lorazepam

Adjunctive therapy

Brands: ATIVAN, LOREEV XR

Last reviewed 2025-12-28

Reviewed by PsychMed Editorial Team.

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Quick answers

What is lorazepam?
Lorazepam (brand Ativan; ER brand Loreev XR) is a short-to-intermediate acting benzodiazepine used for anxiety and insomnia due to anxiety or stress; in psychiatry it is also a cornerstone medication for catatonia evaluation and treatment.
What is ATIVAN?
ATIVAN is a brand name for lorazepam (other brands: LOREEV XR).
What is ATIVAN (lorazepam) used for?
Label indications include: Anxiety disorders; insomnia due to anxiety/stress (label varies by product).
What drug class is ATIVAN (lorazepam)?
Benzodiazepine; positive allosteric modulator of GABA-A receptors.
What strengths does ATIVAN (lorazepam) come in?
Oral tablets: 0.5 mg, 1 mg, 2 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: ATIVAN, LOREEV XR
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-28

Label indications

Anxiety disorders; insomnia due to anxiety/stress (label varies by product).

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Clinical Highlights

Lorazepam (brand Ativan; ER brand Loreev XR) is a short-to-intermediate acting benzodiazepine used for anxiety and insomnia due to anxiety or stress; in psychiatry it is also a cornerstone medication for catatonia evaluation and treatment. It is metabolized via glucuronidation (not CYP), which can simplify drug-interaction management; however, additive sedation and respiratory depression risks remain central, especially with opioids or alcohol.

Dependence, tolerance, and withdrawal risks mandate clear treatment goals, limited duration, and taper plans from the outset.
In catatonia pathways, “lorazepam challenge” response should trigger a broader care plan (medical evaluation, supportive care, and early ECT readiness if response is incomplete) rather than an indefinite standing benzodiazepine order.
Use is generally avoided or approached with extreme caution in older adults, untreated sleep apnea/COPD, and with concurrent opioids or alcohol; sedation, falls, and respiratory compromise can outweigh benefit.
The compare view and the lorazepam evidence feed, along with the lorazepam print page, support side-by-side review of alternatives for agitation/catatonia pathways and patient-friendly counseling.
Product labels include anxiety disorders and some insomnia due to anxiety/stress; for persistent symptoms, psychotherapy and SSRI/SNRI strategies are typically prioritized over benzodiazepine maintenance when feasible.
Generic oral tablets are widely available, and parenteral formulations are common in hospital pathways—clear outpatient guardrails (quantity limits, follow-up cadence, taper plans) remain essential.

Dosing & Formulations

Oral tablets: 0.5 mg, 1 mg, 2 mg. Oral concentrate: 2 mg/mL (select products).

Injection (IM/IV): commonly used in emergency and catatonia pathways.
Extended-release formulations exist (Loreev XR); modified-release products are not crushed or split, and “as needed” redosing on top of scheduled dosing is generally avoided.
Anxiety (label ranges vary): typically 1–3 mg/day in divided doses; higher doses increase sedation and fall risk—titration is typically cautious.
Catatonia (off label): “lorazepam challenge” protocols vary; follow-up frequency is often high, with escalation to ECT pathways when response is inadequate.
Courses >2–4 weeks commonly include a taper plan; abrupt discontinuation increases withdrawal and rebound anxiety risk.
Nightly use for sleep is generally avoided; if insomnia is the primary complaint, underlying drivers and insomnia-specific strategies are often prioritized.

Monitoring & Risks

Boxed warning: Concomitant use with opioids may result in profound sedation, respiratory depression, coma, and death. Sedation and psychomotor slowing: fall risk and ability to drive/operate machinery are commonly assessed.

Cognitive impairment and anterograde amnesia: Dose-dependent; higher risk in older adults.
Respiratory depression risk increases with sleep apnea, COPD, alcohol, or sedating co-prescriptions.
Dependence and withdrawal: gradual tapering is typically used after chronic use, with monitoring for rebound anxiety or seizures.
Paradoxical disinhibition (irritability, agitation) can occur; diagnosis is revisited and discontinuation may be considered if symptoms worsen rather than improve.

Drug Interactions

Additive CNS and respiratory depression with opioids, alcohol, antihistamines, and sedating antipsychotics—combinations are minimized when feasible, and overdose-risk counseling is common. Valproate and probenecid can reduce lorazepam clearance via glucuronidation inhibition—lower dosing and closer sedation monitoring may be needed.

Even without CYP metabolism, lorazepam still carries additive impairment with other sedatives (Z-drugs, gabapentinoids, muscle relaxants); stacking hypnotics is generally avoided when feasible.

Practice Notes

Lorazepam is often reserved for targeted indications (catatonia, severe anxiety) with explicit time limits and a taper plan documented at initiation. For catatonia, daily follow-up is common, with coordination across the schizophrenia and bipolar hubs for escalation and ECT pathways when needed.

Prescription monitoring data and substance use risk are commonly reviewed, along with counseling about driving impairment.
Short prescriptions with planned follow-up are common; “automatic” refills are generally avoided. When discontinuing, gradual tapering and monitoring for withdrawal symptoms and functional relapse are typical.

References

Ativan (lorazepam) prescribing information — DailyMed (2025)
ASAM guideline on benzodiazepines — Journal of Addiction Medicine (2020)
Benzodiazepines FOR Catatonia: Systematic Review AND Meta Analysis — Schizophrenia Research (2018)
Evidence Based Consensus Guidelines FOR THE Management OF Catatonia: Recommendations From THE British Association FOR Psychopharmacology — Journal of Psychopharmacology (2023)
Evidence Based Pharmacological Treatment OF Anxiety Disorders — Depression and Anxiety (2014)