Ativan (Lorazepam) is a prescription medication from the benzodiazepine group, used to treat anxiety disorders, insomnia, and some seizures. It has anxiolytic, sedative, and muscle relaxant effects. The drug can cause addiction and dependence, especially with prolonged use in high doses, so its use should be strictly monitored by a doctor.

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People who suffer from anxiety disorder experience a range of rather unpleasant symptoms, both physical and emotional, which can eventually lead to the cessation of a person’s emotional well-being, affecting one or more areas of their life. Anxiety should be treated by a professional who will determine what type of treatment is best suited for a particular situation.

In most cases, it is only a matter of conducting psychological treatment, but in some others, it is necessary to combine it with the use of certain medications, such as Ativan, in order to help a person cope with the level of anxiety.

Action

The drug, acting on the cells of the central nervous system, relaxes the muscles of the body, regulates sleep, and has an anticonvulsant, antiemetic, and anxiolytic effect.

Ativan has proven itself in the treatment of anxiety, fears, insomnia, and panic attacks, but it is not prescribed for the treatment of external (exogenous) psychoses accompanied by delusional, manic, affective, or hallucinogenic symptoms.

In the treatment of chronic depression, the drug is used as an auxiliary agent that activates the therapeutic effect of the main antidepressant.

It is necessary to strictly adhere to the scheme and duration of use of Ativan since their violation can lead to the development of drug dependence, withdrawal syndrome, or addiction.

The effect of the drug on the human body

The drug has a complex effect on the human body associated with its effect on the central nervous system. The main effects of Ativan:

Anxiolytic effect. The drug enhances the inhibitory effect of the neurotransmitter GABA in the central nervous system, which leads to a decrease in the excitability of neurons (nerve cells) and a decrease in the feeling of anxiety and fear.
Sedative effect. The drug has a general calming effect on the body, reduces the reaction to external stimuli, causes drowsiness, and reduces the time it takes to fall asleep.
Muscle relaxant effect. Ativan reduces the tone of skeletal muscles, which leads to their relaxation and a decrease in muscle tension.
Anticonvulsant effect. The drug suppresses seizure activity in the central nervous system, which is useful for some types of epilepsy and alcohol withdrawal (alcohol withdrawal syndrome).

Indications

Ativan is mainly prescribed for the following:

for psychoreactive conditions;
for the treatment of extreme nervous emotional stress and anxiety, for psychosomatic disorders, to relieve a panic attack;
during schizophrenic conditions;
symptoms of VSD;
in a state of insomnia that appeared due to stress and increased anxiety;
for the treatment of epileptic conditions (in these cases, the drug is used as part of a complex treatment);
during depressive states, in which signs of anxiety are observed (used with extreme caution!);
for headaches that are accompanied by increased muscle tension;
to eliminate neurosis-like conditions and neuroses, in which tension and feelings of anxiety are observed;
to prevent nausea and vomiting that occur during chemotherapy.

Dosage, how to take Ativan

Ativan should be taken orally with a small amount of water. The dosage and duration of treatment should be strictly according to the doctor's instructions.

Adults and children over 12 years of age

For neurotic and neurosis-like conditions, 2 mg to 3 mg of Ativan per day is usually prescribed at first, divided into 1-3 doses, and then, if necessary, the daily dose of the drug is increased to a maintenance dose, which most often ranges from 2 mg to 6 mg per day, divided into 1-3 doses.

To relieve anxiety symptoms, it is recommended to use the smallest effective doses possible.

The dose of Ativan should be increased gradually, starting with an increase in the dose taken in the evening. The maximum can be prescribed up to 10 mg per day.

For sleep disorders caused by anxiety, 2 mg to 5 mg of Ativan is usually prescribed once a day before bedtime.

For premedication, 2 mg to 5 mg is prescribed the night before the planned procedure or surgery, and on the day of the procedure, 2 mg to 5 mg 1-2 hours before the procedure or surgery.

Children under 12 years of age

Ativan is not recommended for use in children due to the lack of data on the safety and efficacy of Ativan in children under 12 years of age.

Patients with mild to moderate hepatic and/or renal impairment

Caution should be exercised when prescribing Ativan to patients with impaired liver function and/or mild to moderate renal failure. The dose is selected individually for each patient, depending on the degree of failure of the diseased organ.

Elderly patients

Elderly patients are more sensitive to drugs acting on the central nervous system. When using Ativan in these patients, it is recommended to prescribe the smallest possible effective dose. Usually, it is enough to use half the dose prescribed for adults.

In symptomatic treatment of anxiety disorders, the duration of treatment should be limited to a minimum - usually from several days to 2 weeks. In individual cases, treatment can be extended.

The maximum duration of treatment, including the period of gradual withdrawal, should not exceed 4 weeks. Gradual withdrawal of the drug must be established individually for each patient. In individual cases, after assessing the patient's condition, the doctor may decide to extend the maximum treatment time.

Overdose

As a result of an overdose of Ativan, the following symptoms may appear: drowsiness, disorientation, slurred speech, and in severe cases, loss of consciousness and coma. Poisoning caused by the simultaneous use of Ativan and alcohol or Ativan and other drugs that have a depressant effect on the central nervous system can be life-threatening.

In case of poisoning with Ativan, it is necessary to take measures aimed at the fastest possible elimination of the drug from the body that has not yet been absorbed or to reduce its absorption from the digestive tract (inducing vomiting, taking activated charcoal, gastric lavage - provided that consciousness is preserved), monitor the main vital functions (respiration, pulse, blood pressure) and, if necessary, apply appropriate symptomatic treatment.

A specific antidote is flumazenil.

Special instructions for the use of Ativan

Doctors give some instructions regarding the use of the drug in certain categories of patients:

Pregnancy and breastfeeding. Ativan can have a negative effect on the development of the fetus, especially when used in the first trimester (first 3 months). Congenital malformations, such as floppy baby syndrome (depressed respiration, decreased muscle tone and reflexes), are possible. The drug passes into breast milk, causing sedation (excessive calming) and respiratory depression in the infant.
Impaired liver function. The drug is metabolized (processed) in the liver, so if it is not functioning properly, the elimination of lorazepam may be slower, and the risk of side effects may increase.
Impaired kidney function. The elimination of the drug from the body is slower, which leads to its accumulation and an increased likelihood of side effects.
In children. The safety and effectiveness of Ativan in children under 12 years of age have not been established. The use of tablets in this age group is possible only according to strict indications and under the close supervision of a doctor.
In elderly patients. Elderly people are more sensitive to the drug and have an increased risk of side effects. This medicine, even when taken as prescribed, can change the reaction speed, which significantly affects the ability to participate actively in road traffic or operate machinery. This is largely due to the action of benzyl alcohol. Patients who have received Ativan are not recommended to drive a car, operate dangerous machinery, or engage in any activity that requires a high degree of attention for the next 24-48 hours. Decreased attention, for example, in elderly patients due to weakening due to surgery or poor general condition, can persist for a long time.

Side effects

The side effects of Ativan depend on the individual sensitivity of the patient and the dose of the drug.

The most common of them are:

Drowsiness, sedation (excessive sedation), and increased fatigue: the patient feels sluggish, inhibited, and has difficulty concentrating.
Dizziness and ataxia (impaired coordination of movements): unsteadiness when walking, unsteadiness of gait, difficulty maintaining balance.
Muscle weakness and hypotonia (decreased muscle tone): the patient feels heaviness in the limbs, difficulty performing routine activities.
Amnesia (memory impairment): especially when using high doses of lorazepam, it is possible that the memorization of new information and events occurring after taking the drug may be impaired.
Paradoxical reactions: in rare cases, the drug causes effects opposite to those expected, such as agitation, aggression, nervousness, and illusions.
Behavioral disorders: disinhibition, euphoria (excessively elevated mood), and inappropriate behavior, especially in the elderly.
Allergic reactions: skin rash, itching, hives, swelling of the face and throat, difficulty breathing (require immediate medical attention).
Withdrawal: sudden discontinuation of the drug after long-term use may cause anxiety, insomnia, irritability, tremors, and seizures.
Drug dependence (addiction): with long-term use, Ativan causes psychological and physical dependence.

Rarer side effects include nausea, vomiting, constipation, dry mouth, visual impairment, decreased libido (sexual desire), and menstrual irregularities in women.

Ativan addiction

Ativan addiction is a serious problem that develops with long-term use of the drug, especially in high doses.

There are two main types of addiction:

A condition in which the body adapts to the constant presence of the substance and needs it for normal functioning. When you stop taking the drug, withdrawal syndrome develops, characterized by unpleasant symptoms: anxiety, insomnia, tremors (shaking), sweating, nausea, and convulsions.
Obsessive desire to take pills in order to achieve the desired effect (reducing anxiety, sedation). The patient experiences a strong desire to take the drug despite the negative consequences for health and social life.

Stages of addiction

Initial- the patient takes the drug as prescribed by the doctor and does not experience problems with control over the intake.

Abuse- a person begins to take Ativan in larger doses or for a longer period of time than recommended by the doctor. Often, at this stage, problems arise in the professional and social spheres.

Dependence- physical and/or psychological addiction develops. The patient continues to take the pills and experiences severe discomfort when trying to stop taking them.

Self-cancellation of the drug after prolonged use is dangerous due to the risk of developing severe withdrawal syndrome. Stopping Ativan should be gradual and only done under the supervision of a doctor.

Addiction prevention

Addiction prevention from Ativan is a set of measures aimed at preventing the development of drug abuse and minimizing health risks:

It is prohibited to independently increase the dose or duration of taking the drug;
Take the tablets strictly under the supervision of a doctor;
Before starting a therapeutic course, take into account contraindications and possible risks;
If signs of addiction appear, you should contact a clinic.

Only a comprehensive approach, including informing patients, responsible prescription of the drug by doctors, timely detection and treatment of addiction, as well as the use of non-drug methods of anxiety management, can effectively prevent the development of addiction to lorazepam and minimize the associated risks to health and quality of life.

How long does Ativan stay in the body?

The duration of lorazepam elimination depends on several factors: dose, individual metabolic characteristics (the rate at which substances are processed in the body), and the functional state of the liver and kidneys.

After oral administration, the medication is quickly absorbed from the gastrointestinal tract and reaches its maximum concentration in the blood after 1-2 hours. The drug is actively metabolized in the liver to form inactive metabolites (processing products), which are then excreted by the kidneys in the urine.

The half-life (the time it takes for the concentration of lorazepam in the blood to decrease by half) is, on average, 12-18 hours. This means that after this time, 50% of the dose taken will be excreted from the body. However, in some patients, especially the elderly or those with impaired liver/kidney function, the half-life increases to 20-40 hours.

With regular use of tablets for several weeks or months, the substance accumulates in the body, which leads to an increase in its concentration in the blood and a longer period of elimination after stopping the use.

Complete elimination of lorazepam and its metabolites occurs within 5-7 half-lives, that is, 2-5 days after the last use.

Combination of the drug with other substances

Combination of Ativan with other substances leads to various interactions that can be dangerous to the health and even life of the patient. Some combinations enhance the therapeutic effects of the tablets, while others increase the risk of adverse reactions and side effects.

Simultaneous use of Ativan and alcohol leads to a marked increase in the depressant effect on the central nervous system. This is due to the fact that both substances are CNS depressants, and their effects are cumulative.

Possible consequences of such a combination include excessive drowsiness, confusion, impaired motor coordination, respiratory depression, and even respiratory arrest.

The combination of Ativan with some antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and paroxetine, leads to increased sedative effects and an increased risk of developing serotonin syndrome - a potentially dangerous condition characterized by increased body temperature, impaired consciousness, seizures, and autonomic dysfunction.

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