Ativan Withdrawal Symptoms, Timeline & Detox Treatment

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Ativan (lorazepam) is a benzodiazepine used to treat anxiety, insomnia, continuous seizures and agitation related to alcohol withdrawal. Benzodiazepines are central nervous system (CNS) depressants that slow activity in the brain, promoting relaxation.

The DEA classifies Ativan as a Schedule IV controlled substance, meaning it has a low potential for abuse and low risk of dependence. While its abuse potential may be low, there are risks associated with Ativan use. Ativan has an FDA Black Box Warning against combining it with opioids and other sedating medications — as doing so can lead to severe adverse reactions, including slowed or difficult breathing and death. Black Box Warnings are the most serious warnings from the FDA.

Ativan is approved for short-term use, but its effectiveness long-term (more than four months) has not been studied. The risk for dependence is low when Ativan is used short-term (for two to four weeks), but it increases with higher doses and more prolonged use. A gradual taper schedule should be followed after long-term use to help prevent withdrawal symptoms.

Ativan Withdrawal: Acute vs. Protracted 

Ativan withdrawal can be separated into two phases, acute withdrawal reaction and protracted withdrawal syndrome. An acute withdrawal reaction can occur when Ativan (lorazepam) is stopped abruptly or the dose is reduced too quickly. Though acute withdrawal symptoms vary from person to person, they can be uncomfortable and possibly life-threatening. Tapering is recommended to reduce the severity of withdrawal symptoms.

Some individuals will experience protracted withdrawal syndrome. This syndrome consists of withdrawal symptoms lasting longer than four to six weeks, sometimes lasting greater than 12 months.

Characteristics of protracted withdrawal syndrome include:

• Anxiety
• Brain fog 
• Depression
• Insomnia
• Weakness, tremor and muscle twitches
• Nerve tingling, “pins and needles” (paresthesia)
• Sensation of having bugs crawling on or under the skin (formication)
• Ringing in the ears (tinnitus)

When Does Ativan Withdrawal Start?

Ativan has an average half-life of 12 hours. This is the time it takes the body to get rid of half the dose of Ativan. Because of its short half-life, early withdrawal symptoms can begin within 24 hours after the last dose but may take up to four days to start.

How Long Does Ativan Withdrawal Last?

Acute withdrawal symptoms from Ativan usually last 10 to 14 days. In some cases, a protracted withdrawal syndrome can occur after the acute withdrawal syndrome. 

Ativan Withdrawal Timeline

• Early Ativan Withdrawal: Early Ativan withdrawal can begin as soon as 24 hours after the last dose of Ativan. Early withdrawal symptoms are usually mild and consist of headache, restlessness, insomnia and nausea.
• Acute Ativan Withdrawal: Acute Ativan withdrawal occurs within one to four days after the last dose of Ativan. This is when peak withdrawal symptoms occur. Acute withdrawal symptoms typically last 10 to 14 days.
• Protracted Withdrawal Syndrome: Protracted withdrawal syndrome occurs in some individuals after the acute withdrawal phase has passed. Symptoms in this stage continue at least four weeks after the acute withdrawal phase and may last greater than 12 months.

Ativan Withdrawal Symptoms

Ativan withdrawal symptoms can vary from person to person. Most withdrawal symptoms occur within one to four days after the last dose of Ativan and can last for about two weeks.

Physical withdrawal symptoms may include:

• Abnormal involuntary movements
• Blurred vision
• Dizziness
• Tiredness
• Nausea, vomiting and diarrhea
• Weight loss and decreased appetite
• Headache
• High blood pressure and rapid heart rate
• Muscle pain and stiffness
• Tremor
• Convulsions
• Seizures
• Delirium tremens

Psychological withdrawal symptoms may include:

• Anxiety
• Depression
• Irritability
• Confusion
• Panic attacks
• Light sensitivity
• Restlessness
• Hallucinations
• Mania
• Psychosis
• Suicidality

Factors Affecting the Severity of Ativan Withdrawal

The severity of Ativan withdrawal symptoms can vary depending on each situation. Several factors that may affect the severity of Ativan withdrawal include:

• Duration of Use: Long-term Ativan users may experience more severe withdrawal symptoms. Some withdrawal symptoms can occur after only one week of Ativan treatment, but taking Ativan long-term for greater than four months can increase the likelihood of severe withdrawal symptoms.
• Dose of Ativan: Those taking higher doses of Ativan may experience more severe withdrawal symptoms. It may be necessary to taper off Ativan to prevent severe withdrawal symptoms after taking Ativan at high doses.
• Underlying Mental Health Conditions: People with underlying mental health conditions may experience more severe psychological withdrawal symptoms when stopping Ativan. Withdrawal symptoms, such as anxiety, depression, irritability, panic attacks and restlessness, may be worse in these individuals.
• Abrupt Discontinuation of Ativan: Abruptly stopping Ativan can result in severe withdrawal symptoms. It is recommended to slowly taper the dose of Ativan to decrease or prevent withdrawal symptoms.
• Rapid Decreased Dose of Ativan: The dose of Ativan should be tapered, or decreased slowly, over time. A rapid decrease in the dose of Ativan may result in severe withdrawal symptoms.

Ativan Withdrawal Medications

Several medications may help reduce Ativan withdrawal symptoms. These medications help people going through Ativan withdrawal cope with anxiety, depression and insomnia during withdrawal.

 Medications prescribed for the management of Ativan withdrawal include:

• Antidepressants: Antidepressants used for depression and sleep problems may include trazodone, doxepin, mirtazapine (Remeron), trimipramine and serotonin-reuptake inhibitors such as escitalopram (Lexapro) and fluoxetine (Prozac).
• Mood stabilizers: The most common mood stabilizer used in the treatment of benzodiazepine withdrawal is carbamazepine (Tegretol).
• Nonbenzodiazepine anxiolytics: Your doctor may prescribe an alternative medication to treat your anxiety, like pregabalin (Lyrica), gabapentin (Neurontin), or beta-blockers. 
• Antihistamines: Antihistamines such as diphenhydramine (Benadryl), doxylamine, hydroxyzine and promethazine may be used for withdrawal symptoms, including insomnia and anxiety.

Ativan Detox Treatment

During a medical Ativan detox, the body eliminates the drug from the system while under medical supervision. Your treatment team at Orlando Recovery Center develops a detailed, individualized treatment plan after thorough intake and evaluation. Treatments and medical monitoring designed for the comfort and safety of each individual are included in each detox plan. Around-the-clock medical care during Ativan detox by clinicians and therapists can help manage withdrawal symptoms. 

The detox process can vary in length depending on the severity of withdrawal symptoms and the needs of the person struggling with Ativan dependence. Transitioning to an inpatient or outpatient rehab program after detox is often essential to continue the recovery process.

Get Help for Ativan Withdrawal

Orlando Recovery Center offers fully licensed and accredited detox and rehab treatment programs for those struggling with Ativan withdrawal. Each day, our licensed multidisciplinary team of experts helps people begin the first steps toward lifelong recovery. Programs at our center are designed to provide safety and comfort during detox and throughout rehab treatment.

Treatment plans at the Orlando Recovery Center are individualized for each patient and may include these programs:

• Medical detox
• Inpatient/residential treatment
• Partial hospitalization program
• Intensive outpatient services
• Outpatient care
• Teletherapy programs
• Individual and group therapy
• Family and couples counseling
• Nutritional counseling and dietary planning
• Life skills training
• Fitness therapy
• Case management
• Aftercare services

Amenities at Orlando Recovery Center include:

• A swimming pool
• A fully equipped exercise gym
• Basketball and sand volleyball courts
• Yoga, art and life skills therapy options
• Designated smoking areas
• Lakefront views

Ativan withdrawal can be challenging and sometimes dangerous to handle on your own. If you or a loved one is struggling with Ativan dependence, contact Orlando Recovery Center today.

Editor – Abby Doty

Abby Doty graduated from Hamline University in 2021 with a Bachelor's in English and Psychology. She has written and edited creative and literary work as well as academic pieces focused primarily on psychology and mental health. Read more