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Ativan (Lorazepam)

Ativan
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“In 2008, news reports revealed that Ativan was being used by the U.S. Customs Service to keep suspected terrorists sedated while deporting them to detention facilities abroad.” Christopher Byron, New York Times

Wyeth Pharmaceuticals first introduced Lorazepam in 1977 under the brand name Ativan. Although Wyeth's original patent has long expired in the United States, the drug continues to be a huge commercial success. Today Lorazepam is marketed under more than 70 brand names.

Ativan is one of the primary benzodiazepine drugs, along with Valium (diazepam), Klonopin (clonazepam), and Xanax (alprazolam). What sets Ativan apart from the other benzos is its superior anti-seizure properties, its ability to control nausea/vomiting (even chemotherapy induced nausea/vomiting), and its greater hypnotic (sleep inducing) properties.

Like all benzodiazepines, Ativan works by increasing the availability of the neurotransmitter, GABA (GAMMA-AMINOBUTYRIC ACID), the body’s natural calming agent.

Lorazepam is referred to as an anxiolytic (anti-anxiety) drug, most often used in the short-term treatment of moderate to severe anxiety. Because of its quick onset, its relative potency, and its propensity to be addictive it is generally not advisable to use Lorazepam for more than four weeks.

In addition to being an anxiolytic drug, Ativan is also known for its sedative-hypnotic properties making it an ideal sleep agent. It is also a very effective anticonvulsant medication used in controlling epileptic seizures.

Its off-label uses are many including seizures in children, agitation, irritability, mania, nervous tension, pre-surgery anxiety, alcohol withdrawal symptoms, irritable bowel syndrome, and severe vomiting due to chemotherapy

The drug is classified by the DEA as a schedule IV controlled substance. This means the drug has a currently accepted medical use with a low to moderate risk of abuse.

The drug has gained a reputation in the U.S. as a widely used recreational drug. In addition, because of its sedative properties, it has been used for criminal purposes in the manner as drugs like GHB (Rohypnol).

The most common side effect associated with lorazepam is sedation. Other common side effects include dizziness, weakness, dry mouth, drowsiness, constipation, and blurred visions. More serious side effects include: fever, rash, irregular heart rate, jaundice, and difficulty breathing.

Lorazepam is available is 0.5mg, 1mg, and 2 mg tablets. A liquid form of the drug is also available in 2mg/ml and 4mg/ml solutions.

Lorazepam's action of onset is quick, about 20 minutes. It reaches peak plasma concentrations in the blood in about two hours. Its half-life is short, only about 12 hours (meaning within 12 hours half of the drug has already left the body).

In terms of its relative potency, 1mg of Ativan is equivalent to about 5 mgs of Valium, 0.5 mg of Xanax, and 0.25 mgs of Klonopin.

Ativan and Xanax are chemically closer in terms of their quick onset of action and their short half-life. This is also what make them more likely to cause dependence. Valium and Klonopin have a much longer half-life making them a safer alternative particularly for long term use.

Patients should not stop taking Ativan abruptly due to the possibility of withdrawal. Withdrawal can occur after just two weeks of taking the medication. Patients should work with their physician or pharmacist be gradually weaned down to lower and lower doses (titration)

Signs of Ativan withdrawal include: headaches, anxiety, depression, insomnia, irritability, sweating, dizziness, numbness/tingling, nausea, vomiting, diarrhea, appetite loss, hallucinations, and seizures.

For more information on benzodiazepines including benzo withdrawal refer to, Mad in America and the titles suggested by the author below.

Source material: Drugs.com, The Fix, Wikipedia, NIH.gov, The U.S. FDA