Lorazepam Detox Guide: Symptoms, Side Effects & Timeline

Lorazepam is a type of benzodiazepine (benzo) medication that is frequently prescribed to treat symptoms of anxiety and, less frequently, to manage insomnia, irritable bowel syndrome that is worsened by anxiety, and alcohol withdrawal ^1,2. Lorazepam, commonly known by the brand name Ativan, is widely prescribed with more than 27.5 prescriptions in 2013 according to the Drug Enforcement Administration (DEA) ¹. As a benzodiazepine, lorazepam works to influence specific neurotransmitter systems in the brain to slow brain activity and depress the central nervous system, which leads to feelings of relaxation and calmness ^2,3.

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Though benzos like lorazepam are helpful for many, the DEA reports they have been abused by more than 20 million people ¹. Lorazepam abuse can result in dependence and addiction ^1,3. In fact, someone can become dependent on medications like lorazepam even when they are taken as prescribed. Due to the increased risk linked to these medications, lorazepam is considered a Schedule IV controlled substance by the DEA ¹.

Someone with a lorazepam addiction or dependence may wish to end use. This is a positive step but should be taken with caution, especially if the substance has been used at high levels or for an extended period ^2,3. A person physically dependent on lorazepam will likely experience unwanted symptoms when use is reduced or stopped suddenly. Called lorazepam withdrawal symptoms, these effects can be unpredictable and range from distressful to dangerous ³.

Lorazepam Withdrawal Symptoms

A person is considered dependent on lorazepam when they require a steady dose to feel normal and function typically. Without lorazepam available, their equilibrium is disrupted—tipping the scales toward an over-excited state and resulting in the unwanted withdrawal symptoms that include physical and psychological symptoms like ^5,6,7:

• Excessive sweating.
• Increased heart rate.
• Increased respiration rate.
• Nausea and vomiting.
• Hand tremors and jerky movements.
• Inability to sleep.
• Tight or achy muscles.
• Agitation.
• Irritability.
• Anxiety.
• Restlessness.
• Poor memory and concentration.
• Seizures.
• Short-term visual, auditory, or tactile hallucinations often referred to as delirium.

Many of these symptoms will induce some discomfort while others are quite dangerous. It can be very beneficial to seek out a professional detox program, rehab that offers detox services, or a hospital-based program.

Detoxification Length

When use of a substance like lorazepam ends, the body begins to process and remove the remaining medication from the system in an act called detoxification (detox) ⁵.  Lorazepam detox is a highly variable process that depends on factors like:

• Dose.
• Frequency of use.
• Duration of use.
• Previous withdrawal history.
• Additional mental health and physical health concerns.
• Individual physiology.

Though each person’s experience during detoxification from lorazepam will be different, the symptoms will commonly begin within the first day (as soon as 6-8 hours) after last use ^5,7. Symptoms tend to persist for an additional 4 or 5 days ⁵. In some cases, withdrawal symptoms from short-acting benzodiazepines like lorazepam can last for 4 weeks or longer ⁷.

Withdrawal symptoms can fluctuate greatly and unexpectedly.

A significant issue with detoxification from a benzo is the erratic appearance of symptoms. Unlike other substances that trigger withdrawal symptoms that peak and gradually fade, lorazepam withdrawal symptoms can fluctuate greatly and unexpectedly throughout its course, which is why seeking a professional detox program is of the utmost importance ⁷.

Lorazepam Withdrawal Effects

Lorazepam withdrawal is a serious concern that can end with significant medical or mental health complications. The American Psychiatric Association (APA) reports that as many as 30% of people withdrawing from a benzodiazepine without professional intervention will experience a grand mal seizure, which could result in serious injury or death ⁵. Additionally, a person in a state of delirium marked by hallucinations will be more likely to make impulsive, dangerous choices.

Two other concerns associated with lorazepam withdrawal are ⁸:

• Symptom rebound: The intensified return of anxiety, insomnia, restlessness, and other acute withdrawal symptoms that can last for weeks after last use.
• Symptom reemergence: The return of previously experienced symptoms in someone using lorazepam to treat a preexisting anxiety disorder or insomnia.

For some people attempting to quit, the discomfort of lorazepam detox will seem too challenging, so they will restart their use to avoid symptoms. This relapse will only renew the lorazepam abuse and complicate recovery.

Detox Options

Trying to detox from lorazepam without professional treatment is never advisable, since formal treatment can provide interventions to improve comfort and safety and successfully manage symptoms during detox and then refer to continuing services ^6,9. For those interested in professional lorazepam detox to manage drug abuse, there are many options like ^6,9:

• Inpatient/ residential setting: Appropriate for people with severe addictions and limited social supports, inpatient/residential treatments involve the person leaving their home to live and receive detox treatment at the facility.
• Outpatient substance abuse/ mental health facility: People with relatively less severe levels of addiction and dependence that have been cleared by a medical assessment as low-risk for complicated withdrawal and have stable supports can be maintained on an outpatient basis, which permits them to live at home and attend treatment during the day.
• Physician’s office: Usually reserved for people that have limited unwanted effects from drug detox, this level of care involves regular visits to a doctor’s office to receive observation and treatment.

Many lorazepam withdrawal programs work to successfully detox patients by tapering the dose of the substance gradually to limit withdrawal symptoms and cravings ^6,7. During and after detox, additional forms of Ativan addiction treatment are vital for maintaining recovery. Remember, detox is very important, but alone, it is not usually enough to maintain long-term abstinence ⁹.

Sources

1. Drug Enforcement Administration. (2013). Benzodiazepines.
2. U.S. National Library of Medicine: MedlinePlus. (2016). Lorazepam.
3. National Institute on Drug Abuse for Teens. (2016). Prescription Depressants.
4. Medscape. (2016). Withdrawal Syndromes.
5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
6. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
7. World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Setting.
8. Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal.
9. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.