Smoking Cessation Medications Safe with Lorazepam
All first-line smoking cessation medications—varenicline, bupropion, and nicotine replacement therapy (NRT)—can be safely used with lorazepam, as there are no significant pharmacokinetic interactions or contraindications between benzodiazepines and these agents.
Recommended Approach
First-Line Options (in order of efficacy):
Varenicline is the most effective choice and has no known interactions with lorazepam. In the EAGLES trial, varenicline achieved a 21.8% quit rate at 6 months, significantly higher than bupropion (16.2%) or nicotine patch (15.7%) 12. A 2016 systematic review confirmed varenicline's superior efficacy with a cessation rate of 25.6% versus 11.1% for placebo (RR 2.24) 1.
Nicotine replacement therapy (NRT) is equally safe with lorazepam. All forms (patch, gum, inhaler, intranasal, tablets) are effective, with combination NRT (patch plus fast-acting form) showing better results than single-product use (16.9% vs 13.9%; RR 1.25) 1. Research specifically examining benzodiazepine-smoking interactions found no significant pharmacokinetic changes in lorazepam clearance between smokers and nonsmokers (0.96 vs 1.08 ml/min/kg) 3.
Bupropion is also safe to use with lorazepam. While bupropion is an antidepressant, it has no documented adverse interactions with benzodiazepines 44. Bupropion achieved a 19.0% cessation rate versus 11.0% for placebo (RR 1.64) 15.
Key Safety Considerations
What the FDA Label Says About Lorazepam:
The lorazepam FDA label warns about combining it with "other central nervous system depressants" but specifically mentions opioids and alcohol—not smoking cessation medications 44. The label advises telling your healthcare provider about all medications, but this is standard precautionary language, not a specific contraindication for smoking cessation drugs 4.
Important Caveats:
- Monitor for sedation: While lorazepam can cause drowsiness, dizziness, and sedation 44, none of the first-line smoking cessation medications significantly potentiate these effects
- Depression monitoring: The lorazepam label notes that "pre-existing depression may emerge or worsen during use of benzodiazepines" 4. If using bupropion (an antidepressant), this actually may provide additional benefit rather than harm
- Avoid abrupt discontinuation: If the patient successfully quits smoking while on lorazepam, do not suddenly stop the lorazepam, as this can cause serious withdrawal symptoms 44
Combination Therapy for Maximum Efficacy
The most effective approach combines pharmacotherapy with behavioral counseling, achieving a 15.2% quit rate versus 8.6% with brief advice alone 12. Consider:
- Varenicline + behavioral support (telephone, text, or in-person counseling)
- Combination NRT (patch + gum/lozenge) + behavioral support
- Varenicline + NRT (some studies show enhanced quit rates with this combination) 2
What NOT to Use
Avoid selective serotonin reuptake inhibitors (SSRIs) like fluoxetine or sertraline for smoking cessation—they showed no significant benefit (RR 0.93) 5. Similarly, monoamine oxidase inhibitors and St. John's wort were ineffective 5.
Bottom Line Algorithm
- Start with varenicline (most effective, no lorazepam interaction)
- If varenicline is contraindicated or not tolerated: Use combination NRT (patch + fast-acting form)
- If patient has depression or contraindication to varenicline/NRT: Use bupropion
- Always add behavioral counseling to any pharmacotherapy
- Continue lorazepam as prescribed—no dose adjustment needed for the benzodiazepine when starting smoking cessation treatment
The evidence is clear: there are no pharmacokinetic or safety concerns preventing the use of any first-line smoking cessation medication with lorazepam 35.