drinking, the brain lacks enough GABA to calm itself down. The brain then becomes over-excited due to glutamate sensitivity. This leads to the unpleasant effects of AWS.

As a central nervous system (CNS) depressant, Ativan helps to slow down brain activity, enhance GABA and stop AWS symptoms. Because Ativan is fast-acting, experts recommend it as a first-choice benzo option to treat AWS symptoms.

Alcohol Withdrawal Symptoms

Alcohol withdrawal symptoms usually begin 6–24 hours after the last drink and often peak within 36–72 hours. Symptoms can persist for up to 10 days and can consist of: 

  • Anxiety
  • Insomnia
  • Tremors
  • Sweating
  • Fast heart rate
  • High blood pressure
  • Nausea
  • Vomiting
  • Diarrhea

Symptoms like vomiting and diarrhea can cause severe dehydration, which can result in a medical emergency.

For those with severe alcohol use disorder, withdrawal symptoms may be even more challenging. Severe withdrawal symptoms can include:

  • Blood pressure fluctuations
  • Body temperature fluctuations
  • Extreme agitation
  • Delirium
  • Hallucinations
  • Seizures

How Ativan Helps with Alcohol Withdrawal

Ativan works on the same neural receptors as alcohol, but it lasts much longer than alcohol. It enhances the actions of GABA, effectively alleviating alcohol withdrawal symptoms caused by a lack of GABA. For this reason, Ativan is one of the first-choice medications prescribed for alcohol withdrawal symptoms.

Effectiveness of Ativan for Alcohol Withdrawal

Experts consider Ativan one of the first-line drugs for AWS treatment. It has been shown to work as well as chlordiazepoxide, another first-line benzo for AWS. The drug is also versatile. It is available in a fast-acting injectable form and an oral form. The oral form can manage AWS symptoms as needed. On the other hand, the injectable form can be quickly administered if a person experiences more severe AWS symptoms, such as a seizure.Verify Insurance

Ativan Dosage for Alcohol Withdrawal

Depending on the person’s needs, Ativan may be used in different formulations and doses. For example, a person with AWS who is experiencing a seizure will need an injectable form of Ativan.

Benzos like Ativan are generally given as needed to treat AWS symptoms. This means the drug is only used when the person’s symptoms require it. For this reason, dosing is highly individualized and can vary from person to person. However, a common dose of Ativan for AWS treatment is generally 2–4 mg taken orally as needed. Some patients with persistent symptoms may need higher doses. However, each regimen should be given by an experienced clinician.

Loading Dose Regimen (LDR)

A loading dose regimen (LDR) is a way to achieve a high concentration of a therapeutic drug in a short period to elicit a prompt response. A loading dose consists of a higher dose up-front, with ongoing smaller doses. This regimen can be useful for severe cases of alcohol withdrawal. It can help prevent the most extreme symptoms like seizures or delirium. However, it should only be used under close supervision and continual medical monitoring.

Symptom-Triggered Regimen (STR)

During symptom-triggered therapy, medical professionals assess the severity of a patient’s alcohol withdrawal symptoms. If the patient’s symptoms warrant it, doctors can then offer a medication dose. The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) is the most commonly used scale for grading alcohol withdrawal symptoms. Practitioners will score patients in ten categories. This system helps them assess whether a patient’s withdrawal symptoms are mild, moderate or severe. Medications are given accordingly with close monitoring. At regular intervals, the medical team can reassess the patient’s needs. 

Fixed-Tapered Dose Regimen (FTDR)

A fixed-tapered dosage regimen (FTDR) is often suited for an outpatient context. A specific dosage of Ativan or a replacement benzo like diazepam (Valium) is prescribed for a set period. After that, the dosage is gradually reduced at preset intervals. Sometimes, this method is simply referred to as a taper. Tapers can last for weeks or months.

How Long Do You Take Ativan for Alcohol Withdrawal?

Ativan is intended for short-term use at the lowest effective dose. Prolonged use risks dependence on the drug and even the potential for addiction. For alcohol withdrawal symptoms, Ativan is typically used for a few days. How long Ativan is used depends on how severe the alcohol withdrawal symptoms are and the chosen dosing regimen to relieve them.

Side Effects of Ativan

Ativan side effects may include:

  • Sedation, occurring in 16% of people
  • Dizziness, occurring in almost 7% of people
  • Weakness, occurring in around 4% of people
  • Unsteadiness, occurring in 3.4% of people

Other side effects may occur if a person needs repeated high doses of injected Ativan during AWS. This is due to a chemical called propylene glycol in the injectable forms of Ativan. These side effects are:

  • Low blood sodium
  • Metabolic acidosis

Risks of Ativan for Alcohol Withdrawal

Like all drugs, Ativan carries some risks, even when taken as prescribed and under medical supervision in a hospital setting. These risks can include:

  • Oversedation
  • Slowed breathing
  • Movement difficulties
  • Confusion
  • Memory problems
  • Delirium

Delirium can be particularly tricky to manage when a person is being treated for AWS. Delirium could be an Ativan side effect or a symptom of AWS.

Because Ativan is a Schedule IV controlled substance, it also carries a risk of abuse, addiction and dependence. These risks are so pronounced that the FDA is implementing a new black box warning for all benzos to inform people about benzo addiction risks.

Ativan Addiction

The possibility of Ativan addiction makes addiction specialists cautious when prescribing it for AWS treatment. For example, addiction doctors will often prescribe only a one-to-three-day supply of Ativan. When alcohol withdrawal is over, the doctor will discontinue prescriptions.

Drug Interactions

Benzos like Ativan are central nervous system (CNS) depressants. As such, people should avoid taking Ativan with other CNS depressants. These include:

  • Opioids: The FDA has a black box warning on benzos that details the risks of taking these drugs with an opioid. The risks include extreme sedation, slowed breathing and death.
  • Alcohol: Combining Ativan and alcohol can be deadly, as it may cause extremely slowed breathing.

Other Benzodiazepines for Treating Alcohol Withdrawal

Besides lorazepam, the most commonly used benzos for AWS treatment are diazepam (Valium) and chlordiazepoxide (previously sold as Librium). All three of these benzos are long-acting, which leads to a smoother withdrawal and fewer breakthrough symptoms.

Get Help for Alcohol Addiction and Withdrawal Today

At The Recovery Village Palm Beach at Baptist Health Drug and Alcohol Rehab, we utilize the latest evidence-based addiction treatments, including medication-assisted treatment (MAT). Our goal is to provide our patients with a lifelong path to sobriety. If you are struggling with alcohol misuse, you may be eligible for medication to ensure a safer, more comfortable alcohol withdrawal. 

If you or a loved one are struggling with alcohol, The Recovery Village is here for you. If you’d like to know more about medication-assisted treatment or treatment for alcohol use disorder, our Recovery Advocates are available to help you. We can connect you with resources and support for getting started on your path to recovery.

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