Ativan Side Effects, Warnings, and Drug Interactions

Ativan (lorazepam) is a benzodiazepine used to manage anxiety disorders, and for the short-term relief of symptoms of anxiety or anxiety associated with depression, to treat panic attacks, for short-term and long-term treatment of insomnia, used in combination with other medications to prevent nausea and vomiting resulting from chemotherapy, administered before anesthesia for sedation, for prevention and treatment of alcohol withdrawal, and for treating seizures (status epilepticus).

Common side effects of lorazepam include sedation, dizziness, weakness, unsteadiness, depression, amnesia, loss of orientation, headaches, sleep disturbances, low blood pressure (hypotension), impotence (erectile dysfunction, ED), changes in appetite, and sleep apnea.

Serious side effects of lorazepam include extrapyramidal symptoms (muscle spasms, restlessness, slow movement, tremors, and jerky movements), respiratory depression, suicidal ideation/attempt, seizures, and depression. Like all benzodiazepines, lorazepam can cause physical dependence. Suddenly stopping Lorazepam therapy after a few months of daily therapy may be associated with a feeling of loss of self-worth, agitation, and insomnia.

Drug interactions of lorazepam include other drugs that slow the brain’s processes such as alcohol, barbiturates, narcotics, and tranquilizers. Lorazepam and other benzodiazepines have been associated with fetal damage, including congenital malformations, when taken by pregnant women in their first trimester. Lorazepam is best avoided if at all possible in the first trimester and probably throughout pregnancy. Lorazepam is excreted in human milk and should be avoided during breastfeeding.

The most common side effects associated with Ativan are:

• Weakness
• Unsteadiness

Other side effects include:

• A feeling of depression
• Amnesia
• Loss of orientation
• Headaches
• Sleep disturbances
• Low blood pressure (hypotension)
• Impotence (erectile dysfunction, ED)
• Changes in appetite
• Sleep apnea

Possible serious side effects include:

• Extrapyramidal symptoms
• Respiratory depression
• Suicidal ideation/attempt
• Seizures
• Depression

WARNING:

• Like all benzodiazepines, Ativan can cause physical dependence. Suddenly stopping therapy after a few months of daily therapy may be associated with a feeling of loss of self-worth, agitation, and insomnia. If Ativan is taken continuously for longer than a few months, stopping therapy suddenly may produce seizures, tremors, muscle cramping, vomiting, and sweating.

Most adverse reactions to benzodiazepines, including CNS effects and respiratory depression, are dose dependent, with more severe effects occurring with high doses.

In a sample of about 3500 patients treated for anxiety, the most frequent adverse reaction to Ativan (lorazepam) was sedation (15.9%), followed by dizziness (6.9%), weakness (4.2%), and unsteadiness (3.4%). The incidence of sedation and unsteadiness increased with age.

Other adverse reactions to benzodiazepines, including lorazepam are fatigue, drowsiness, amnesia, memory impairment, confusion, disorientation, depression, unmasking of depression, disinhibition, euphoria, suicidal ideation/attempt, ataxia, asthenia, extrapyramidal symptoms, convulsions/seizures, tremor, vertigo, eye function/visual disturbance (including diplopia and blurred vision), dysarthria/slurred speech, change in libido, impotence, decreased orgasm; headache, coma; respiratory depression, apnea, worsening of sleep apnea, worsening of obstructive pulmonary disease; gastrointestinal symptoms including nausea, change in appetite, constipation, jaundice, increase in bilirubin, increase in liver transaminases, increase in alkaline phosphatase; hypersensitivity reactions, anaphylactoid reactions; dermatological symptoms, allergic skin reactions, alopecia; SIADH, hyponatremia; thrombocytopenia, agranulocytosis, pancytopenia; hypothermia; and autonomic manifestations.

Paradoxical reactions, including anxiety, excitation, agitation, hostility, aggression, rage, sleep disturbances/insomnia, sexual arousal, and hallucinations may occur. Small decreases in blood pressure and hypotension may occur but are usually not clinically significant, probably being related to the relief of anxiety produced by Ativan (lorazepam). To report SUSPECTED ADVERSE REACTIONS, contact Valeant Pharmaceuticals North America LLC at 1-800-321-4576 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

The benzodiazepines, including Ativan (lorazepam), produce increased CNS-depressant effects when administered with other CNS depressants such as alcohol, barbiturates, antipsychotics, sedative/hypnotics, anxiolytics, antidepressants, narcotic analgesics, sedative antihistamines, anticonvulsants, and anesthetics.

Concomitant use of clozapine and lorazepam may produce marked sedation, excessive salivation, hypotension, ataxia, delirium, and respiratory arrest.

Concurrent administration of lorazepam with valproate results in increased plasma concentrations and reduced clearance of lorazepam. Lorazepam dosage should be reduced to approximately 50% when coadministered with valproate.

Concurrent administration of lorazepam with probenecid may result in a more rapid onset or prolonged effect of lorazepam due to increased half-life and decreased total clearance. Lorazepam dosage needs to be reduced by approximately 50% when coadministered with probenecid.

The effects of probenecid and valproate on lorazepam may be due to inhibition of glucuronidation.

Administration of theophylline or aminophylline may reduce the sedative effects of benzodiazepines, including lorazepam.