From the Research
Ativan (lorazepam) may potentially loosen the lower esophageal sphincter (LES), as benzodiazepines, including diazepam, have been shown to reduce pressure in the LES 1. This effect could theoretically contribute to symptoms of gastroesophageal reflux disease (GERD) in some patients. The mechanism of action of lorazepam, enhancing the effects of GABA, an inhibitory neurotransmitter in the brain, may also play a role in relaxing the LES. However, it is essential to note that the primary use of Ativan is for anxiety, insomnia, and seizures, and its effect on the LES is not a commonly recognized side effect. If you're taking Ativan and experiencing reflux symptoms such as heartburn, regurgitation, or chest pain, it's crucial to discuss this with your healthcare provider. They may recommend taking the medication at a different time relative to meals, adjusting the dosage, or considering alternative medications. Additionally, standard reflux precautions like avoiding large meals before bedtime, elevating the head of your bed, and avoiding trigger foods may help manage any reflux symptoms that might be exacerbated by the medication. Some studies have investigated the use of drugs that target the underlying mechanisms of GERD, such as transient lower esophageal sphincter relaxations (TLESRs) and esophageal hypersensitivity, as add-on therapy to proton pump inhibitors (PPIs) 2, 3. However, the most recent and highest quality study on the topic of drug-induced GERD and esophagitis, published in 2019, provides the most relevant information for this question 1. This study categorizes drugs that can induce GERD and esophagitis into three groups, including those that reduce pressure in the LES, and benzodiazepines are included in this group. Therefore, based on the most recent and highest quality evidence, it is recommended to exercise caution when taking Ativan, especially in patients with pre-existing GERD or reflux symptoms, and to discuss any concerns with a healthcare provider.