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Ativan is the trade name for the drug Lorazepam and is a benzodiazepine derivative. Pharmacologically, it is classified as a sedative-hypnotic, anxiolytic and anticonvulsant. Ativan is rapidly and nearly completely absorbed after any mode of administration (oral, sublingual, i.m., i.v.). The onset of effects is several minutes after i.v. injections, 30 to 45 minutes after oral/sublingual administration, and up to 1 hour after i.m. injections. The duration of effects from Ativan depends on the dose, and is normally 6 to 12 hours. The half-life of Ativan in patients with normal liver function is 11 to 18 hours.

Ativan is prescribed for:
Treatment of anxiety disorders
Short-term treatment of insomnia, particularly if associated with severe anxiety
Treatment of symptoms associated with alcohol withdrawal
As a premedication,
To facilitate unpleasant procedures, such as endoscopies and dental surgery.
To augment the action of the primary anaesthetic drug.
To produce varying degrees of anterograde amnesia for the duration of the procedure.
Long-term treatment of otherwise resistant forms of petit mal epilepsy
Acute therapy of status epilepticus
Acute therapy of catatonic states alone/or with haloperidol
As an initial adjunctive treatment for depressions, mania and psychosis
Treatment of acute delirium, preferably together with haloperidol
Supportive therapy of nausea/emesis frequently associated with cancer chemotherapy, usually together with firstline antiemetics like 5-HT3-antagonists
Ativan is available in tablets and as a solution for intramuscular and intravenous injections. It is also available as a parenteral patch.

Other uses for Ativan
Ativan is also used to treat irritable bowel syndrome, epilepsy, insomnia, and nausea and vomiting from cancer treatment and to control agitation caused by alcohol withdrawal. Talk to your doctor about the possible risks of using this drug for your condition.

Ativan Dosage
Daily doses vary greatly from 0.5 mg bedtime for insomnia and 2.5 mg every 6 hours and more in the acute treatment of mania, before the firstline drugs (lithium, valproic acid) control the situation.

In every case, dose requirements have to be individualized especially in the elderly and debilitated patients in whom the risk of oversedation is greater. Safety and effectiveness of Ativan is not well determined in children under 18 years of age, but it is used to treat serial seizures. With higher doses (preferably i.v.-doses) the patient is frequently not able to recall unpleasant events (anterograde amnesia) such as therapeutic interventions (endoscopies etc.), which is a desirable effect. But in these cases the risk is given that a patient later makes unjustified allegations of sexual abuse during treatment due to poor recall.

How should Ativan be used?
Ativan comes as a tablet and concentrate (liquid) to take by mouth. It usually is taken two or three times a day and may be taken with or without food. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take Ativan exactly as directed.

Ativan concentrate (liquid) comes with a specially marked dropper for measuring the dose. Ask your pharmacist to show you how to use the dropper. Dilute the concentrate in 1 ounce or more of water, juice, or carbonated beverages just before taking it. It also may be mixed with applesauce or pudding just before taking the dose.

Ativan can be habit-forming. Do not take a larger dose, take it more often, or for a longer time than your doctor tells you to. Tolerance may develop with long-term or excessive use, making the drug less effective. Do not take Ativan for more than 4 months or stop taking this medication without talking to your doctor. Stopping the drug suddenly can worsen your condition and cause withdrawal symptoms (anxiousness, sleeplessness, and irritability). Your doctor probably will decrease your dose gradually.

Disadvantages of Ativan
Ativan, like other benzodiazepines, can cause psychological and/or physical dependence. Withdrawal symptoms are similar in character to those of alcohol and barbiturates have been observed after abrupt discontinuation, therefore, a gradual taper is recommended over a period of weeks or even months, depending on the length of time it was used and the dosage taken.

The likelihood of abuse, dependence and withdrawal symptoms is substantially greater with Ativan relative to other benzodiazepines because of its short half-life, higher potency and stronger binding to the GABA receptor complex.

Generally, Ativan is not suited for long-term treatment except when medically necessary. The stress of everyday life usually does not require treatment with an anxiolytic and is best treated with psychotherapy.

Ativan belongs to the FDA pregnancy category D which means that it is likely to cause harm to the unborn baby, although this is very rarely seen. Ativan given near the time of birth may cause floppy infant syndrome and withdrawal symptoms in the infant.

In some cases there can be paradoxical effects with benzodiazepines, such as increased hostility and aggression. This is thought by some doctors to be due to disinhibition, and is therefore more likely to occur in those with preexisting personality disorders who may have less than average inhibition.

What side effects can Ativan cause?
Side effects from Ativan are common and include:

  • drowsiness
  • dizziness
  • tiredness
  • weakness
  • dry mouth
  • diarrhea
  • upset stomach
  • changes in appetite
  • restlessness or excitement
  • constipation
  • difficulty urinating
  • frequent urination
  • blurred vision
  • changes in sex drive or ability
  • shuffling walk
  • persistent, fine tremor or inability to sit still
  • fever
  • difficulty breathing or swallowing
  • severe skin rash
  • yellowing of the skin or eyes
  • irregular heartbeat

Ativan Abuse
Those with preexisting substance abuse disorders or addictive personalities are likely to abuse medications such as Ativan, and care should be taken when prescribing it on an outpatient basis. It is often used in an inpatient setting to assist with detox.

Illegal use: Special data is not available but as a highly potent benzodiazepine it might be used to modulate the effects of stimulant abuse or to help with a "bad trip" caused by LSD or other hallucinogens. It can be expected that Ativan has some street use to boost the euphoriant effects of opioids like heroin, perhaps heroin and other drugs could be "cut" with Ativan without the knowledge of the user. The risk if used together with an opioid is respiratory depression or arrest.

Ativan as a date rape drug: Ativan has no particular taste and could in principle be misused as a 'date rape drug' since it has strong amnesic properties relatively to other benzodiazepines. But as Ativan has poor water solubility flunitrazepam is the more commonly used drug for this purpose. The action of Ativan together with alcohol can be dangerous, both in terms of criminal behavior and, in higher amounts, significant central nervous system depression manifesting as unconsciousness, respiratory depression, coma or - in rare instances - death.

Ativan is a Schedule IV drug under the Controlled Substances Act in the US and internationally under the United Nations Convention on Psychotropic Substances.

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