From the Guidelines
Tapering off lorazepam should be done gradually under medical supervision to minimize withdrawal symptoms, with a recommended dose reduction of 25% every 1-2 weeks, as supported by the most recent and highest quality study 1.
Potential Side Effects
When tapering off lorazepam, patients may experience a range of side effects, including:
- Rebound anxiety
- Insomnia
- Irritability
- Restlessness
- Headaches
- Muscle tension
- Tremors
- Sweating
- Nausea
- Difficulty concentrating More severe withdrawal symptoms can include sensory hypersensitivity, heart palpitations, increased blood pressure, panic attacks, and in rare cases, seizures or psychosis, as noted in studies 1.
Tapering Schedule
The severity of these effects typically depends on factors such as dosage, duration of use, and individual physiology. A typical taper schedule might reduce the dose by 10-25% every 1-2 weeks, but this should be personalized by a healthcare provider, taking into account the patient's specific needs and medical history, as emphasized in 1.
Managing Withdrawal Symptoms
During tapering, maintaining good sleep hygiene, regular exercise, stress management techniques, and avoiding alcohol and caffeine can help manage symptoms. Additionally, evidence-based psychotherapies, such as cognitive-behavioral therapy (CBT), and/or specific anti-depressants or other nonbenzodiazepine medications approved for anxiety may be offered to support patients, as recommended in 1.
Importance of Medical Supervision
It is essential to taper off lorazepam under medical supervision to minimize the risk of severe withdrawal symptoms and ensure a safe and comfortable tapering regimen, as highlighted in 1. Abrupt cessation or sudden reduction in dose can lead to significant morbidity and even death, especially in the case of benzodiazepines and other central nervous system depressants.
From the FDA Drug Label
ADVERSE REACTIONS Most adverse reactions to benzodiazepines, including CNS effects and respiratory depression, are dose dependent, with more severe effects occurring with high doses. Paradoxical reactions, including anxiety, excitation, agitation, hostility, aggression, rage, sleep disturbances/insomnia, sexual arousal, and hallucinations may occur.
The potential side effects when tapering off of Lorazepam (Ativan) may include paradoxical reactions such as:
- Anxiety
- Excitation
- Agitation
- Hostility
- Aggression
- Rage
- Sleep disturbances/insomnia
- Sexual arousal
- Hallucinations These reactions can occur due to the dose-dependent nature of benzodiazepines, and the incidence may increase when tapering off the medication 2.
From the Research
Potential Side Effects of Tapering Off Lorazepam (Ativan)
- Sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty in concentration, dry wretching and nausea, some weight loss, palpitations, headache, muscular pain and stiffness, and perceptual changes 3
- Rebound anxiety and insomnia, which can occur within 1-4 days of discontinuation, depending on the half-life of the particular drug 3
- Full-blown withdrawal syndrome, which can last 10-14 days 3
- Return of anxiety symptoms, which can persist until some form of treatment is instituted 3
- Seizures, which can occur with abrupt withdrawal of lorazepam, especially in patients who have been taking high doses for long periods of time 4, 5
- Grand mal seizures, which can be life-threatening 4, 5
- Memory impairment and confusion 6
- Rebound insomnia, which can be several times more severe than the peak degree of sleep improvement with drug administration 6
- Increased tension and anxiety after withdrawal 6
- Dizziness, motor incoordination, or ataxia, which can occur in some patients 7
- Risk of having a first drink after treatment, which can be 3 times greater for lorazepam-treated patients compared to carbamazepine-treated patients 7