What Is Lorazepam?
Lorazepam is a prescription benzodiazepine medication that reduces activity in the central nervous system (CNS). In the United States, oral lorazepam tablets are FDA-approved for the management of anxiety disorders and for short-term relief of anxiety symptoms, including anxiety associated with depressive symptoms. Injectable lorazepam has additional FDA-labeled uses, including treatment of status epilepticus and preanesthetic medication for adults undergoing procedures.
Lorazepam is also commonly recognized by the brand name Ativan. Other U.S. products include lorazepam oral solution/concentrate and extended-release formulations. MedlinePlus lists Ativan, Lorazepam Intensol, and Loreev XR among lorazepam brand names.
Because lorazepam can cause sedation, physical dependence, misuse, and potentially dangerous respiratory depression—particularly when combined with opioids or other CNS depressants—it is a medication that should be used only under appropriate medical supervision. The FDA requires a class-wide boxed warning for benzodiazepines addressing abuse, misuse, addiction, physical dependence, and withdrawal.
How Does Lorazepam Work?
Lorazepam enhances the effects of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain.
Benzodiazepines bind to specific sites associated with GABA receptors. This increases inhibitory signaling and reduces excessive neuronal activity. The resulting effects can include:
- Reduced anxiety
- Relaxation
- Drowsiness or sedation
- Reduced seizure activity
- Muscle-relaxing effects
- Decreased ability to form or recall memories in some clinical settings
The pharmacological effects of benzodiazepines are related to their ability to slow CNS activity. Injectable lorazepam labeling specifically describes antianxiety, sedative and seizure-reducing effects.
This mechanism explains why the same medication can be used in different clinical situations—but also why excessive CNS depression can become dangerous.
What Is Lorazepam Used For?
The indication depends on the formulation.
1. Anxiety disorders
Oral lorazepam tablets are FDA-labeled for the management of anxiety disorders and short-term relief of anxiety symptoms, including anxiety associated with depressive symptoms. The prescribing information also notes that ordinary stress associated with everyday life generally does not require treatment with an anxiolytic medication.
Lorazepam may reduce symptoms such as excessive anxiety and nervousness by decreasing excessive CNS activity.
However, benzodiazepines are generally approached cautiously when longer-term treatment is being considered because continued use can lead to physical dependence and other risks.
2. Status epilepticus
Injectable lorazepam is FDA-indicated for the treatment of status epilepticus, a medical emergency involving prolonged or recurrent seizure activity without adequate recovery between seizures.
This use is substantially different from taking an oral benzodiazepine for routine anxiety. Status epilepticus requires emergency medical management, monitoring of vital functions and readiness to provide respiratory support.
The current injectable labeling emphasizes that respiratory depression is an important risk during treatment and that airway and respiratory function must be closely monitored.
3. Preanesthetic sedation
Injectable lorazepam is also FDA-indicated in adults as a preanesthetic medication. It can provide sedation, reduce anxiety before surgery and decrease recall of events surrounding the procedure.
Because injectable lorazepam can produce significant sedation, appropriate monitoring and equipment for maintaining the airway and supporting breathing should be available when clinically required.
4. Other clinical uses
Lorazepam may sometimes be used by clinicians for purposes outside its principal FDA-labeled indications. MedlinePlus notes that healthcare professionals may prescribe it in certain circumstances for nausea and vomiting related to cancer treatment or agitation associated with alcohol withdrawal. Such uses should be distinguished from the drug’s FDA-approved indications.
Lorazepam Dosage and Administration
Lorazepam dosage depends heavily on the formulation, indication, age, other medications, and clinical circumstances.
For oral lorazepam, the current U.S. labeling includes 0.5 mg, 1 mg, and 2 mg tablets.
MedlinePlus notes that oral tablets and concentrate may be taken with or without food, while dosing frequency depends on the prescribed formulation and reason for treatment. Patients should follow their prescription exactly rather than adjusting the amount or frequency themselves.
Injectable lorazepam is administered by healthcare professionals in clinical settings. Its dosing is different from oral treatment and is dependent on whether it is being used for status epilepticus or preanesthetic medication.
Important: The appropriate dose is not simply determined by the diagnosis. Age, other CNS depressants, respiratory status, liver or kidney considerations, and previous exposure to benzodiazepines can affect clinical decisions.
Common Lorazepam Side Effects
Because lorazepam slows CNS activity, many of its common adverse effects are related to sedation and impaired coordination.
Common effects include:
- Drowsiness
- Dizziness
- Weakness
- Unsteadiness
- Reduced alertness
- Impaired coordination
MedlinePlus identifies drowsiness, dizziness, weakness and unsteadiness among common side effects.
These effects can interfere with driving, operating machinery, walking safely and performing tasks that require concentration.
Older adults may be particularly susceptible to sedation and related complications such as falls, so clinicians generally use additional caution in this population.
Serious Risks and Lorazepam Safety Warnings
1. Respiratory depression
One of the most important risks occurs when lorazepam is combined with other substances that suppress the CNS.
Particularly concerning combinations include:
- Opioid pain medicines
- Opioid cough medicines
- Alcohol
- Other sedatives
- Certain medications that depress CNS activity
The FDA warns that combining benzodiazepines with opioids can result in profound sedation, respiratory depression, coma and death.
Symptoms requiring urgent medical attention can include:
- Extreme sleepiness
- Difficulty waking
- Slow or difficult breathing
- Severe dizziness or lightheadedness
- Loss of consciousness
MedlinePlus specifically advises seeking emergency medical care for unusual dizziness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness.
2. Abuse, misuse and addiction
Lorazepam carries a significant regulatory warning concerning abuse, misuse and addiction.
The FDA requires benzodiazepines to carry a boxed warning because misuse can result in overdose or death. Risk may be increased when benzodiazepines are taken with alcohol, opioids or other substances.
The current DailyMed labeling similarly states that lorazepam can expose users to risks of abuse, misuse and addiction.
For this reason, lorazepam should not be shared with another person, even if that person reports similar symptoms.
3. Physical dependence and withdrawal
Physical dependence can develop during continued benzodiazepine use.
Importantly, physical dependence and addiction are not identical concepts. A person can develop physical dependence even when taking a medication according to a prescription.
Stopping lorazepam suddenly after continued use can produce withdrawal symptoms. Depending on the circumstances, withdrawal may include:
- Anxiety
- Sleep problems
- Tremors
- Difficulty concentrating
- Irritability
- Perceptual changes
- Muscle twitching
- Seizures
- Other serious neurological or psychological symptoms
The FDA warns that abrupt discontinuation or excessively rapid dose reduction can cause potentially life-threatening withdrawal reactions, including seizures.
Therefore, someone who has been taking lorazepam regularly should not stop it abruptly without medical guidance. A clinician can determine an appropriate gradual reduction plan.
Lorazepam and Opioids
The combination of lorazepam and an opioid deserves particular attention.
Examples of opioids include:
- Hydrocodone
- Oxycodone
- Morphine
- Fentanyl
- Codeine
Both drug classes can suppress CNS activity. Their combined effects can substantially increase sedation and respiratory depression.
The FDA recommends that concurrent prescribing be reserved for circumstances in which alternatives are inadequate, with careful attention to dosage, treatment duration and monitoring.
Patients should tell their healthcare professional about all opioid medicines they take before starting lorazepam.
Lorazepam and Alcohol
Alcohol can intensify the sedating effects of lorazepam.
Combining them may increase:
- Drowsiness
- Dizziness
- Poor coordination
- Impaired judgment
- CNS depression
- Risk of serious respiratory effects
MedlinePlus specifically advises patients to discuss safe alcohol use with their healthcare professional because alcohol can worsen lorazepam’s adverse effects.
Avoiding alcohol while taking lorazepam may therefore be recommended depending on the individual’s treatment plan.
Can Lorazepam Affect Driving?
Yes.
Lorazepam can cause drowsiness, dizziness, impaired coordination and reduced alertness. Patients should not drive or operate machinery until they understand how the medication affects them.
The risk can become substantially greater when lorazepam is combined with opioids, alcohol or other sedating medicines.
Injectable lorazepam can produce particularly significant perioperative sedation. The current injectable labeling warns that impairment may persist after administration and that the decision about returning to driving or hazardous activities must be individualized.
Who May Need Extra Caution With Lorazepam?
Healthcare professionals may need to use additional caution in people with certain conditions, including:
- Sleep apnea
- Respiratory disease
- COPD or other breathing disorders
- Glaucoma
- Liver disease
- Certain neurological conditions
- A history of substance misuse
- Older age
MedlinePlus recommends discussing sleep apnea, lung problems, heart or liver disease and other relevant medical conditions before taking lorazepam.
Injectable lorazepam has specific contraindications that include acute narrow-angle glaucoma, sleep apnea syndrome and severe respiratory insufficiency, subject to specific clinical circumstances described in the labeling.
Lorazepam During Pregnancy and Breastfeeding
Pregnancy and breastfeeding should be discussed with a healthcare professional before using lorazepam.
MedlinePlus advises patients who are pregnant, planning pregnancy or breastfeeding to discuss lorazepam with their healthcare provider.
Because benzodiazepines can cross the placenta and can affect the newborn, the risks and benefits require individualized medical assessment.
Lorazepam should not be stopped abruptly during pregnancy simply because pregnancy has occurred; sudden discontinuation can itself cause serious withdrawal. Any medication change should be medically supervised.
Lorazepam Overdose
Taking more lorazepam than prescribed can cause excessive CNS depression.
Possible overdose symptoms include:
- Extreme drowsiness
- Confusion
- Severe tiredness
- Poor coordination
- Slowed breathing
- Slowed heartbeat
- Loss of consciousness
MedlinePlus advises contacting Poison Control at 1-800-222-1222 for suspected overdose. If someone has collapsed, cannot be awakened, has a seizure or has trouble breathing, emergency medical services should be contacted immediately.
Combining lorazepam with opioids or other CNS depressants can make overdose particularly dangerous.
Lorazepam vs. Ativan
Ativan is a brand name for lorazepam.
The active ingredient is lorazepam, so the pharmacological effects are based on the same active drug. Generic lorazepam products are also available in the United States.
MedlinePlus lists Ativan among lorazepam brand names, while current DailyMed records include multiple generic lorazepam products.
When comparing products, patients should focus on the active ingredient, formulation, strength and prescribing information rather than assuming that different brand names represent different medications.
Lorazepam vs. Other Benzodiazepines
Lorazepam belongs to the same broad drug class as medications such as:
- Alprazolam
- Clonazepam
- Diazepam
- Temazepam
- Chlordiazepoxide
However, benzodiazepines differ in pharmacokinetics, approved indications, formulations, onset and duration of effects.
For example, lorazepam has an oral plasma half-life of approximately 12 hours according to current DailyMed labeling.
That does not mean every benzodiazepine effect disappears after 12 hours. Clinical effects and impairment can vary according to dose, patient characteristics, formulation and other substances.
Frequently Asked Questions About Lorazepam
Is lorazepam a benzodiazepine?
Yes. Lorazepam is a benzodiazepine that enhances inhibitory GABA-related activity in the CNS.
What is lorazepam mainly used for?
In the U.S., oral lorazepam is FDA-labeled for anxiety disorders and short-term relief of anxiety symptoms. Injectable lorazepam is additionally indicated for status epilepticus and as a preanesthetic medication in adults.
Does lorazepam treat seizures?
Injectable lorazepam is FDA-indicated for status epilepticus, a medical emergency.
Is lorazepam addictive?
Lorazepam has recognized risks of abuse, misuse and addiction and can cause physical dependence. The FDA requires a boxed warning addressing these risks.
Can I stop lorazepam suddenly?
People who have been using lorazepam regularly should not stop it suddenly without medical guidance. Abrupt discontinuation can cause serious withdrawal reactions, including seizures.
Can lorazepam be taken with opioids?
The combination can cause profound sedation, respiratory depression, coma and death. FDA labeling recommends reserving concurrent use for situations where alternatives are inadequate and requires careful monitoring.
Can lorazepam make you sleepy?
Yes. Drowsiness and sedation are common effects because lorazepam reduces CNS activity.
Does lorazepam treat everyday stress?
The U.S. prescribing information states that anxiety or tension associated with ordinary everyday stress generally does not require treatment with an anxiolytic medication.
Is lorazepam the same as Ativan?
Yes. Ativan is a brand name associated with lorazepam. Generic lorazepam is also available in the United States.
Key Takeaways
- Lorazepam is a benzodiazepine that reduces excessive CNS activity through GABA-related mechanisms.
- Oral lorazepam is FDA-approved for anxiety disorders and short-term relief of anxiety symptoms.
- Injectable lorazepam is FDA-indicated for status epilepticus and preanesthetic medication in adults.
- Common adverse effects include drowsiness, dizziness, weakness and unsteadiness.
- Lorazepam carries FDA-required warnings concerning abuse, misuse, addiction, physical dependence and withdrawal.
- Combining lorazepam with opioids can cause profound sedation and life-threatening respiratory depression.
- Alcohol and other CNS depressants can increase sedation and other risks.
- Regular lorazepam use should not be discontinued abruptly because serious withdrawal can occur.
- Severe breathing difficulty, inability to awaken, loss of consciousness or seizure activity requires emergency medical attention.
