Is lorazepam (Ativan) indicated for the treatment of tremors?

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Last updated: April 3, 2025View editorial policy

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From the Guidelines

Lorazepam is not the preferred first-line treatment for tremors, particularly essential tremor, where beta-blockers such as propranolol are typically recommended. According to the most recent and highest quality study available, beta-blockers like propranolol have been used to treat essential tremor for more than 40 years and are considered effective 1. Lorazepam, a benzodiazepine, may be used for tremors associated with anxiety, alcohol withdrawal, or certain neurological conditions, but its use should be cautious due to risks of dependence, tolerance, and withdrawal symptoms.

Some key points to consider when using lorazepam for tremors include:

  • Typical dosing ranges from 0.5 to 2 mg taken 2-3 times daily, but should be individualized based on symptom severity and patient response
  • Treatment duration should be as short as possible, ideally not exceeding 2-4 weeks
  • Side effects may include sedation, dizziness, and cognitive impairment, which can be particularly problematic in elderly patients
  • Patients should avoid alcohol while taking lorazepam and should not abruptly discontinue the medication

It's essential to note that the provided evidence does not strongly support the use of lorazepam as a first-line treatment for tremors, and other options like beta-blockers should be considered first 1. The use of lorazepam should be based on a thorough evaluation of the patient's condition and medical history, and its potential benefits and risks should be carefully weighed.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Lorazepam for Tremors

  • Lorazepam is not explicitly mentioned as a treatment for tremors in the provided studies 2, 3, 4, 5, 6.
  • However, benzodiazepines, a class of drugs that includes lorazepam, are mentioned as potentially effective in some patients with essential tremor, particularly those with associated anxiety 2.
  • Alprazolam, another benzodiazepine, has been studied as a treatment for essential tremor and has shown promise, with one study finding it to be superior to placebo and equipotent to primidone 4.
  • Another study classified alprazolam as possibly useful for the treatment of essential tremor 3.

Alternative Treatments

  • The most commonly used and effective medications for essential tremor are propranolol and primidone, which can be administered as monotherapy or in combination 2, 3, 6.
  • Other medications, such as topiramate, gabapentin, and botulinum toxin A, may also be effective in treating essential tremor 3, 5.
  • Surgical interventions, such as thalamic DBS and radiofrequency thalamotomy, may also be considered for patients with refractory essential tremor 3.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

MDS evidence-based review of treatments for essential tremor.

Movement disorders : official journal of the Movement Disorder Society, 2019

Research

New alternative agents in essential tremor therapy: double-blind placebo-controlled study of alprazolam and acetazolamide.

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2000

Research

Essential tremor - drug treatments present and future.

Expert review of neurotherapeutics, 2025

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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