From the FDA Drug Label
Acute withdrawal signs and symptoms associated with benzodiazepines have included abnormal involuntary movements, anxiety, blurred vision, depersonalization, depression, derealization, dizziness, fatigue, gastrointestinal adverse reactions (e.g., nausea, vomiting, diarrhea, weight loss, decreased appetite), headache, hyperacusis, hypertension, irritability, insomnia, memory impairment, muscle pain and stiffness, panic attacks, photophobia, restlessness, tachycardia, and tremor Protracted withdrawal syndrome associated with benzodiazepines is characterized by anxiety, cognitive impairment, depression, insomnia, formication, motor symptoms (e.g., weakness, tremor, muscle twitches), paresthesia, and tinnitus that persists beyond 4 to 6 weeks after initial benzodiazepine withdrawal.
Lorazepam can cause twitching as a result of abnormal involuntary movements or muscle twitches associated with acute withdrawal signs and symptoms or protracted withdrawal syndrome when the medication is suddenly stopped or the dosage is rapidly reduced 1. It is essential to follow a gradual taper to discontinue lorazepam or reduce the dosage to minimize the risk of withdrawal reactions.
- Key points:
- Lorazepam can cause twitching due to withdrawal symptoms.
- Gradual taper is necessary to reduce the risk of withdrawal reactions.
- Muscle twitches are a possible symptom of protracted withdrawal syndrome. 1
From the Research
Lorazepam (Ativan) can cause muscle twitching as a side effect through its action on the central nervous system, particularly due to paradoxical excitation, as reported in a recent case presentation and literature review 2. This benzodiazepine medication works by enhancing the effects of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter that reduces neuronal excitability throughout the nervous system. Paradoxically, this inhibitory action can sometimes lead to muscle twitching, particularly during withdrawal, dose changes, or in some sensitive individuals. Twitching may occur at standard therapeutic doses (typically 0.5-2mg taken 2-3 times daily), but is more common when tapering off the medication or at higher doses. The mechanism involves altered neuromuscular signaling and potential rebound excitation in motor pathways. Some studies have also reported paradoxical reactions to benzodiazepines, including increased aggressiveness, restlessness, and talkativeness, particularly in elderly patients or those with certain neurological conditions 3. If you experience twitching while taking lorazepam, you should not abruptly stop the medication but instead consult your healthcare provider, who may adjust your dosage or transition you to a longer-acting benzodiazepine for a more gradual taper. Key points to consider include:
- The risk of paradoxical excitation and muscle twitching with lorazepam use
- The importance of gradual tapering when discontinuing the medication
- The need for dosage adjustments in elderly patients or those with certain neurological conditions
- The potential for benzodiazepines to cause adverse events, including drowsiness, dizziness, and central nervous system side effects 4, 5. It is essential to weigh the benefits and risks of lorazepam use and to closely monitor patients for any adverse effects, particularly those that may impact morbidity, mortality, and quality of life.