Can Ativan Be Stopped Abruptly?

TC2018 asked

My doctor has prescribed me Ativan 3-3.5 mg daily as needed. For the past 3-4 months I have used the prescribed amount 3-4 times per week ( usually 3). I want to stop the Ativan or at least reduce the frequency. Can I just stop the Ativan or should I taper? If I need to taper, how quickly or slowly should I do that? How quickly would withdrawal symptoms start if I were to have them?

Answer

It is not recommended to stop Ativan (lorazepam) abruptly without discussing it with your doctor first. Stopping Ativan 'cold-turkey', without a gradual dose reduction, greatly increases the risk of relapse/rebound of the condition being treated and withdrawal symptoms. These symptoms can include:

• Sweating
• Increased heart rate
• Muscle cramps
• Tremor
• Insomnia
• Anxiety
• Agitation
• Nausea
• Vomiting
• Sweating
• Hallucinations
• Seizures

The prescribing information states the following regarding withdrawal symptoms with Ativan:

Withdrawal symptoms (e.g., rebound insomnia) can appear following cessation of recommended doses after as little as one week of therapy. Abrupt discontinuation of product should be avoided and a gradual dosage-tapering schedule followed after extended therapy.

It is important that you speak with your doctor regarding how to safely and effectively stop Ativan if you plan on discontinuing it.

There are many factors to take into consideration and your doctor will be your best resource as they have your complete medical history.

Benzodiazepine Withdrawal

Ativan (lorazepam) is classified as a benzodiazepine. Physiologic dependence and the resulting difficulty in getting off the medication occurs often as a natural consequence of regular use. It doesn't necessarily imply misuse or abuse.

How quickly dependence develops depends on a variety of factors, but studies suggest that it can occur in as few as 1-6 weeks, especially if high doses are used. Resulting withdrawal symptoms with benzodiazepines like Ativan are commonly seen if stopped abruptly or your dose is reduced too quickly.

Additionally, certain benzodiazepines are more likely than others to cause withdrawal symptoms, especially ones that have a short duration of action of half-life. Ativan is one benzodiazepine that has been associated with more severe withdrawal symptoms than many others due to its relatively short duration of action.

Withdrawal symptoms, if they occur, can start almost immediately after a change in dose. They generally range from mild to moderate in severity, but can certainly be worse depending on the individual.

If treating certain conditions, like epilepsy, it is vitally important that individuals not be withdrawn abruptly from benzodiazepines due to the risk of inducing seizures. The greatest risk of seizure is typically during the first 24 to 72 hours.

Ativan Taper Strategies

It is important to remember that following a tapering protocol does not eliminate the risk of withdrawal symptoms. If nothing else, it should hopefully reduce the severity and duration of them.

There is no single recommended tapering method for Ativan. The approach used is very much patient-specific and should be based on a discussion with your doctor as there are many factors to consider, such as:

• Co-morbidities
• Concomitant medications
• Dose you have been taking
• How long you have been taking the medication
• Disease being treated

One source recommends tapering a benzodiazepine like Ativan no faster than a 25% dose reduction per week. This would result in a 4 week long, gradual dose reduction, until the drug is finally discontinued.

Other sources vary their recommendations based on the condition being treated. For example, for panic disorder, The Practice Guideline For The Treatment of Patients With Panic Disorder recommends a taper no faster than 10% per week. This would result in a taper of nearly 3 months.

Yet another strategy involves switching from Ativan to another benzodiazepine with a long half-life, such as clonazepam or diazepam. Long half-life drugs tend to have less severe, more manageable withdrawal reactions.

All in all, even though there is no single agreed-upon 'best' tapering strategy, the important thing to remember is that, in general, benzodiazepines like Ativan should be slowly tapered to minimize the risk of withdrawal.

Be sure to discuss your particular situation with your doctor to find the best approach.