LorazepamA fast-acting sedative: why is it prescribed, and when does it turn into dependence?

12What is lorazepam?

“The doctor prescribed it for only two weeks for my anxiety, and for a year now I haven't been able to sleep without it.” This sentence sums up the story of many lorazepam users: an effective medicine that calms anxiety quickly, but one designed for short-term use, and when it goes on too long without follow-up it turns from a treatment into a habit that is hard to break.

Lorazepam is a medicine from the benzodiazepine family, the same family that includes Xanax, Valium, and Rivotril. Its best-known brand name worldwide is “Ativan.” According to the US Food and Drug Administration, lorazepam alone accounted for about 20% of benzodiazepine prescriptions dispensed in the United States in 2019, which makes it one of the most widely used members of this family.

What sets lorazepam apart is that the liver clears it by attaching it directly to a substance that makes it inactive, without turning it into long-lasting active products as happens with Valium. For this reason doctors may prefer it in certain cases, such as some older adults or people with liver disease, a decision that is theirs alone.

13When does a doctor prescribe lorazepam?

• Severe anxiety for a short period, until a long-term treatment such as antidepressants or psychotherapy starts to work.
• Insomnia linked to anxiety.
• Calming before surgery, medical procedures, and dental treatment.
• Prolonged seizures, for which it is given by injection in hospital.
• Agitation accompanying alcohol withdrawal under a medical protocol, with details in the guide to alcohol withdrawal symptoms.

The UK National Health Service says it is not advised for more than 4 weeks, and that the chance of addiction is small with a low dose taken for a short time, from two to four weeks. Its US label states that its effectiveness in long-term use beyond 4 months has not been evaluated in systematic studies, and that the doctor should periodically reassess its benefit.

14How does lorazepam affect the brain?

Lorazepam strengthens the effect of GABA, the chemical messenger responsible for calming brain activity. According to its label, the body absorbs about 90% of it, it peaks in the blood after about two hours, and its half-life is about 12 hours. The UK National Health Service states that its sedative effect begins within 20 to 30 minutes and lasts about 6 to 8 hours. The result is:

• Rapid calming of anxiety and physical tension, which is both the reason it helps and the reason people become attached to it.
• Drowsiness, its most common side effect.
• Impaired memory for what happens after taking it, an effect that is put to use before surgery but is troublesome in daily life.
• Muscle relaxation and prevention of spasms and seizures, which is why it is used by injection in seizures.

15Forms and names of lorazepam

Lorazepam comes as tablets and a drinkable liquid, and is given by injection in hospitals only. MedlinePlus also mentions extended-release capsules in some countries. Its brand names include Ativan, and the available names differ from country to country. It has no common street names, but it is sometimes sold outside pharmacies, and the contents of those tablets cannot be verified.

16Why is lorazepam misused?

• Staying on it for months after the crisis it was prescribed for has passed.
• Using it to numb everyday anxiety instead of treating it.
• Raising the dose on one's own after its effect weakens.
• Mixing it with alcohol, painkillers, or other substances in search of a “buzz.”
• Believing it is safe because it is a prescription medicine.

The medicine label warns that use as prescribed can also expose some patients to the risk of misuse, and that most serious cases and deaths occur when a benzodiazepine is combined with other medicines, alcohol, or illicit substances. The US agency states that about 5.4 million Americans aged 12 and older misused benzodiazepines in 2018.

17Lorazepam compared with Xanax and Valium

Half-lives are from Professor Heather Ashton's guide to benzodiazepines and are approximate.

18The legal status of lorazepam in Egypt

Lorazepam is a prescription-only medicine, and dispensing or trading in it outside medical settings is an offense. In the United States its label lists it under Schedule IV of controlled substances, and in 2020 the Food and Drug Administration required a boxed warning on abuse, dependence, and withdrawal for all benzodiazepines. For anyone who needs help, the Fund for Drug Control and Treatment of Addiction offers the hotline 16023.

This is general educational information and not legal advice.

19Lorazepam in numbers

Sources: US Food and Drug Administration 2020, and the US Ativan label.

20Lorazepam in brief: harms, symptoms, withdrawal, and treatment

Each topic has a detailed page: lorazepam harms, symptoms of lorazepam addiction, lorazepam withdrawal symptoms, lorazepam addiction treatment, and how long lorazepam stays in the body.

21The lorazepam guide: everything you need to know

We have gathered everything about lorazepam into 5 pages, each answering one question in detail. Choose what you are looking for:

22Do you suspect a family member is dependent on lorazepam?

1. Remember that many people started it with a prescription, so begin with questions and understanding, not accusations.
2. Notice: do the tablets run out before they should? Are they taking it with alcohol or painkillers?
3. Do not suddenly stop them taking it and do not hide the tablets; abrupt stopping can cause seizures.
4. Encourage them to see a psychiatrist who will treat the anxiety itself and set up a safe reduction plan.
5. Learn the emergency signs and the ambulance number, 123, especially when it is mixed with opioids.