Lorazepam
Generic: lorazepam · Brand: Ativan® · Class: Anxiolytic — Benzodiazepine — Schedule IV
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How It Works
Lorazepam is a short-to-intermediate acting benzodiazepine that enhances the activity of GABA — the brain's main inhibitory neurotransmitter — by binding to GABA-A receptors. This produces rapid, potent anxiolytic, sedative, muscle-relaxant, and anticonvulsant effects. It has a relatively short half-life (10–20 hours) with no active metabolites, making it one of the safest benzodiazepines for older adults and those with liver disease. It works within 15–30 minutes and is best used for acute, situational, or short-term anxiety rather than chronic daily use.
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What It Treats
Acute Anxiety and PanicFast-acting relief for acute anxiety episodes and panic attacks
Short-Term AnxietyAppropriate for brief periods of significant anxiety — medical procedures, acute stress
SeizuresIV form used in emergency settings for status epilepticus
Alcohol WithdrawalFirst-line treatment for alcohol withdrawal seizures in medical settings
Presurgical SedationWidely used for procedural anxiety and sedation
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Dosing Overview
| Population | Start | Typical Range | Max |
|---|---|---|---|
| Adults Anxiety (as needed) | 0.5–1 mg | 0.5–2 mg per dose | 10 mg/day |
| Adults Scheduled anxiety | 1 mg 2–3x daily | 2–6 mg/day | 10 mg/day |
| Older Adults Start low | 0.25–0.5 mg | 0.5–2 mg/day | 2 mg/day |
Taken with or without food. Onset 15–30 minutes; duration 6–8 hours. Sublingual tablets available for faster absorption. Recommended for short-term use only. Schedule IV controlled substance.
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Side Effects
Common
- Sedation and drowsiness
- Dizziness
- Memory impairment
- Coordination problems
- Fatigue
- Confusion
- Slurred speech
- Rebound anxiety between doses
Call us if you notice
- Respiratory depression (especially with opioids or alcohol)
- Severe paradoxical reaction (agitation, aggression)
- Severe confusion or disorientation
- Signs of dependence
- Withdrawal symptoms if stopped abruptly
Lorazepam is highly effective for acute anxiety but is not intended for long-term daily use due to dependence risk and tolerance development. The "rebound anxiety" between doses is common and can lead to a cycle of increasing use. Use as sparingly as possible.
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Tips for Success
As Prescribed OnlyTake only as prescribed — not more, not more often.
No AlcoholNever combine with alcohol — can be dangerous or fatal.
Caution DrivingDo not drive until you know how this medication affects you.
Tell All ProvidersAlways share this medication with all prescribers and pharmacists.
Don't Stop AbruptlyAlways taper with your provider — do not stop suddenly.
Track AnxietyNote what triggers anxiety and how the medication helps to share at visits.
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Important Safety Information
Dependence and Withdrawal: Benzodiazepines can cause physical dependence with regular use. Never stop abruptly — withdrawal can cause seizures, severe anxiety, and in rare cases can be life-threatening. Always taper slowly with your provider.
Alcohol is Dangerous: Combining benzodiazepines with alcohol or other CNS depressants can cause respiratory depression and death. Never mix these.
Opioid Combination — BLACK BOX WARNING: Combining benzodiazepines with opioids significantly increases the risk of respiratory depression, coma, and death. If you take any opioid medication, tell your provider immediately.
Impaired Driving: Benzodiazepines impair reaction time and coordination. Do not drive or operate heavy machinery until you know how this medication affects you.
Pregnancy: Benzodiazepines can cause fetal harm and neonatal withdrawal. Discuss risks and benefits carefully with your provider.
Tolerance Develops: The sleep and anxiety effects often diminish with regular use as tolerance develops. These medications are generally recommended for short-term use only.
Questions? I am here. Reach me between appointments if you have concerns about side effects, notice mood changes, or have questions about your medication.
360-389-3712info@rootedmindspsychiatry.com