Ativan contains lorazepam, a benzodiazepine. It is prescribed for short-term severe anxiety, as premedication before procedures, for status epilepticus and for alcohol withdrawal. It comes as tablets, a sublingual tablet and an injection. It is Schedule 5, and dependence develops with regular use.
What is Ativan?
Ativan is Schedule 5 in South Africa — prescription-only with additional controls:
| Product | Contains |
|---|---|
| Ativan | Lorazepam 0.5 mg, 1 mg, 2.5 mg tablets |
| Ativan SL | Lorazepam 1 mg sublingual tablet |
| Ativan injection | Lorazepam 4 mg/ml |
Lorazepam is a benzodiazepine. It enhances the effect of GABA, the brain’s main calming neurotransmitter, making each unit of GABA more effective and so reducing excitability across the nervous system.
Lorazepam has a particular profile that explains where it is used:
- Intermediate-acting — longer than alprazolam, shorter than diazepam. That gives smoother cover through a day without diazepam’s long accumulation.
- No active breakdown products. Diazepam is converted into substances that themselves persist and accumulate; lorazepam is not. This makes it the preferred benzodiazepine in liver disease and in older people, where accumulation is the main hazard.
- Strongly amnesic — it impairs formation of new memories more than most benzodiazepines. That is a drawback in everyday use and precisely why it is valued as premedication before unpleasant procedures.
- Well absorbed sublingually, which is why the SL tablet exists — useful when a fast effect is needed or swallowing is difficult.
The same properties that make it clinically useful make it easy to become dependent on, which is why courses are short.
What is Ativan commonly used for?
- Severe anxiety, short-term, where it is disabling.
- Panic attacks, for acute relief.
- Premedication before surgery or procedures — reducing anxiety and, through its amnesic effect, reducing memory of an unpleasant experience.
- Status epilepticus — a prolonged seizure — where the injection is a first-line emergency treatment.
- Alcohol withdrawal, preventing seizures and managing agitation. Lorazepam is often preferred here, because alcohol-related liver impairment does not cause it to accumulate as diazepam does.
- Acute agitation, in hospital settings.
- Nausea from chemotherapy, as an adjunct.
- Short-term severe insomnia, occasionally, where anxiety is the driver.
The short-term framing is not a formality. Tolerance to the calming effect develops within weeks, and physical dependence follows regular use. Courses are usually limited to two to four weeks, including the taper.
For ongoing anxiety, the treatments that work over the long run are different: SSRIs such as escitalopram, and cognitive behavioural therapy, whose benefits persist after treatment ends. A benzodiazepine is a bridge, not a destination.
How Ativan fits into this medicine category
| Group | Examples | Typical role |
|---|---|---|
| Benzodiazepines | Lorazepam (Ativan), diazepam, alprazolam | Short-term anxiety, seizures, withdrawal |
| SSRIs | Escitalopram, fluoxetine | First-line for ongoing anxiety |
| SNRIs | Venlafaxine, duloxetine | Anxiety and depression |
| Beta-blockers | Propranolol | Physical symptoms — tremor, palpitations |
| Anti-epileptics | Carbamazepine, lamotrigine | Seizures, mood stabilisation |
| Tricyclics | Amitriptyline | Nerve pain, mood, sleep |
See the mental health, nerve and neurological medicines hub.
What to check before using Ativan
Do not combine it with opioids unless a doctor has specifically planned it. Lorazepam with codeine, tramadol, morphine or similar substantially raises the risk of severe sedation, suppressed breathing, coma and death. This combination is among the most common contributors to medication-related deaths worldwide.
Do not drink alcohol with it. The same risk applies, and alcohol worsens the memory effects.
Never stop abruptly after regular use. Withdrawal can cause rebound anxiety and insomnia, tremor, sweating, nausea, perceptual disturbance and — importantly — seizures, which can be life-threatening. Stopping is done by tapering slowly under medical guidance, sometimes over months.
Tell your doctor or pharmacist if you:
- Have breathing problems — sleep apnoea, COPD or severe asthma.
- Have liver or kidney disease. Lorazepam is often the preferred benzodiazepine in liver disease, but this should still be known.
- Are elderly. Older people are markedly more sensitive: confusion, unsteadiness and falls with fractures are real risks, and lower doses are used.
- Have myasthenia gravis, or narrow-angle glaucoma.
- Have a history of substance or alcohol misuse, or dependence on these medicines.
- Have depression, which benzodiazepines can deepen.
- Have a history of disinhibited behaviour on sedatives.
- Are pregnant, planning pregnancy or breastfeeding.
- Take any other sedating medicine, including sedating antihistamines, sleeping tablets or antipsychotics.
- Take valproate or probenecid, which raise lorazepam levels.
Do not drive or operate machinery. Lorazepam impairs reaction time, coordination, judgement and memory, often for longer than it feels. Driving while impaired by a prescribed sedative is still an offence.
Possible cautions and when to ask a pharmacist or doctor
Common effects are drowsiness, unsteadiness, poor coordination, muddled thinking, memory gaps, dry mouth and reduced alertness the following day.
Memory gaps deserve mention. Lorazepam impairs formation of new memories more than most benzodiazepines — so you may not recall events after taking it. That is expected as premedication; in everyday use it is a reason to be cautious about important conversations, decisions or driving.
Seek medical attention urgently if you notice:
- Slow, shallow or difficult breathing, or unusual difficulty rousing someone. An emergency, especially where an opioid or alcohol is involved.
- Marked confusion or hallucinations, particularly in an older person.
- Paradoxical reactions — agitation, restlessness, irritability, aggression or disinhibition instead of calm. Uncommon but recognised, and more likely in older people and children.
- A fall, or repeated unsteadiness.
- New or worsening depression, or thoughts of self-harm.
- Yellowing of the eyes or skin, or a severe rash.
If you find you need it more often, need more for the same effect, or feel unable to cope without it, tell your doctor. Dependence on a prescribed medicine taken as directed is common and treatable, and raising it early makes it considerably easier to resolve.
Contact your doctor if anxiety persists beyond the short course intended, so that longer-term treatment can be arranged.
Related medicine guides
- Browse Mental Health, Nerve & Neurological Medicines guides
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Frequently asked questions
What is Ativan used for? Short-term severe anxiety and panic, premedication before procedures, status epilepticus, and alcohol withdrawal. It contains lorazepam.
What is Ativan 1 mg used for? A common tablet strength for short-term anxiety. The sublingual 1 mg tablet is used where a faster effect is needed.
What is Ativan 2 mg used for? Higher strengths are used for more severe anxiety or agitation, and in specific hospital settings. Your doctor sets the dose.
Is Ativan addictive? Physical dependence develops with regular use, as with all benzodiazepines. That is a property of the medicine, not a failing of the person taking it.
How long can I take it? Usually no more than two to four weeks including the taper. Longer use should be a deliberate medical decision.
Can I stop taking it suddenly? No. Abrupt withdrawal can cause severe symptoms including seizures. Stopping must be tapered under medical guidance.
Why might I not remember things? Lorazepam impairs formation of new memories more than most benzodiazepines. That is useful as premedication and a reason for caution otherwise.
Can I drink alcohol with it? No. The combination can dangerously suppress breathing.