Ativan (lorazepam) is a brand-name drug that your doctor may prescribe off-label for alcohol withdrawal. The drug isn’t approved for this use, but it has been shown to be helpful in treating alcohol withdrawal.

Ativan is available in these forms: oral tablet and solution for injection. Ativan belongs to a drug class called benzodiazepines. The medication is available in a generic version.

Read on for more information about Ativan. You can also refer to this article for a comprehensive look at Ativan and its approved uses.

Note: The Food and Drug Administration (FDA) has approved Ativan to treat anxiety disorders and symptoms. In some cases, your doctor may prescribe Ativan off-label for alcohol withdrawal. Off-label drug use is when an FDA-approved drug is prescribed for a purpose other than what it’s approved for.

Ativan has boxed warnings. A boxed warning is the most serious warning from the FDA. For details, see the “Before taking Ativan” section.

Alcohol withdrawal (also called alcohol withdrawal syndrome, or AWS) happens when a person suddenly stops or significantly reduces drinking after long-term heavy alcohol use.

Alcohol has a depressant effect on your central nervous system. It slows down activity in your brain and nerves.

Over time, heavy alcohol use causes your brain to become used to alcohol’s depressant effects. In response, your brain makes more excitatory neurotransmitters (chemical messengers) to counter alcohol’s effects. If you then suddenly reduce or stop alcohol use, your nervous system becomes overactive due to an imbalance in calming and excitatory neurotransmitters.

Symptoms of alcohol withdrawal

Symptoms of alcohol withdrawal include:

Alcohol withdrawal is often mild. But in extreme cases, it can be fatal.

Who Ativan is prescribed for

Doctors may prescribe Ativan off-label for adults who are experiencing alcohol withdrawal. Benzodiazepines (including Ativan) are considered first-choice treatment options for alcohol withdrawal.

Your doctor may choose to prescribe Ativan instead of other benzodiazepines depending on a few factors, including your medical history. Depending on other medical conditions you may have, Ativan may be a safer choice than other benzodiazepines. For example, Ativan may be preferred if you:

  • have a severe liver problem such as cirrhosis
  • have a severe lung disease such as severe chronic obstructive pulmonary disease (COPD) or asthma
  • are 65 years old or older

Because benzodiazepines such as Ativan have a high potential for misuse, abuse, and dependence, your doctor may prescribe a different medication if you have a substance use disorder (such as opioid use disorder) that doesn’t involve alcohol.

Your doctor will determine whether taking Ativan off-label for alcohol withdrawal is safe for you.

You should not take Ativan for alcohol withdrawal unless your doctor has prescribed the drug for this purpose. The use of Ativan for alcohol withdrawal is considered an off-label use. Off-label drug use is when a medication the Food and Drug Administration (FDA) has approved is prescribed for a purpose other than what it’s approved for.

Alcohol withdrawal symptoms are caused by an imbalance between calming and excitatory signals in your nervous system. Ativan treats alcohol withdrawal by increasing the activity of calming nerve signals.

The way Ativan works

Ativan works by attaching to gamma-aminobutyric acid (GABA) receptors (binding sites). GABA is a chemical your body makes naturally. GABA functions in your body to slow down nerve signals, which has a calming effect on your nervous system.

When Ativan binds to GABA receptors, it makes it easier for GABA to bind to these receptors. By making it easier for GABA to attach to its receptors, Ativan increases GABA activity and calms your nervous system. This brings better balance between excitatory and calming nerve signals, which can relieve alcohol withdrawal symptoms.

Ativan and other benzodiazepines are considered first-choice preferred treatment options for alcohol withdrawal. These medications are proven to treat and prevent alcohol withdrawal symptoms, including lowering the risk of seizures and delirium.

Ativan is one of the most commonly prescribed benzodiazepines for alcohol withdrawal. Other benzodiazepines commonly used for alcohol withdrawal include chlordiazepoxide (Librium), diazepam (Valium), and oxazepam.

Ativan is a short-acting benzodiazepine, while chlordiazepoxide and diazepam are long-acting. Ativan may be preferred if you have severe liver problems such as cirrhosis. But chlordiazepoxide and diazepam may otherwise be preferred over Ativan because long-acting benzodiazepines have a lower risk of withdrawal symptoms*.

* Ativan has a boxed warning for the risk of dependence and withdrawal symptoms. This is a serious warning from the Food and Drug Administration (FDA). To learn more, see the “Before taking Ativan” section.

Ativan is available as an oral tablet and a solution for intramuscular (IM) or intravenous (IV) injection. Dosages for these forms are described below.

Dosage

For treating alcohol withdrawal symptoms, Ativan may be given as needed or as a fixed dose.

A fixed dose schedule means you’ll regularly take Ativan doses even if you’re not actively experiencing symptoms of alcohol withdrawal. Either the oral tablet or the solution for injection form of Ativan may be used. One example of a commonly used fixed dose schedule is:

  • 2 milligrams (mg) every 6 hours, for 4 doses, followed by
  • 1 mg every 6 hours, for 8 doses

Ativan use as needed for alcohol withdrawal is referred to as a symptom-triggered regimen. Under this dosing, Ativan is given as needed at a dose based on the severity of your symptoms. Typical dosages are 2 mg to 4 mg given only as needed. Either form of Ativan may be used.

Treating alcohol withdrawal delirium

For treating delirium related to alcohol withdrawal, the solution for injection form is preferred. The recommended dose depends on whether the solution is given as an IM or IV injection:

  • IM injection: 1 to 4 mg, every 30 to 60 minutes, until delirium resolves; this may be repeated every hour as needed
  • IV injection: 1 to 4 mg, every 5 to 15 minutes, until delirium resolves; this may be repeated every hour as needed

Note: In addition to being prescribed off-label for alcohol withdrawal, Ativan is approved by the Food and Drug Administration (FDA) for certain uses. Keep in mind that the drug’s dosage may differ with these approved uses. To learn more, talk with your doctor.

How to take

You can take Ativan oral tablet with or without food. If you’re prescribed Ativan oral tablet, ask your doctor or pharmacist whether it’s OK to split the tablets. Some Ativan tablets come with a score, which makes it easy to split the tablet. Your pharmacist or doctor can help if you’re having trouble swallowing pills.

Ativan solution for IM or IV injection is given only by a healthcare professional. You won’t give yourself doses of this form of Ativan.

How often to take

For treating alcohol withdrawal, Ativan is usually prescribed as a short-term treatment.

How often you’ll take Ativan for alcohol withdrawal depends on the form and dosing schedule you’re prescribed. For more information, see the “Dosage” section. You can also talk with your doctor or pharmacist to learn more.

The off-label use of Ativan for alcohol withdrawal may cause side effects that are mild or serious. Off-label drug use is when a medication the Food and Drug Administration (FDA) has approved is prescribed for a purpose other than what it’s approved for.

The lists below include some of the main side effects reported in clinical trials of Ativan for its FDA-approved uses. The side effects of Ativan when used off-label for alcohol withdrawal are expected to be similar.

For information about other potential side effects of the drug, talk with your doctor or pharmacist. You can also refer to Ativan’s prescribing information.

Note: After the FDA approves a medication, it tracks and reviews side effects of the drug. If you develop a side effect while taking Ativan and would like to inform the FDA, visit MedWatch.

Mild side effects

Mild side effects reported with Ativan include:

  • appetite changes
  • confusion
  • dizziness
  • drowsiness
  • fatigue
  • libido (sex drive) changes
  • memory problems
  • problems with balance and coordination
  • slurred speech
  • weakness

These side effects of Ativan may be temporary, lasting a few days to weeks. But if they last for a longer time, bother you, or become severe, it’s important to talk with your doctor or pharmacist.

Serious side effects

Serious side effects reported with Ativan include:

  • depression
  • low blood pressure, which can be severe enough to cause fainting
  • paradoxical reactions, such as agitation, aggression, or hostility
  • respiratory depression (slow, shallow breathing)
  • seizures
  • suicidal thoughts or behaviors
  • risk of misuse and addiction*
  • risk of dependence and withdrawal*
  • risk of severe or life threatening side effects if used with opioids*

Call your doctor right away if you develop serious side effects while taking Ativan. If the side effects seem life threatening or you think you’re having a medical emergency, call 911 or your local emergency number immediately.

* Ativan has a boxed warning for this side effect. A boxed warning is the most serious warning from the FDA. To learn more, see the “Before taking Ativan” section.

Allergic reaction

For some people, Ativan can cause an allergic reaction.

In general, symptoms of allergic reaction can be mild or serious.

Ways to manage

For mild allergic reaction symptoms, such as a mild rash, call your doctor right away. They may recommend treatments to help manage your symptoms. They’ll also let you know whether you should keep taking the medication.

For severe allergic reaction symptoms, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms require immediate medical care because they can become life threatening. If you’ve had a serious allergic reaction to Ativan, your doctor may recommend taking a different medication instead.

How much Ativan costs is based on several factors. These can include your prescribed treatment regimen, the insurance plan you have, the pharmacy you use, and your location.

If you receive Ativan solution for injection, you may also need to pay for a healthcare professional to administer this form.

Ativan is a brand-name drug that’s also available as a generic called lorazepam. Brand-name drugs usually cost more than generics. Your doctor can advise you on whether the generic is safe for you to take off-label* for alcohol withdrawal. If it is, they can also help determine whether the brand-name drug or the generic is right for you. To learn about the generic form, talk with your doctor.

* Off-label drug use is when a drug the Food and Drug Administration (FDA) has approved is prescribed for a purpose other than what it’s approved for.

Before your doctor prescribes Ativan off-label for alcohol withdrawal, there’s some important information to keep in mind. The drug may not be a safe option for you if you have certain medical conditions or other factors that affect your health. Some of these are mentioned below.

Off-label drug use is when a drug the Food and Drug Administration (FDA) has approved is prescribed for a purpose other than what it’s approved for.

Boxed warnings

This drug has boxed warnings about risks of misuse and abuse, dependence and withdrawal, and severe or life threatening side effects if used together with opioids. These are serious warnings from the FDA.

Risk of misuse and addiction: Like other benzodiazepines, Ativan carries a risk of misuse and addiction. Misuse involves taking a medication in a manner other than how it’s prescribed. With addiction, drug use continues even though it’s causing harm, even if you have a desire to stop.

Risk of dependence and withdrawal symptoms: Even when used as prescribed, Ativan can lead to physical dependence and withdrawal symptoms. With dependence, your body needs a drug in your system in order to function as usual. Withdrawal symptoms are symptoms that can occur when you stop taking a medication your body is dependent on. To learn more about benzodiazepine withdrawal, check out this article.

To lower your risk of these side effects, only use Ativan exactly as prescribed by your doctor for alcohol withdrawal. Your doctor may gradually lower your Ativan dose over time until it’s safe for you to stop taking the medication entirely. If you have questions or concerns about how Ativan could affect you, talk with your doctor.

Risk of severe or life threatening side effects if used together with opioids: Taking Ativan together with opioids can lead to life threatening side effects, including respiratory depression and coma. Due to the risk of severe side effects, doctors typically avoid prescribing Ativan and opioids together unless there are no other treatment options available. Be sure to tell your doctor about all medications you take before you start taking Ativan for alcohol withdrawal.

To learn more about these warnings, talk with your doctor or pharmacist.

Other warnings

In addition to boxed warnings, Ativan has other warnings.

If any of the following medical conditions or other health factors are relevant to you, talk with your doctor before using Ativan:

  • if you have a history of benzodiazepine use disorder
  • if you depression
  • if you have a history of suicidal thoughts or behaviors
  • if you have a breathing problem such as asthma
  • if you have a kidney or liver problem
  • pregnancy
  • breastfeeding
  • alcohol consumption
  • if you’ve had an allergic reaction to Ativan or any of its ingredients

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.