Can Ativan Cause Restless Leg Syndrome?
Yes, Ativan (lorazepam) and other benzodiazepines can potentially cause or worsen restless leg syndrome, though they are not among the most commonly implicated medications. 1
Mechanism and Evidence
Benzodiazepines like lorazepam (Ativan) are not specifically listed among the primary drug classes that cause RLS, but the American Academy of Sleep Medicine explicitly recommends against using clonazepam (another benzodiazepine) to treat RLS, which suggests benzodiazepines as a class may not be beneficial and could potentially worsen the condition. 1
The primary medications known to induce or exacerbate RLS include antipsychotics (dopamine antagonists), antidepressants (particularly SSRIs and mirtazapine), and antihistaminergic medications—all of which should be avoided in RLS patients. 1, 2
Drug-induced RLS is most commonly associated with medications that affect dopamine receptors and neurotransmitter systems, with risk factors including older age, gastrointestinal diseases, high medication doses, and simultaneous use of multiple drugs. 2
Clinical Considerations
If you suspect Ativan is causing or worsening RLS symptoms in your patient, consider discontinuation or dose reduction as the primary intervention, similar to the approach recommended for other drug-induced RLS cases. 3, 2
The American Academy of Sleep Medicine specifically recommends addressing potential exacerbating medications including antihistaminergic, serotonergic, and antidopaminergic agents before initiating pharmacological treatment for RLS. 1
Benzodiazepines like clonazepam have been shown to improve subjective sleep quality but do not reduce the periodic limb movement index (an objective marker of RLS), suggesting they mask symptoms without treating the underlying condition. 1
Alternative Management Approach
Instead of using benzodiazepines for RLS-related sleep disturbance, the American Academy of Sleep Medicine strongly recommends alpha-2-delta ligands (gabapentin, gabapentin enacarbil, or pregabalin) as first-line therapy. 1
Before starting any pharmacological treatment, check serum ferritin and transferrin saturation in the morning after avoiding iron supplements for 24 hours, and supplement if ferritin ≤75 ng/mL or transferrin saturation <20%. 1
Address lifestyle factors that can exacerbate RLS, including avoiding alcohol, caffeine, and nicotine close to bedtime, as these substances can significantly worsen symptoms. 1
Critical Pitfall to Avoid
- Do not add a benzodiazepine to "help with sleep" in a patient with RLS without first optimizing iron status and considering guideline-recommended treatments (alpha-2-delta ligands), as this may worsen the underlying condition while only masking sleep-related symptoms. 1