Recommended Number of Refills for Ativan (Lorazepam)
Ativan (lorazepam) should be prescribed with minimal or no refills due to its high potential for tolerance, addiction, and withdrawal symptoms. 1
Risks and Considerations
- Benzodiazepines like lorazepam can lead to tolerance, addiction, depression, and cognitive impairment with regular use 1
- Approximately 10% of patients treated with benzodiazepines experience paradoxical agitation 1
- Withdrawal symptoms can be significant after discontinuation, with rebound insomnia occurring several days after stopping the medication 2
- The peak degree of withdrawal sleep disturbance can be several times worse than the peak degree of sleep improvement achieved during treatment 2
Prescribing Guidelines
- Lorazepam should be used infrequently and at low doses to minimize adverse effects 1
- Short-acting benzodiazepines with short half-lives (like lorazepam) are least problematic but still carry risks 1
- For anxiety management, the recommended dosage varies by individual but should be kept to the minimum effective dose 1
- When used for sedation/anxiolysis, the IV dose is 0.05-0.10 mg/kg (maximum single dose: 5 mg) 1
Withdrawal Management
- Patients who have taken benzodiazepines for more than 5 years experience greater withdrawal symptoms 3
- Withdrawal symptoms are most marked in patients with personality disorders, particularly dependent personality types 3
- When discontinuation is necessary, gradual tapering is recommended to minimize withdrawal symptoms 3
Special Populations
- For alcohol withdrawal syndrome, lorazepam is recommended at 1-4 mg every 4-8 hours (PO/IV/IM), particularly for patients with severe symptoms, advanced age, liver failure, or other serious medical comorbidities 1
- In elderly patients, lower doses should be used with careful monitoring 1
Monitoring and Follow-up
- Due to the risk of dependence, patients should be evaluated frequently when on lorazepam 1
- Regular assessment for signs of tolerance, dependence, and adverse effects is essential 1
- If long-term treatment is unavoidable, consider periodic drug holidays or dose reductions to reassess the need for continued therapy 1
Recommendation for Refills
Based on the evidence, lorazepam should ideally be prescribed with zero refills, requiring patient evaluation before any prescription renewal. If clinical circumstances necessitate refills, limit to 1-2 refills maximum with close monitoring to prevent dependence and ensure appropriate use 1, 2.