Did you know that there were 42,874 emergency department (ED) visits involving the abuse of lorazepam in 2011? This number rounds up to 3.4% of all ED visits from nonmedical use of pharmaceutical agents recorded that year.
Unfortunately, Ativan (lorazepam) has relatively high abuse potential, and its overdose can be fatal.
This habit isn’t impossible to break, though. The recovery journey usually starts with a period dedicated to detoxing the body from Ativan, which often comes with uncomfortable withdrawal symptoms.
What are these symptoms? How intense can the Ativan detox phase get?
This post will walk you through the withdrawal stages, the average detox process, and how trained professionals can help make things easier for you or your loved one. We’ll also check out what comes after the detox period.
Table of Contents
The Need for Medical Detox: Ativan Withdrawals Explained
Before we take a look at how the detox process works, we need to cover some basics about Ativan and its withdrawals.
Why Ativan Withdrawals Happen
Ativan is only a brand name used to refer to the active compound called lorazepam.
You’ll likely notice that the pharmaceutical generic name sounds close to diazepam (Valium) and alprazolam (Xanax), and it’s all for good reason—they all belong to the benzodiazepine “benzo” drug family.
All benzodiazepines “depress” the central nervous system by targeting the inhibitory GABA receptors. As a result, they slow down many of the neuron functions, creating a sedating, relaxing effect.
In monitored doses, this sedative effect can help with anxiety disorders. However, in just a few weeks, the body can get used to the benzodiazepine and build up tolerance or physical dependence.
That’s why the Drug Enforcement Administration (DEA) considers benzodiazepines addictive controlled substances. Ativan/lorazepam, in particular, is a schedule IV controlled substance.
The potency and abuse potential changes among the class. Generally speaking, benzodiazepines that are either highly lipophilic (can cross the blood-brain barrier and get to the brain faster) and those with shorter half-lives come with a higher risk of abuse.
As it happens, Ativan, with its short-to-intermediate action, is one of the highly potent benzo drugs.
When the Withdrawals Hit
Ativan’s half-life is around 12 hours, and it’s metabolized by the liver and excreted by the kidney (in urine).
While it could take 5–6 half-lives for the drug to be eliminated from the body, the withdrawals can start within 24 hours from the last dose. After 3–4 days, the majority of the symptoms start showing up.
That said, it’s worth noting the symptoms vary a bit throughout the detox process. Here’s the expected withdrawal timeline:
| Stage/Phase | Duration | Prevalence |
| Acute Withdrawal | Around 2 weeks | Most individuals experience this short stage |
| Prolonged/protracted (Post-acute withdrawal syndrome or PAWS) | Lasts for months or years | 10–25% of detoxing individuals |
What Ativan Withdrawals Look Like
Let’s split the withdrawals into two stages and take a closer look at each one.
Acute Stage
The first stage lasts anywhere from a few days to a couple of weeks. During this phase, the patient experiences acute withdrawal symptoms, which include:
- Headache, difficulty concentrating, and mental agitation
- Nausea, vomiting, and weight loss
- Increased heart rate and/or blood pressure
- Drug ravings
- Seizures (rare)
Some people might also experience “rebound effects” for 2–3 days, where the anxiety and insomnia (or whatever the patient was taking Ativan for) come back. This effect is more common among individuals with co-occurring conditions like anxiety and panic attacks.
Protracted Stage
The common post-acute symptoms aren’t all that different from the acute ones. There’s also a bit of tinnitus, paresthesia, and altered perception.
That said, not everyone will experience protracted or post-acute withdrawal symptoms.
Researchers estimate that benzodiazepine protracted withdrawal (PW) is experienced by around 10–25% of chronic users. Other sources narrow the range down and put the estimate at 10–15%, but it’s still not a prevalent concern.
The main issue here is that, when PW or PAWS do happen, it’s hard to figure out how long they’ll last. In some cases, they only last for a few months, but in others, they could linger around for 1–2 years.
Factors Affecting the Withdrawal Intensity and Duration
The timeline and symptoms listed above are generalized estimates for chronic benzodiazepine users in general. Each case can experience the detox process differently, depending on several factors.
Let’s take a look at the top factors affecting the duration and severity of withdrawal symptoms:
History of Addiction
Remember that it takes 5–6 half-lives for the body to get rid of the typical medical dose of Ativan.
However, chronic abusers usually take higher amounts of the drug, so their bodies will need more time to eliminate it. This means that the detox process will be lengthier.
Combination Drugs
Sometimes, Ativan abuse comes hand-in-hand with other substance use disorders (SUDs), which can make the withdrawal symptoms more intense.
Keep in mind that combining sedatives or alcohol with Ativan, in general, is risky—so much so that the FDA issued a Black Box Warning about the adverse side effects!
Individual Differences
Not all patients metabolize drugs at the same rate. Genetics and coexisting disorders both play important roles here. Plus, the patient’s mental health can make a difference in the type and intensity of the withdrawals.
Ativan Detox Program: How Does It Work
In most cases, quitting cold turkey isn’t the way to go. Abrupt cessation can be dangerous and sometimes not as effective as a well-planned detox program.
Instead, a taper can make the process smoother and more comfortable.
That said, reducing the dose on your own can be risky and could lead to relapse. The physical and physiological symptoms are often too much to handle without a support network of trained professionals.
Supervised Ativan Tapering
During a supervised medical detox program, professionals will provide progressively smaller doses of Ativan over weeks or even months.
Keep in mind that there isn’t a one-size-fits-all tapering schedule. The detox protocol, duration, supplementary therapies, and level of care could be customized to fit the case.
It’s even possible for professionals in the medical detox center to “pause” the taper if the patient suffers from severe withdrawal symptoms. This way, the body gets a chance to adjust.
However, even during the pause, the dose seldom increases. Doing so would be counterproductive and take the patient a few steps back on their recovery journey.
Promising Detox Medications
Aside from the dose reduction, medical professionals could use prescription medications to assist with the process.
Here are a few of the medications that could be incorporated into the detox program:
1. Another Benzodiazepine
It might sound a little counterintuitive to swap Ativan for yet another benzodiazepine. However, research indicates that switching to a long-acting benzodiazepine (like diazepam) can help manage the withdrawal symptoms and keep up with the maintenance therapy.
For reference, the half-life of diazepam (and its active metabolites) is 20–80 hours, which is obviously much longer than the 12 hours estimated for lorazepam.
Yet, one of the main issues here is that the equivalent doses don’t always line up between different benzodiazepines. Taking one gram of lorazepam is definitely not the same as taking one gram of diazepam.
So, you’ll need a trained professional to adjust the daily doses for you. Plus, they’ll monitor your progress and start reducing the intake of the long-acting benzodiazepine gradually when your body is ready.
2. Anticonvulsants
Seizures are a possible side effect of many drug detox programs, not just those related to Ativan. To help address this issue, the treatment team can prescribe anticonvulsants.
3. Antidepressants
It’s also normal for the withdrawals to hit the patient’s mood, which will only make the entire detox process harder than it needs to be.
Back in 2006, a randomized controlled trial looked at selective serotonin reuptake inhibitors (SSRIs) as a possible tapering aid.
If you’re not familiar with SSRIs, they’re a class of antidepressants that work to increase serotonin (a chemical that positively influences mood and sleep) levels in the brain.
SSRI tablets are often considered a first-choice medication for depression, thanks to their relatively low side effects. So far, the FDA has approved more than five drugs under the SSRI class.
The trial in question focused, specifically, on paroxetine (sold as Paxil and Pexeva), though.
Here’s what the researchers found at the end of the trial:
- 45.5% of those who used paroxetine in their detox program succeeded in becoming benzodiazepine-free.
- Only 17.4% of those who didn’t use paroxetine succeeded in becoming benzodiazepine-free.
This indicates that SSRI-assisted detox programs can be an effective alternative to traditional non-medicated tapering. So, don’t be surprised if your doctor recommends taking antidepressants during the detox phase!
4. Sleep Aids
Patients who struggle with insomnia (or other sleep disorders) during their Ativan withdrawals might be prescribed a sleeping aid, like melatonin.
One case report supported the use of melatonin to help with benzodiazepine reduction after long-term use while also improving sleep quality. However, there’s still a need for further investigation to gauge the additional medication’s effectiveness.
Treating teams have to consider each case individually before prescribing any sleep aids during detox.
Who Needs Ativan Detox Programs: Stats and Warning Signs
People who misuse/abuse Ativan for 3–4 weeks or more are more prone to getting intense withdrawals. They’ll likely need to go through a supervised detox program.
Accidental and Intentional Ativan Abuse
As we’ve mentioned, Ativan (much like many other SUD drugs) can be prescribed and taken legitimately.
In fact, 20% of all benzodiazepine prescriptions filled in US pharmacies in 2019 were for lorazepam specifically. This makes it one of the top prescribed benzodiazepines on the market.
But even with a prescription, it’s not uncommon for patients to slip into physical dependence.
That’s because some patients take more than the recommended dose. Others take the dose more frequently or keep the intake going for longer than the ideal treatment period. These are all forms of drug misuse.
Some people might abuse Ativan from their friends/family’s prescriptions, too. Note that one study examined benzodiazepine misuse among adults in the US and found that 15.4% of the respondents were using Ativan.
All in all, Ativan is one of those drugs that can be abused accidentally and intentionally. In both cases, the patient might have to deal with severe symptoms during the withdrawal process.
Common Signs of Ativan Abuse
The main warning signs that you’re abusing Ativan and need medical intervention:
- Tolerance: Your body got used to the drug, and you now need a larger dose just to get the same effects.
- Dependence: You can no longer function properly without taking a dose of lorazepam.
- Desperation: You’re seeking more of the drug illegally after your prescription has run out, “doctor shopping,” or neglecting financial obligations to buy more Ativan.
It’s also worth noting that chronic users might suffer from other health issues, from simple skin irritation and hostility to impaired coordination and amnesia.
The previous signs are a good place to start to identify abuse patterns in yourself. Meanwhile, if you’re concerned about your loved one’s Ativan addiction, you need to pay closer attention to their behavior and spot any uncharacteristic actions or sudden changes.
The common red flags include compromised hygiene/grooming, mood swings, withdrawing from social gatherings, neglecting obligations, and secretiveness.
Beyond the Ativan Detox: Completing the Recovery Journey
Detoxing from Ativan is only the beginning of the journey. Once the acute withdrawals are over and the patient is stabilized, they need to complete a well-rounded benzo addiction treatment program.
This program could be based on inpatient or outpatient management. Either way, it’ll most likely include cognitive or behavioral therapies.
Effective treatment programs also focus on aftercare via sessions and moving into a sober living facility during the transition period.
Final Thoughts
While detoxing from Ativan can be a difficult process, it’s vital for getting the recovery journey started. Having a team of trained professionals on your side can make the process more comfortable.
If you still have questions about Ativan detox, don’t hesitate to get in touch with our team at Live Free Recovery.
Additional Resources
Published on: 2023-11-22
Updated on: 2024-04-01