How Ativan Treats Alcohol Withdrawal

Detoxification from any drug can be uncomfortable and challenging, and alcohol withdrawal syndrome can be particularly severe, dangerous, and even life threatening in certain cases.

To reduce the severity of alcohol withdrawal syndrome (AWS) during medical detoxification, benzodiazepine anticonvulsant and anxiolytic medications like Ativan (lorazepam), diazepam (Valium), oxazepam (Serax), and Librium (chlordiazepoxide) are often prescribed.

Ativan For Alcohol Withdrawal

Acute alcohol withdrawal occurs when a person who has built up a physical dependence on alcohol ends their alcohol consumption.

After the last drink is metabolized, the body is deprived of a central nervous system depressant it has become adapted and accustomed to.

This can lead to an over-correction and temporary, uncomfortable effects relating to physical and mental health that may include:

• irritability
• fatigue
• sweating
• diarrhea
• dehydration
• stress or anxiety
• hand tremors
• hypertension/ high blood pressure
• nausea or vomiting
• severe mood swings
• rapid heart rate
• hallucinations
• delirium tremens (DT)
• seizures

Ativan, a brand name version of the generic benzodiazepine drug lorazepam, interacts with central nervous system receptors that increase the body’s sensitivity to gamma-aminobutyric acid (GABA). This increase in GABA significantly calms and slows overactive central nervous system activity as well as physical and mental tension.

This effect can relieve many of the symptoms listed above, helping those in detox avoid relapse and remain safe and relatively comfortable as their alcohol dependence is reversed.

Ativan Dosage For Alcohol Withdrawal

Use of benzodiazepines for the management of alcohol withdrawal is likely limited to an as-needed basis, due to the variation in symptoms and needs between different individuals.

Because Ativan is fast acting with a long half-life and extended duration of effect, it can be administered when required and then discontinued as symptoms of alcohol withdrawal ease.

Dosing, in these cases, typically falls between 2-4 mg divided into two doses daily. Alternatively, healthcare providers may use specific dosing regimens in certain cases.

Symptom Triggered Regimen (STR)

In this regimen, medical staff use a scale of symptoms, typically CIWA-Ar (clinical institute withdrawal assessment), to evaluate the severity of a patient’s alcohol withdrawal symptoms on a numerical scale.

Ativan or another long-acting benzodiazepine is then prescribed and dosed based on this result.

STR is the most common regimen for use of a benzodiazepine in inpatient treatment for alcohol withdrawal.

Loading Dose Regimen (LDR)

LDR is a less common strategy that uses a single high dose of a long-acting benzo drug administered proactively to reduce the risk of withdrawal seizures, delirium, and other severe symptoms as withdrawal progresses.

LDR is only used in a closely monitored inpatient detox or intensive care setting.

Fixed Tapering Dose Regimen (FTDR)

FTDR is preferred for patients moving through withdrawal in an outpatient setting. Patients are prescribed a certain amount of Ativan or a similar drug for a set period of time with decreasing/tapering dosage towards the end of the regimen.

However, use of Ativan in an outpatient setting increases the risk that the medication will be misused, abused, or sold/diverted.

Benefits & Risks Of Using Ativan For Alcohol Withdrawal

Because of its unique properties, Ativan can be used at a lower dose and for a shorter period than barbiturates or other benzos commonly used to treat alcohol withdrawal symptoms. It is also less likely to cause serious side effects, including depressed breathing.

Unfortunately, any use of Ativan also involves certain risks, including the risk of drug abuse/overdose and dependence/addiction.

Drug Abuse & Overdose

If taken in high doses, Ativan can trigger a relaxed drug high and intoxication. It can also intensify the euphoric effects of other common drugs of abuse, including opioids and alcohol, which are also CNS depressants.

However, Ativan abuse also increases the risk of overdose effects, including severe sedation and respiratory depression, which can be fatal.

Because of this, it is very important that any patients who begin taking Ativan for alcohol withdrawal do not relapse and begin drinking while the drug is still in their body.

Ativan Dependence & Addiction

Benzodiazepines, including Ativan, are habit-forming. They have a very high risk for the development of dependence and withdrawal after any prolonged period of use (2-4 weeks at most).

Because of this, treatment professionals strongly recommend limiting the use of Ativan to a period of 10-14 days for alcohol withdrawal.

Addiction Treatment

Alcohol use disorder (AUD) treatment programs are available in both inpatient and outpatient treatment settings. Following a detox for severe alcohol withdrawal symptoms, treatment options for alcohol abuse include medication-assisted treatment, behavioral therapy, and peer support.

For information on our substance use treatment programs, and to learn how our clinicians treat AUD on an outpatient basis, please contact us today.