Ativan (Lorazepam) Side Effects: Common, Serious & Long-Term
Table of Contents
Ativan side effects range from mild drowsiness to slowed breathing that can turn deadly. Ativan is the brand name for lorazepam, a benzodiazepine the U.S. Drug Enforcement Administration classifies as a Schedule IV controlled substance. Most people feel sedation, dizziness, or unsteadiness, and those effects often ease within a few days. A smaller number hit serious trouble: heavy sedation, dependence, or dangerous breathing changes, and the risk climbs sharply when lorazepam is taken with opioids or alcohol.
Key Takeaways
- ✓ Most Ativan side effects are mild and sedative. Sedation, dizziness, weakness, and unsteadiness are the most frequent reactions on the FDA label.
- ✓ Lorazepam carries an FDA boxed warning for misuse, physical dependence, withdrawal, and a deadly risk when combined with opioids.
- ✓ Older adults and children face amplified risk. The AGS Beers Criteria advise against benzodiazepines for adults 65 and older.
- ✓ Slowed or stopped breathing is an emergency. So are blue lips, a seizure, or thoughts of self-harm. These need immediate medical care.
Common Side Effects of Ativan
The most common Ativan side effects are sedation, dizziness, weakness, and unsteadiness.
In the manufacturer’s data on about 3,500 patients treated for anxiety, the FDA label for Ativan records sedation in 15.9% of people, dizziness in 6.9%, weakness in 4.2%, and unsteadiness in 3.4%, and both sedation and unsteadiness grow more common with age, which is why the same prescription that barely fazes a 30-year-old can leave a 75-year-old foggy and off-balance for hours.
Most of it is dose related.
Other routine effects include blurred vision, nausea, appetite or weight changes, and constipation. People who get lorazepam by injection sometimes notice pain, stinging, or redness at the injection site.
These reactions often settle within the first few days. They still matter: drowsiness and slowed reflexes make driving and other alertness tasks dangerous until you know how the medication hits you.
What to knowTiming changes whether drowsiness is a problem or a help. A daytime dose for anxiety can leave you foggy at work, while the same dose at bedtime may simply help you sleep. Ask your prescriber about timing before you change anything yourself.
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Serious Side Effects and the FDA Boxed Warnings
Ativan’s most serious risks sit in an FDA boxed warning, the agency’s strongest label alert.
In September 2020, regulators required a stronger boxed warning across the whole benzodiazepine class, covering three dangers: misuse and addiction, physical dependence and withdrawal, and the risk of serious injury or death when these drugs are combined with opioids, and beyond that warning lorazepam can occasionally cause delirium, paranoia, severe depression, suicidal thoughts, seizures, and dangerously deep sedation even at prescribed doses.
Some people get the opposite of calm.
That’s a paradoxical reaction, meaning agitation, excitement, irritability, or aggression, and it shows up more often in children and older adults. Dependence and depression are both treatable, and support exists for anyone whose use has drifted past what their prescriber intended.
Overdose Risk and Opioid Combination
An Ativan overdose gets far more likely the moment lorazepam meets another depressant.
Alone, too much lorazepam tends to cause slurred speech, clumsy movement, confusion, and heavy sedation.
The deadly version is a mixture: benzodiazepines stacked with opioids or alcohol pile their effects onto the brain’s breathing centers, and during January through June 2020 roughly 93% of benzodiazepine-involved overdose deaths also involved opioids, mostly illicitly made fentanyl, which is the plainest reason not to pair Ativan with another sedating substance outside a doctor’s direct supervision.
Respiratory Depression and Allergic Reactions
Respiratory depression is the most dangerous acute effect of lorazepam.
Watch for shallow or slow breathing, long pauses between breaths, blue-tinged lips, and a person who’s hard to wake, because the risk multiplies with opioids, alcohol, or other central nervous system depressants, and this is the failure mode that quietly turns a sedative into a fatal one while the person looks like they’re only sleeping deeply.
Allergic reactions are rarer, and also serious. Signs include rash, hives, swelling of the face, lips, or throat, and sudden trouble breathing. Any swelling of the airway means emergency help, fast.
When to Seek Emergency Help
Some side effects can’t wait for a routine appointment.
- Treat as an emergency: slowed or stopped breathing, blue lips, an unresponsive person, a seizure, or thoughts of suicide or self-harm.
- Contact a provider promptly: new or worsening depression, repeated falls, severe confusion, or early signs of dependence such as needing higher doses for the same effect.
Early dependence is easy to miss because it hides inside normal-looking use: the same dose stops working, the gaps between doses get harder to ride out, a refill starts to feel urgent, and the medication slowly becomes the thing that organizes the day, and catching that pattern early is what separates a manageable taper from a much harder one later. You’ll find crisis numbers and helpline details in the closing section of this page.
Worried about how much Ativan you or someone you love is taking? Help is available and completely confidential.
Long-Term Side Effects, Dependence & Withdrawal
Ativan is built for short-term use, and the reasons surface over time.
With steady use the body adjusts, the dose stops working as well, and physical dependence can set in within days to a few weeks—and this is the part that blindsides people—even when the drug is taken exactly as prescribed, while stopping suddenly or cutting the dose too fast can trigger withdrawal that includes seizures.
Longer use carries other costs: cognitive slowing and memory problems, emotional blunting, more falls, and more motor-vehicle crashes. In older people, benzodiazepine use raises the risk of hip fracture by at least 50%.
Dependence isn’t the same as misuse. A person can become physically dependent on a correctly prescribed medication without ever taking more than directed. Misuse means taking lorazepam in a way it wasn’t prescribed, for the effect rather than the medical reason. Both can lead to withdrawal, and both deserve a careful plan rather than blame.
Withdrawal can bring tremor, rebound anxiety and insomnia, sweating, cravings, and, in severe cases, seizures. The safest way off lorazepam is a gradual taper run by a prescriber. At Reach Recovere, our Find-and-Fund approach pairs that step with the part most people actually worry about: finding a program that fits, then sorting out how to pay for it.
Ativan Side Effects in Older Adults
Adults 65 and older face heightened risk from Ativan, which is why the American Geriatrics Society recommends against it for this group.
The 2023 AGS Beers Criteria advise avoiding benzodiazepines in older adults because of cognitive impairment, delirium, falls, fractures, and motor-vehicle crashes, and the effects an older body feels are simply the usual ones amplified: sedation runs deeper, confusion comes easier, and balance suffers, which is how a fall becomes a broken hip.
Interactions make it worse.
An older adult taking lorazepam alongside a blood-pressure medication can get compounded dizziness, and that combination pushes fall risk higher still. Prescribers usually start at lower doses, since sensitivity to sedation runs higher with age, a caution reflected in the prescribing information.
Ativan Side Effects in Children
Ativan isn’t established as safe for children under 12, and pediatric use calls for caution. Safety and effectiveness of lorazepam tablets in children younger than 12 haven’t been established.
Children also run a higher chance of paradoxical reactions, and in open-label studies paradoxical excitement, with tremors, agitation, and brief visual hallucinations, was reported in 10% to 30% of children younger than 8, per the FDA prescribing information, so when lorazepam is used in a child for procedural sedation or seizures, it happens under direct medical supervision, and parents should watch for agitation rather than calm.
Ativan Drug Interactions That Worsen Side Effects
The substances that most worsen Ativan’s side effects are other depressants.
Opioids, alcohol, other benzodiazepines, sleep medications, and some sedating antidepressants and antihistamines all add to lorazepam’s effect on the central nervous system, producing more drowsiness, more unsteadiness, a higher chance of falls, and a real risk of slowed breathing, and opioids sit at the top of that list, singled out in the FDA boxed warning and reflected in the roughly 93% of early-2020 benzodiazepine overdose deaths that also involved opioids.
Alcohol works the same way, layering one sedative on another.
- Avoid entirely without medical guidance: opioids, alcohol, and other benzodiazepines.
- Use only with prescriber awareness: prescription sleep aids, sedating antihistamines, muscle relaxants, and certain antidepressants.
Tell every provider you see about all of it, including over-the-counter products, so no one adds a second depressant by accident.
If Ativan has become hard to stop, a supervised taper and the right program can change that. We can help you find both.
Frequently Asked Questions About Ativan Side Effects
Does Ativan cause weight gain or weight loss?
Significant weight change isn’t a well-documented Ativan side effect. Appetite changes are a listed effect, though, so some people eat more or less while taking it, and that can nudge weight in either direction. If your weight shifts noticeably, mention it to your prescriber rather than adjusting the dose yourself.
Is anger or aggression a side effect of Ativan?
It can be, through a paradoxical reaction. Instead of calming a person, lorazepam occasionally produces agitation, irritability, or aggression. These reactions are more common in children and older adults. New or out-of-character anger after starting Ativan is worth a prompt call to the prescriber.
Can Ativan cause memory loss?
Yes. Lorazepam can cause anterograde amnesia, meaning trouble forming new memories, which is one reason it’s used before some medical procedures. These effects usually improve after the drug is stopped. Evidence on whether long-term use causes lasting memory problems is mixed and not settled.
How long do Ativan side effects last?
Common side effects such as drowsiness and dizziness often ease within a few days as the body adjusts. Withdrawal effects are different. If dependence has developed, stopping can bring symptoms that last weeks, which is why a supervised taper matters. Timelines vary from person to person.
Sources
- U.S. Food and Drug Administration. Ativan (lorazepam) prescribing information, DailyMed. dailymed.nlm.nih.gov
- U.S. Food and Drug Administration. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class (September 2020). fda.gov
- U.S. Drug Enforcement Administration, Diversion Control Division. Benzodiazepines drug fact sheet (Schedule IV). deadiversion.usdoj.gov
- Centers for Disease Control and Prevention. Trends in Nonfatal and Fatal Overdoses Involving Benzodiazepines, MMWR (2021). cdc.gov/mmwr
- Cumming RG, Le Couteur DG. Benzodiazepines and risk of hip fractures in older people: a review of the evidence. PubMed. pubmed.ncbi.nlm.nih.gov
- 2023 American Geriatrics Society Beers Criteria Update Expert Panel. AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. PubMed. pubmed.ncbi.nlm.nih.gov
If this is an emergency, call 911 now, especially for slowed or stopped breathing, a seizure, or an unresponsive person. If you or someone you know is thinking about self-harm or suicide, call or text the 988 Suicide & Crisis Lifeline. For free, confidential, 24/7 treatment referrals, contact the SAMHSA National Helpline at 1-800-662-4357.
This content is for general information and is not a substitute for professional medical advice, diagnosis, or treatment. Always talk with a qualified provider about your medications and never stop a benzodiazepine abruptly without medical guidance. Reach Recovere is a nonprofit that helps people find treatment and figure out how to pay for it; we do not provide medical care.
Patrick Bailey
I am a professional writer, mainly in the fields of mental health, addiction, and living in recovery. I attempt to stay on top of the latest news in the addiction and the mental health world and enjoy writing about these topics to break the stigma associated with them.
Patrick Bailey
I am a professional writer, mainly in the fields of mental health, addiction, and living in recovery. I attempt to stay on top of the latest news in the addiction and the mental health world and enjoy writing about these topics to break the stigma associated with them.