Can you take Ativan (lorazepam), Prozac (fluoxetine), and Buspar (buspirone) together?

Safety of Taking Ativan, Prozac, and Buspar Together

While it is possible to take Ativan (lorazepam), Prozac (fluoxetine), and Buspar (buspirone) together in certain clinical situations, this combination carries significant risks and should generally be avoided whenever possible due to the potential for serious adverse effects.

Understanding the Medications

Ativan (lorazepam)

• Benzodiazepine anxiolytic used for management of insomnia, anxiety, and agitation 1
• Regular use can lead to tolerance, addiction, depression, and cognitive impairment 1
• Paradoxical agitation occurs in approximately 10% of patients 1

Prozac (fluoxetine)

• Selective serotonin reuptake inhibitor (SSRI) antidepressant 1
• Used for depression, anxiety disorders, and other mood conditions 1
• Has a long half-life compared to other SSRIs 1

Buspar (buspirone)

• Non-benzodiazepine anxiolytic 1
• Initial dosage typically 5 mg twice daily; maximum 20 mg three times daily 1
• Only useful for mild to moderate agitation and may take 2-4 weeks to become effective 1
• Has lower sedation potential compared to benzodiazepines like lorazepam 2

Risks of This Combination

Increased CNS Depression

• Benzodiazepines like Ativan and opioids both cause central nervous system depression and can decrease respiratory drive 1
• Concurrent use of benzodiazepines with other CNS depressants increases risk of adverse effects 1

Serotonin Syndrome Risk

• Combining buspirone with fluoxetine can potentially cause serotonin syndrome, a potentially life-threatening condition 3
• Symptoms include confusion, diaphoresis, incoordination, diarrhea, and myoclonus 3
• Serotonin syndrome can develop rapidly or over several weeks 3

Medication Interaction Concerns

• SSRIs (especially fluoxetine) may interact with drugs metabolized by CYP2D6 1
• Combining multiple serotonergic medications increases the risk of serotonin syndrome 1

Clinical Recommendations

Alternative Approaches

• Consider using buspirone alone for anxiety if appropriate, as it has lower sedation potential than benzodiazepines 2
• If an antidepressant is needed with an anxiolytic, buspirone may be safer than combining an SSRI with a benzodiazepine 4

If Combination Is Necessary

• Clinicians should have a clear rationale for using medication combinations 1
• Valid reasons include treating multiple disorders in the same patient or addressing side effects of an effective agent 1
• Start with the lowest effective doses and monitor closely for adverse effects 1

Monitoring Requirements

• Regular assessment for signs of serotonin syndrome, especially in the first 24-48 hours after dosage changes 1
• Watch for excessive sedation, cognitive impairment, or respiratory depression 1
• Monitor for paradoxical reactions, particularly agitation or disinhibition 1

Special Considerations

Tapering Recommendations

• If discontinuation is needed, benzodiazepines should be tapered gradually to avoid withdrawal symptoms 1
• A commonly used tapering schedule is reduction of benzodiazepine dose by 25% every 1-2 weeks 1
• SSRIs like fluoxetine have longer half-lives and may require less careful tapering than shorter-acting SSRIs 1

Patient Education

• Patients should be informed about the risks of this combination, including potential for dependence with benzodiazepines 1
• Advise against alcohol consumption, which would further increase CNS depression 1
• Instruct patients to report any unusual symptoms promptly, particularly those suggestive of serotonin syndrome 3