Benzodiazepines, or benzos, are widely considered to be the best drugs for managing symptoms of alcohol withdrawal syndrome (AWS). 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, including insomnia, agitation and AWS.

Ativan for Alcohol Withdrawal Symptoms

A person who drinks heavily often experiences changes in their brain. Specifically, drinking interferes with the body’s ability to balance the neurotransmitters gamma-aminobutyric acid (GABA) and glutamate. GABA is known as the calming chemical in the brain, while glutamate excites the cells. Because heavy drinking overly depresses brain activity and enhances GABA, 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, leading to the unpleasant effects of AWS.

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

Dosage and Administration

Ativan may be used in different formulations and different doses, depending on the person’s needs. 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, meaning the drug is only used when the person’s symptoms require it. This means that 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.

Side Effects

Like all drugs, Ativan has side effects. These 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

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

  • Low blood sodium
  • Metabolic acidosis

Drug Interactions

Benzos like Ativan are central nervous system depressants. As such, people should avoid taking Ativan with other central nervous system depressants, such as:

  • 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.

Risks of Ativan Treatment

Like all drugs, Ativan carries some risks. Even when Ativan is taken as prescribed and under medical supervision in a hospital setting, 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 can be both an Ativan side effect as well as a symptom of AWS itself.

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 educate people about the risks of benzo addiction.

Addiction

Because Ativan addiction is possible, addiction medicine specialists are careful when prescribing it for AWS treatment. For example, addiction doctors will often prescribe only a one-to-three-day supply of Ativan and will discontinue prescriptions after alcohol withdrawal is complete.

Ativan Effectiveness 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, as it is available in an oral form to manage AWS symptoms as-needed and a fast-acting injectable form. The injectable form can be quickly administered if a person experiences more severe AWS symptoms, such as a seizure.

Other Benzodiazepines 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.

If you struggle with alcohol use and are wondering if Ativan may ease your withdrawal symptoms, The Recovery Village at Baptist Health can help. Contact us today to learn more about treatment programs that can work well for your needs.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.