Ativan Side Effects
The most common Ativan side effects include central nervous system depression which typically manifest as clumsiness, drowsiness, unsteadiness of date, dizziness, weakness, lightheadedness and sometimes headache. Because of these common Ativan side effects individual citizens should avoid driving or operating otherwise dangerous equipment while under the influence of Ativan. Most serious Ativan side effects can include severe allergic reactions like rash, itching, hives, tightness of the chest or swelling of the mouth, trouble breathing and other symptoms of anaphylaxis. Additional severe Ativan side effects can be memory loss, depression, and in excessive dosage or when combined with other central nervous system depressant respiratory depression and death. It’s really important to avoid using Ativan with other central nervous system depressant like alcohol, barbiturates, other benzodiazepines, or high doses of antihistamines.
Like all of the benzodiazepines Ativan can lead to physical tolerance and severe withdrawal symptoms. Ativan withdrawal can be very difficult because agitation and anxiety are common Ativan side effects associated with withdrawal and because Ativan is typically used for anxiety this makes for very difficult situation. Unlike opioid withdrawal which although very uncomfortable and much dreaded by patients benzodiazepine withdrawal can lead to severe or life-threatening concerns. Ativan withdrawal seizures are well documented when moderately high or high dose Ativan therapy is abruptly discontinued. The seizures can even include a condition called status epilepticus which if untreated can be fatal. Typically patients who been using Ativan regularly for extended periods need to carefully coordinate with their physician a regimen to gradually taper off their Ativan.
Let’s look at some of the common side effects in more detail. This article will focus primarily on the use of oral Ativan rather than the use of intravenous Ativan which is sometimes used in hospitals or urgency situations for management of agitation or status epilepticus.
Central nervous system Ativan side effects: these are the most common Ativan side effects mentioned by patients. Most patients prescribed Ativan will notice dose-related drowsiness on initiation of therapy with less difficulty with these side effects after use the medication for period of time developing tolerance. In addition to the drowsiness many patients will complain of confusion, difficulty thinking clearly, loss of memory, loss of balance and coordination with Ativan that is again dose-related. These central nervous system side effects will often become less notable over time on a given Ativan dosage. This tolerance to Ativan has the associated problem of the potential for Ativan withdrawal symptoms. The use of benzodiazepines including Ativan in the elderly has been associated with an increased incidence of falls and is best avoided when possible.
Respiratory Ativan side effects: oral Ativan is not commonly associated with respiratory depression except in overdosage situations but the use of Ativan in patients with severe respiratory insufficiency like COPD is a concern.
Endocrine related Ativan side effects: condition called the syndrome of inappropriate ADH secretion has been rarely reported with Ativan use. In this condition patients can develop extremely low serum sodium levels and become very weak, have seizures with severe hyponatremia and require emergent hospitalization therapy.
Hematologic Ativan side effects: although quite uncommon like many other drugs bone marrow related blood dyscrasias including aplastic anemia, neutropenia and pancytopenia have been noted. Additionally a condition where red blood cells are destroyed by the immune system called hemolytic anemia can also be rarely included among Ativan side effects.
Renal Ativan side effects: renal Ativan side effects are extremely uncommon and the primary concern is of acute renal insufficiency related to cardiovascular collapse with Ativan overdosage.
Paradoxical stimulation with Ativan: Ativan, like other benzodiazepines, is occasionally associated with irritability, agitation, aggressiveness, psychosis, rage, hallucinations and other neuropsychiatric symptoms that are relatively obvious of the typical central nervous system depression. These are called paradoxical reactions and necessitate continuation of Ativan therapy. These paradoxical reactions are very uncommon and are unpredictable. Use of Ativan or other benzodiazepines in patients who had paradoxical Ativan side effects should be done with extreme caution if at all.
Dermatologic Ativan side effects: skin rashes have been reported with Ativan and in patients with allergic reaction Ativan hives is sometimes noted.
Ativan overdosage is unfortunately a relatively common concern. Like all of the benzodiazepines when taken in overdosage can cause severe respiratory depression and cardiovascular collapse, culminating in death. Patients who are considered potentially suicidal should be provided from access to major Ativan overdosage by limiting the number of pills they have access to if possible. Unfortunately is not always realistic because suicidality may be unrecognized. Ativan overdosage is more common when taken in conjunction with other central nervous system depressant most commonly alcohol. Ativan overdosage in patients intoxicated with alcohol is a relatively commonly encountered method of suicide attempt. Emergency management the situation is very important and if even considered a possibility emergency medical attention should be requested without any delay.
Ativan drug interactions: Ativan is contraindicated for use with sodium oxybate. Ativan therapy should be monitored carefully are modification considered for use with other drugs that can potentially cause central nervous system depression as well as especially with several of the drugs. Valproic acid derivatives is a specific example where lorazepam blood levels can be markedly increased when taken in conjunction with valproic acid derivatives. Propofol is another drug where when used in conjunction with Ativan can lead to severe central nervous system depression. Probenecid, and antimicrobial agent used in the treatment of tuberculosis and other infections can lead to increased lorazepam serum levels and use with Ativan requires careful monitoring or consideration of discontinuing Ativan. Additive effects have been noted with the use of aripiprazole and dexmedetomidine, two infrequently used medications. Most of the other drugs with significant drug interactions with Ativan are those with central nervous system depressant effects or effects on coordination or cognition. The use of Ativan in conjunction with antihistamines, opioids, barbiturates, alcohol, inhaled anesthetics, antipsychotics, tramadol, numerous anticonvulsants and almost any medication that can cause drowsiness can have additive adverse central nervous depressant Ativan side effects. Interestingly a large number of herbal drugs can potentially increase or decrease Ativan efficacy and sedation including milk Thistle, passionflower, green tea, Hawthorne, goldenseal, Siberian ginseng, and German chamomile among other supplements. This list of Ativan drug interactions is intentionally limited and patients are strongly encouraged to consult their pharmacist or personal physician with specific concerns and to notify the physician of all medications and supplements their taking as well as notifying the physicians of the quantity of their alcohol use prior to considering taking Ativan.
Ativan indications: there are number of FDA approved uses of Ativan including treatment of anxiety, short term treatment of insomnia, treatment of chemotherapy related nausea and vomiting, and as a preoperative or pre-procedure sedative. Off label use of Ativan includes management of severe vertigo although Valium is more typically used for this indication.
Ativan addiction: Ativan, like other benzodiazepines, can lead to both physical and psychologic addiction. Ativan is a fairly commonly abused drug for recreational use and has significant black market Street value. Anyone being prescribed Ativan needs to keep their supply of Ativan secured from theft and misuse. It’s important remember that the most common way that children at of lessons have access to medications for recreational use is by stealing it from their parents or other household members. Ativan overdosage by very in children can be very serious and fatal and so securing medicine from infants and children is extremely important. See the section above on Ativan withdrawal for discussion of the issues with management of Ativan discontinuation in cases of Ativan addiction. Controlled tapering of the medication is critical because abrupt discontinuation of high-dose Ativan can lead to very serious Ativan withdrawal that can be fatal on occasion.
Ativan use in pregnancy and lactation: Ativan is considered pregnancy category D. This means that there is documented evidence of fetal risk and that Ativan is generally used only in serious a life-threatening conditions where it’s benefit outweighs the documented risks. Ativan is considered possibly unsafe for use during lactation and generally avoided if possible.
Ativan is a scheduled for drug requiring physician prescription and careful monitoring. Patient should definitely avoid casual use of benzodiazepines including Ativan because of the risk of abuse, addiction and Ativan side effects.