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Ativan Withdrawal and Detox

Ativan withdrawal occurs soon after the last dose is taken, placing the user at risk of detrimental, potentially dangerous symptoms. Withdrawal symptoms vary in severity, with stronger symptoms associated with higher doses and longer duration of use. Moreover, those who use Ativan with alcohol and or other sedatives generally experience worse symptoms.1 Benzodiazepine withdrawal syndrome typically includes a rebound of some of the physical and psychological symptoms Ativan is meant to reduce or eliminate, including:

  • Heightened anxiety
  • Increased heart rate and blood pressure
  • Worsening insomnia
  • Sensory hypersensitivity
  • Delirium
  • Seizures
  • Convulsions
  • Depression
  • Headache
  • Dizziness
  • Paresthesia (numbness/prickly sensation in extremities)
  • Tremors
  • Sweating
  • Abdominal pain
  • Vomiting
  • Diarrhea1,2

Although these symptoms are generally short-lived, some people experience intensified symptoms for a longer duration, also called post-acute withdrawal syndrome, including:

  • Worsening anxiety
  • Worsening depression
  • Continued insomnia1

Ativan Detox Treatment

Professionally supervised detox incrementally reduces the dose (tapering) to minimize withdrawal symptoms. The current dose of the short-acting benzodiazepine (e.g. Ativan) is converted to the equivalent dose of a longer-acting benzodiazepine, such as Valium (diazepam). The dose is typically decreased in two-week decrements to 75%, 50%, 25%, 12.5% and 0%. This approach enables stabilization and makes it easier to achieve complete cessation of the originally prescribed benzodiazepine at the end of the tapering schedule. Adding 5 mg of melatonin or 10 mg of Ambien (zolpidem) a night to a tapering dose of sedative-hypnotic benzodiazepine helps reduce insomnia and restless sleep associated with detox.3

Ativan intoxication or overdose can be reversed with flumazenil, which inhibits the benzodiazepine binding sites on the GABA receptor, thereby reversing the effects of the drug. This approach may not always reverse respiratory depression and can cause seizures, especially in individuals with epilepsy.3

After detox, rehab including individual, group, family therapy and 12-step support groups helps clients achieve long-term recovery. Alternative/complementary approaches include stress and relaxation techniques, meditation, yoga and acupuncture. Individuals with chronic anxiety may still require pharmacological interventions, although great care needs to be taken to prescribe these safely, including regular monitoring to prevent relapse.

  1. The Effects of Ativan Use. Drug Abuse website. http://drugabuse.com/library/the-effects-of-ativan-use/ Accessed February 7, 2017.
  2. Ativan Withdrawal. Withdrawal.net website. http://www.withdrawal.net/learn/ativan/ Accessed February 7, 2017.
  3. Sedative, Hypnotic and Anxiolytic Use Disorder DSM-5 304.1 (F13.1). Theravive website. http://www.theravive.com/therapedia/Sedative,-Hypnotic-and-Anxiolytic-Use-Disorder-DSM–5-304.1-(F13.1) Accessed February 7, 2017.
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