Can I administer Lorazepam (Ativan) after Clonazepam (Klonopin)?

From the Guidelines

It is not recommended to take Ativan (lorazepam) after Klonopin (clonazepam) without medical supervision. Both medications are benzodiazepines that work similarly in the brain by enhancing the effects of GABA, a neurotransmitter that inhibits brain activity. Taking these medications together can lead to dangerous additive effects, including excessive sedation, respiratory depression, and increased risk of overdose. Klonopin has a long half-life (30-40 hours), meaning it stays in your system for an extended period, so adding Ativan could compound these effects even if taken hours later.

Key Considerations

• The concurrent use of benzodiazepines and other central nervous system depressants can increase the risk of fatal respiratory depression 1.
• Clinicians should avoid prescribing opioids and benzodiazepines concurrently whenever possible, and consider alternative strategies for managing anxiety and pain 1.
• If benzodiazepines are prescribed for anxiety, they should be tapered gradually if discontinued to avoid rebound anxiety, hallucinations, seizures, and other withdrawal symptoms 1.

Recommendations

• If you're experiencing breakthrough anxiety while on Klonopin, contact your healthcare provider immediately to discuss appropriate management options.
• They might adjust your Klonopin dosage or recommend alternative strategies rather than adding another benzodiazepine.
• In emergency situations, always inform medical personnel about all medications you've taken recently to ensure safe treatment.
• Consider evidence-based psychotherapies (e.g., CBT) and/or specific anti-depressants or other nonbenzodiazepine medications approved for anxiety as alternative treatment options 1.

From the Research

Administration of Lorazepam after Clonazepam

There is limited research directly addressing the administration of Lorazepam (Ativan) after Clonazepam (Klonopin). However, the available studies provide some insights into the use of these benzodiazepines in various clinical settings:

• The study 2 compared the effects of alprazolam, clonazepam, and placebo in patients with panic disorder, finding that both active agents had similar positive effects. Although this study does not directly address the administration of Lorazepam after Clonazepam, it suggests that benzodiazepines with different half-lives can be effective in managing anxiety.
• The study 3 reported on the use of benzodiazepines in a palliative care unit, where Lorazepam was commonly used to treat anxiety and agitation, while Clonazepam was rarely prescribed to prevent or resolve convulsions. This study implies that Lorazepam and Clonazepam can be used in different clinical contexts, but does not provide information on their sequential administration.
• The study 4 discussed the maintenance treatment of catatonia with benzodiazepines, including a case series where some patients were switched from oral Lorazepam to oral Clonazepam, but experienced relapses. This study suggests that cross-tapering from Lorazepam to Clonazepam can be challenging and may result in relapse.

Key Findings

• Benzodiazepines, including Lorazepam and Clonazepam, are effective in managing anxiety and other conditions 2, 3, 4.
• The sequential administration of Lorazepam after Clonazepam is not directly addressed in the available studies.
• Cross-tapering from Lorazepam to Clonazepam can be challenging and may result in relapse 4.