How to Wean Off Ativan (Lorazepam) Safely

Ativan taper works to minimize and even avoid the undesirable effects of withdrawal. Some people may decide to attempt an at-home taper.

Moving forward can be difficult once an individual acquires a tolerance for Ativan. Said patients or recreational users will often take extra quantities of the drug to achieve feelings of relief or euphoria.

Deciding to stop Ativan isn’t as simple as not consuming the drug any longer, as withdrawal can be uncomfortable and dangerous. Stopping the drug takes a proper adjustment stage and comprehensive care — medical detoxification provides both.

Effective detoxes usually use time to their advantage, and perhaps the best example is the taper method. An Ativan taper utilizes the resources at a rehabilitation center’s disposal and ample recovery time to help users succeed.

What Is Ativan (Lorazepam) Tapering or Weaning off Benzodiazepines?

The human body has the remarkable ability to regenerate, healing itself from physical and psychological trauma of all kinds. Its power to do so for drug use is no different. Tapering gives the patient’s body the platform to do so. Over time, bodily systems can correct and readapt themselves to life without benzodiazepine (benzo) use.

Following a physician-approved Ativan taper works to minimize and even avoid the undesirable effects of withdrawal. Deciding to quit the drug cold turkey without a taper can lead to:

•  Headaches
•  Lethargy
•  Confusion
•  Insomnia
•  Irritability
•  Spasms
•  Nausea
•  Constipation
•  Panic disorders
•  Hallucinations
•  Anxiety
•  Seizures

Each medical taper begins with a tapering schedule provided by a physician. Some people may decide to attempt an at-home taper. However, given the risks of Ativan withdrawal symptoms like seizure, a benzo withdrawal tapering schedule should only be done under medical supervision.

Who Can Benefit From Tapering Their Ativan (Lorazepam) Benzos Intake

Benzodiazepine tapers are designed to lessen the worries of detoxification. Many people can trace their hesitation to stop benzos to withdrawal symptoms. Tapering benzodiazepines can alleviate these uncertainties. At its core, tapering is about gradually familiarizing the body to live without benzos while making withdrawal manageable.

Types of Ativan (Lorazepam) Tapering Methods

Taper schedules are highly individualized because benzo withdrawal symptoms can be unpredictable and do not necessarily follow a steady time course. If someone starts experiencing withdrawal symptoms while on a taper, they are often kept on the current benzo dose until symptoms resolve. At that point, the taper can continue. Generally, experts recommend two types of tapers: a direct taper or a substitute taper. A third type of taper, a titration taper, is not recommended.

Direct Tapering

In a direct taper, your doctor slowly decreases your Ativan dose over time until it can eventually be safely stopped. Your taper can be stopped or slowed if you have withdrawal symptoms. Generally, your Ativan dose is initially reduced by 25–30% and then lowered by 5–10% daily or weekly.

Substitute Tapering

Sometimes, doctors recommend a substitution taper. This type of taper trades a short-acting benzo like Ativan for a long-acting one like Valium. Long-acting benzodiazepines last longer, meaning withdrawal is held off, and the patient doesn’t have to take Ativan doses all the time.

The first step in a substitution taper is to convert the amount of Ativan the person takes to an equivalent Valium dose. Generally, 1 mg of Ativan is equal to 5 mg of Valium. The taper then typically proceeds similarly to a direct taper, with the dose initially reduced by 25–30% and subsequently reduced a further 5–10% daily or weekly.

Titration Tapering

Titration tapering is not recommended. In titration tapering, Ativan is mixed with water and consumed, continuously decreasing amounts of the water-Ativan combination daily to lower the total amount taken. Unfortunately, Ativan is not completely soluble in water, meaning you would get unpredictable amounts of Ativan in your system, which could be dangerous.

Why Consider Tapering vs. Stopping Ativan (Lorazepam) Cold Turkey?

Tapering Ativan allows your body to be gently eased off the drug. This is important because when you take Ativan regularly, your body becomes used to its presence and adapts accordingly, expecting the drug. If you suddenly stop taking the drug cold turkey, you can experience withdrawal symptoms that may be severe in some cases and can include seizures.

Common Ativan (Lorazepam) Withdrawal Symptoms

When Ativan use is abruptly stopped, withdrawal symptoms may occur and can include:

• Sweating
• Fast pulse
• Tremor
• Trouble sleeping
• Nausea or vomiting
• Hallucinations
• Agitation
• Anxiety
• Seizures

Challenges of Cutting Down on Benzodiazepines

It can be extremely hard to cut down on benzodiazepines on your own. Besides the risk of withdrawal symptoms, many people initially started taking benzodiazepines to treat underlying conditions like panic disorder, anxiety or insomnia. It can be difficult to cut back on benzos if you are not taking other medications to help control those underlying medical conditions. For these reasons, seeking medical assistance when you stop taking benzos is important.

Side Effects of Benzodiazepine Tapering

When benzos are appropriately tapered, there should be no side effects. Side effects during a benzo taper mean that your taper may need to be paused or slowed. If you take Ativan to control an underlying medical condition like anxiety, your doctor will likely need to start you on a replacement anxiety medication to ensure it stays appropriately controlled as your Ativan dose decreases. You should talk to your doctor if you have breakthrough symptoms during your Ativan taper. 

Ativan (Lorazepam) Withdrawal Timeline

Ativan withdrawal follows a general timeline. Because Ativan is a comparatively short-acting benzo, withdrawal symptoms typically start within six to eight hours after the last dose. Symptoms will generally peak by the second day and decrease by the fourth or fifth day. Although most symptoms will resolve by then, some lingering symptoms, like anxiety, may last several months.

Medications Used When Tapering off Ativan (Lorazepam) Benzodiazepines

Generally, Ativan tapers are successfully managed by switching the person to a longer-acting benzodiazepine like diazepam. In general, symptoms can be successfully managed using this method. However, other medications may occasionally be prescribed to help ease symptoms during the taper.

Anticonvulsants

Withdrawal symptoms occasionally require adjunct medications like anti-seizure drugs to control despite an Ativan taper. Carbamazepine (Tegretol) and pregabalin (Lyrica) have data supporting their use during withdrawal.

Antidepressants

Although antidepressants have not shown a benefit in controlling symptoms during an Ativan taper, some antidepressants like mirtazapine and trazodone may sometimes be prescribed for depression and insomnia.

Buspirone

Buspirone is an anxiety medication not recommended during an Ativan taper due to lack of benefit.

Flumazenil

Flumazenil is a medication that blocks the GABA receptors to which Ativan binds and is not typically recommended for Ativan withdrawal as it can worsen withdrawal symptoms like seizures.

Why Ativan (Lorazepam) Withdrawal Symptoms Occur

Benzodiazepines work by enhancing the effects of the brain chemical gamma amino-butyric acid (GABA). Normally, GABA is responsible for dampening certain signals sent by the central nervous system (CNS).

Benzos enhance the effects of GABA. The body develops a tolerance to excess GABA to maintain normal functioning. When benzos are removed from the system, it leads to higher-than-normal GABA levels, which leads to overexcitement of the CNS. Symptoms can include nervousness, anxiety and seizures.

Can Tapering Your Ativan (Lorazepam) Benzodiazepines Intake Reduce Withdrawal Symptoms?

A benzo taper can sometimes rid someone recovering from withdrawal symptoms. This is because tapering allows the central nervous system to slowly adjust to the drug’s removal. It never gets the opportunity to enter a withdrawal phase.

On the other end of the spectrum, quitting cold turkey provides no such safeguard — withdrawals are at their worst, even deadly. For this reason, neither at-home detoxes nor stopping cold turkey are recommended by physicians. These outdated approaches lack support, guidance and safety measures.

Ativan (Lorazepam) Tapering Schedule

As a general rule of thumb, physicians and rehabilitation personnel suggest reducing benzo use by 25% weekly. This means the higher the benzodiazepine dose, the longer it will take to wean off the drug completely.

Challenges of Cutting Down Your Ativan (Lorazepam) Intake

Weaning yourself off a benzodiazepine without medical supervision can be complex. If you accidentally taper too quickly, your doctor can adjust the schedule to ease breakthrough withdrawal symptoms. Also, make sure your doctor knows all other medications you are taking so they prepare the best plan for you.

Relapse Prevention Strategies

Avoiding benzo withdrawal can help reduce your risk of relapse. Limiting withdrawal symptoms through a medically managed taper increases your chances of successfully staying off benzos long-term. However, it is not the only step. Recent studies have shown that combining therapy and other psychological care with tapering or detox is often more successful than tapering alone.

How The Recovery Village Uses Ativan (Lorazepam) Tapering

An addiction treatment facility like The Recovery Village is an excellent resource when it comes to helping you wean off benzos:

• They can design a taper schedule to decrease your benzo dose gradually. 
• They can prescribe lower doses of the medication(s), so you do not need to cut up higher-dose pills. 
• They can prescribe adjunctive medications if needed to help control withdrawal symptoms.

Medically assisted detox and addiction treatment is your best bet if you are trying to taper your drug or alcohol use. The Recovery Village provides 24-hour detox care and addiction rehab at facilities nationwide, and each care plan can be customized to your exact needs. Don’t risk your life with addiction or recovering alone — contact The Recovery Village today to learn more about medical detox.

Editor – Theresa Valenzky

Theresa Valenzky graduated from the University of Akron with a Bachelor of Arts in News/Mass Media Communication and a certificate in psychology. She is passionate about providing genuine information to encourage and guide healing in all aspects of life. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more