Ativan interactions: Alcohol, medications, and other factors

Ativan (lorazepam) is a brand-name prescription drug that’s prescribed for anxiety and anxiety-related sleep problems. The medication is also prescribed for a type of severe seizure called status epilepticus. Ativan may also be given before surgery to reduce anxiety and make you sleepy.

As with other medications, Ativan can interact with alcohol and certain other drugs. It can also interact with some supplements. An interaction occurs when one substance causes another substance to have a different effect than expected.

Ativan is available in oral tablet and injection forms. These forms have similar interactions.* To learn more about Ativan’s interactions, keep reading. For additional information about Ativan, including details about its uses, see this article.

* You can find out more in “When to avoid Ativan” below.

In some cases, certain factors or conditions could prevent your doctor from prescribing Ativan due to the risk of harm. These are known as contraindications. The contraindications of Ativan include:

Having acute narrow-angle glaucoma

Ativan can increase the pressure in your eye. If you have acute narrow-angle glaucoma, Ativan could make the condition worse. Due to this risk, your doctor will likely not prescribe Ativan. You can ask them what other medications may be more suitable for you.

Having had an allergic reaction to Ativan or any of its ingredients

Doctors will likely not prescribe Ativan if you’ve had an allergic reaction to Ativan or any of its ingredients. The injection form of Ativan contains an additional ingredient: a preservative called benzyl alcohol. (Preservatives help prevent contamination and help keep the drug fresh and usable.)

Taking Ativan could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Having had an allergic reaction to other benzodiazepines

Doctors will likely not prescribe Ativan if you’ve had an allergic reaction to other benzodiazepines, such as diazepam (Valium). Ativan is a type of benzodiazepine. Taking Ativan when you’ve had an allergic reaction to any of these medications could cause another allergic reaction. Your doctor can advise you on other possible treatments.

Note: Before you start treatment with Ativan, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe Ativan.

You should avoid drinking alcohol with Ativan. You may be more sensitive to the effects of alcohol while taking Ativan. For example, alcohol may cause a lack of energy and respiratory depression (slowed breathing). If you drink and take Ativan, these effects may be more severe.

Also, Ativan and alcohol both slow down activity in your central nervous system, which includes your brain and spinal cord. Consuming alcohol with Ativan can cause serious side effects such as:

• excessive sleepiness
• memory loss
• breathing problems
• coma

Drinking alcohol with Ativan can also increase your risk of an overdose with the drug and, in some cases, be fatal. You can find more information about overdose and Ativan here.

If you have concerns or questions about avoiding alcohol during Ativan treatment, talk with your doctor.

Before you start treatment with Ativan, tell your doctor and pharmacist which prescription, over-the-counter (OTC), and other medications you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a chart of drugs that can interact with Ativan. Keep in mind that this chart does not include all drugs that may interact with Ativan. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* For more about Ativan’s side effects, see this article.
† Ativan has a boxed warning about the risk of life threatening problems when taken with opioids. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more about this interaction, see “Drug interactions in depth” just below.

Here’s a closer look at certain drug interactions of Ativan.

Opioids

Ativan has a boxed warning about the risk of life threatening problems if taken with opioids. A boxed warning is a serious warning from the Food and Drug Administration (FDA).

Opioids are powerful drugs derived from the opium poppy. They include strong prescription pain-relievers and the illegal drug heroin.*

Interaction result. Taking Ativan with an opioid can cause excessive sleepiness, breathing problems, coma, and, in some cases, death. Your doctor can provide more information.

Interaction explained. Ativan and opioids can both cause central nervous system (CNS) depression, which refers to reduced activity in your brain and spinal cord. Ativan and opioids can also cause respiratory depression (slowed breathing). Taking the drugs together can increase the effect of these conditions, which can be severe.

Examples of opioid drugs. Some opioids include:

• buprenorphine (BuTrans, Sublocade, Belbuca)
• fentanyl (Subsys, Lazanda, Fentora, others)
• methadone
• morphine (MS Contin)
• oxycodone (Oxycontin, Xtampza ER, Oxaydo, others)
• tramadol (Ultram, ConZip)

Steps you or your doctor may take. Due to the risk of life threatening problems, doctors typically will not prescribe Ativan with opioids unless there are no suitable alternatives.

If your doctor does recommend Ativan with an opioid, they’ll prescribe the lowest possible dosage of both medications. You should tell your caregiver, people you live with, and people close to you that you’re taking these drugs together. If you become very sleepy or aren’t able to wake up, another person should call 911 or the local emergency number right away. Someone should also call for emergency medical help if your breathing becomes slow and shallow or stops altogether.

As a precaution, your doctor may want you to have naloxone (Narcan) nasal spray on hand. The drug serves as an emergency treatment for a known or possible opioid overdose. Narcan helps reverse the effects of opioids, including respiratory depression. Someone else will need to administer the medication. Your doctor can prescribe Narcan, or you can request it at your pharmacy. To learn more about Narcan, talk with your doctor or pharmacist.

* Medical News Today does not support taking illegal substances. However, we do support access to important health information. This interaction is mentioned to help you stay safe during Ativan treatment.

Sedating antihistamines

Sedating antihistamines are drugs used to treat allergies, nausea and vomiting, motion sickness, and insomnia. Many are available over the counter.

Interaction result. Taking Ativan with a sedating antihistamine may cause excessive sleepiness and breathing problems.

Interaction explained. Ativan and sedating antihistamines can both cause CNS depression and respiratory depression. Taking the medications together can increase the risk of these side effects.

Examples of sedating antihistamine drugs. Some sedating antihistamines include:

• dimenhydrinate (Gravol, Dramamine)
• diphenhydramine (Benadryl)
• doxylamine (Unisom)
• promethazine
• chlorpheniramine

These drugs may also be found in combination products that you can buy over the counter.

Steps you or your doctor may take. Your doctor will likely not prescribe Ativan with a sedating antihistamine. Before taking any over-the-counter drugs with Ativan, be sure to check with a pharmacist whether the combination is safe.

If you have sleeping problems while taking Ativan, talk with your doctor. They can recommend the right treatment for you. You should not take any other medications to help you sleep unless your doctor recommends them.

If you need a medication for allergies, nausea and vomiting, or motion sickness, ask your doctor or pharmacist.

Sedatives and anxiolytics

Sedatives are drugs that cause sleepiness. They may be prescribed for sleeping problems or anxiety. Anxiolytics are drugs for anxiety. Ativan is both a sedative and an anxiolytic.

Interaction result. Taking Ativan with a sedative or an anxiolytic may cause excessive sleepiness and breathing problems.

Interaction explained. Ativan and other sedatives and anxiolytics can cause CNS depression and respiratory depression. Taking the drugs together can increase your risk of these side effects.

Examples of sedative and anxiolytic drugs. Some sedative and anxiolytic drugs include:

• buspirone
• lorazepam
• diazepam (Valium)
• zolpidem (Ambien)
• zaleplon (Sonata)

Steps you or your doctor may take. Your doctor will likely not prescribe Ativan with other sedatives or anxiolytics, especially other benzodiazepines, such as lorazepam. (Ativan is a type of benzodiazepine. Ativan also contains the active drug lorazepam.)

Because Ativan and other benzodiazepines have the same effects, taking the drugs together could make the effects more severe, possibly leading to an overdose. You can find more information about overdose and Ativan here.

If you have trouble sleeping or have anxiety symptoms while taking Ativan, talk with your doctor. They can recommend the right treatment for you. You should not take any other medications to treat your symptoms unless your doctor recommends them.

Ativan may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Ativan.

Ativan interactions with supplements

Before you start treatment with Ativan, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

Taking Ativan with supplements that cause sleepiness may lead to excessive sleepiness. An example of such a supplement is melatonin. In general, you should avoid taking melatonin products with Ativan.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Ativan interactions with herbs

Taking Ativan with herbs that cause sleepiness may lead to excessive sleepiness. Examples of these supplements include:

• chamomile
• kava
• lavender
• valerian

In general, you should avoid taking these products with Ativan. If you have questions, you can ask your doctor or pharmacist.

Ativan and vitamins

There have been no specific reports of vitamins interacting with Ativan. However, it’s possible that interactions with vitamins could be recognized in the future. So, it’s still important to check with your doctor or pharmacist before taking any of these products during Ativan treatment.

Ativan and food

Food has not been reported to interact with Ativan. If you’d like to learn more about eating certain foods during treatment with Ativan, talk with your doctor.

Ativan and vaccines

No vaccine interactions have been reported with Ativan. However, you should still talk with your doctor or pharmacist before getting vaccines during Ativan treatment.

Ativan and lab tests

There have been no specific reports of Ativan interacting with lab tests. Keep in mind that if you have lab tests during Ativan treatment, you should tell the healthcare professional that you’re taking Ativan.

Ativan interaction with cannabis or CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Ativan. These products may increase the amount of Ativan in your body, which could raise your risk of Ativan side effects.

Also, both Ativan and cannabis products can cause sleepiness. So, you may have excessive sleepiness if you take both drugs together.

Before you start treatment with Ativan, tell your doctor and pharmacist if you take cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Ativan. Before you take Ativan, be sure to talk with your doctor about your health history. Ativan may not be the right treatment option for you if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Ativan include:

• Breathing problems. Ativan can cause breathing problems, such as slowed breathing. If you have a breathing or lung problem, such as chronic obstructive pulmonary disease (COPD) or sleep apnea, Ativan could make your condition worse. You can talk with your doctor about whether Ativan is right for you.
• History of depression. Ativan may cause or worsen depression. If you have or have had depression, talk with your doctor about whether Ativan is right for you. If you currently have depression, your doctor will likely not prescribe Ativan unless you’re also taking an antidepressant medication.
• Past drug or alcohol misuse or dependence. If you have misused or been dependent on drugs or alcohol in the past, you may have an increased risk of misuse and addiction* with Ativan. Your doctor will assess your risk of these problems before prescribing the medication.
• Older age. If you’re age 65 years or older, you may have an increased risk of side effects with Ativan.† Your doctor will likely prescribe an Ativan dosage that’s lower than usual.
• Kidney or liver problems. If you have liver or kidney problems, you may have an increased risk of side effects with Ativan.† Your doctor will likely prescribe an Ativan dosage that’s lower than usual.
• Pregnancy. Ativan may have harmful effects if taken during pregnancy. Your doctor will likely not prescribe Ativan if you’re pregnant. You can ask them about other treatments that may be better choices for you.
• Breastfeeding. Ativan can pass into breast milk and may have harmful effects on a child who’s breastfed. Your doctor will likely not prescribe Ativan if you’re breastfeeding. You can ask them about other treatments that may be better choices for you.
• Allergic reaction. If you’ve had an allergic reaction to Ativan, any of its ingredients, or other benzodiazepines, your doctor will likely not prescribe Ativan. For more information, see the “When to avoid Ativan” section above.
• Acute narrow-angle glaucoma. If you have acute narrow-angle glaucoma (sudden increased pressure in your eye), your doctor will likely not prescribe Ativan. For more information, see the “When to avoid Ativan” section above.

* Ativan has a boxed warning about the risk of misuse and addiction. A boxed warning is a serious warning from the Food and Drug Administration (FDA). To learn more, see “Boxed warnings” at the start of this article.
† For more about Ativan’s side effects, see this article.

Here are some frequently asked questions about Ativan and possible interactions.

Does Ativan interact with ADHD drugs such as Adderall or Vyvanse?

Ativan is not known to interact with drugs for attention deficit hyperactivity disorder (ADHD). This includes amphetamine/dextroamphetamine (Adderall) and lisdexamfetamine (Vyvanse). However, taking Ativan with Adderall or Vyvanse may not be safe.

Doctors sometimes prescribe Ativan with Adderall or Vyvanse for people with ADHD who also have anxiety or sleeping problems. Taking these medications together when prescribed by a doctor for these purposes is not known to be harmful.

However, all three drugs have a risk of misuse and addiction.* (Misuse refers to taking a drug for a purpose or in a way that a doctor has not prescribed.) If Ativan is misused with Adderall or Vyvanse, this may increase the risk of overdose from either medication.† You should take Ativan with Adderall or Vyvanse only if your doctor has prescribed them.

If you have additional questions about Ativan, Adderall, Vyvanse, or other ADHD drugs, talk with your doctor.

* Ativan has a boxed warning about the risk of misuse and addiction. A boxed warning is a serious warning from the Food and Drug Administration (FDA). To learn more, see “Boxed warnings” at the start of this article.
† You can find more information about overdose and Ativan here.

Can I take Ativan with Tylenol?

Yes, you can typically take Ativan with mild pain relievers such as acetaminophen (Tylenol). Ativan is not known to interact with Tylenol.

However, it’s important to note that Ativan does interact with stronger pain medications that contain acetaminophen and an opioid. An example of such a drug is acetaminophen/oxycodone (Oxycet, Percocet). Taking Ativan with pain relievers that contain opioids can cause serious side effects, such as excessive sleepiness and breathing problems.*

Also, if you have a seizure disorder, your doctor may not recommend taking Ativan with Adderall or Vyvanse. All three drugs may cause seizures. Taking more than one of these drugs could further increase your risk of seizures.

Before taking any pain medication with Ativan, you should check with your doctor or pharmacist to see whether the combination is safe. They can tell you what you should not mix with Ativan.

* Ativan has a boxed warning about the risk of life threatening problems if taken with opioids. A boxed warning is a serious warning from the FDA. To learn more, see “Drug interactions in depth” above.

Does Ativan interact with Claritin?

It’s possible, but not likely. Loratadine (Claritin) is a type of allergy medication called an antihistamine. Sedating antihistamines cause drowsiness and can interact with Ativan to cause excessive sleepiness. (You can see “Drug interactions in depth” above to learn more about this.)

However, Claritin is considered a nonsedating antihistamine. This means it typically does not cause drowsiness in people who take it. However, drowsiness may occur rarely, especially if you take more than the recommended dose.

Until you know how Claritin affects you, it’s best to avoid taking it with Ativan. If Claritin does not make you drowsy, it’s generally considered safe to take it with Ativan. If Claritin does make you drowsy, you should avoid taking it with Ativan. Your doctor or pharmacist can recommend a suitable alternative.

You can take certain steps to help prevent interactions with Ativan. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. They can tell you what you should not take with Ativan. For example, you should plan to do the following:

• Let them know if you drink alcohol or take cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the label of Ativan and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions. (If Ativan does not come with paperwork, you can ask your pharmacist to print a copy for you.) If this information is difficult to understand, ask your doctor or pharmacist to help explain it.

You can also help prevent interactions with Ativan by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Ativan. These resources might help:

• Overview of Ativan. For a general overview of Ativan, you can see this article.
• Side effects. If you’re interested in the side effects of Ativan, see this article. Another option is to refer to the prescribing information for Ativan tablets or Ativan injections.
• Dosage specifics. To learn about the dosage of Ativan, see this article.
• Drug comparison. Find information abouthow Ativan compares with Xanax and other drugs, such as Klonopin, Valium, and Ambien.
• Facts about your condition. To learn more about your condition, you can refer to our anxiety hub and epilepsy and seizures hub.

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 another 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.