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Lorazepam (brand name Ativan) is a widely used prescription benzodiazepine for anxiety, sedation, seizures and alcohol withdrawal. It enhances GABA, the brain's main calming neurotransmitter, to produce anxiety relief, sedation and muscle relaxation. It is intermediate-acting and, unlike many benzodiazepines, has no active metabolites, but it carries the same dependence and depressant-synergy risks as the rest of its class.
- Anxiety relief
- Sedation and calm
- Seizure and alcohol-withdrawal control
- Drowsiness and impaired coordination
- Memory impairment
- Tolerance and dependence with regular use
- Dangerous with alcohol or opioids
Mechanism
Lorazepam is a positive modulator at the benzodiazepine site of the -A receptor, increasing the frequency of chloride-channel opening in response to GABA and broadly dampening neural activity. It is metabolized simply by conjugation without producing active metabolites, which gives it a relatively predictable duration and makes it useful in acute settings such as seizures and alcohol-withdrawal management.
receptor fingerprint
-A receptor (benzodiazepine site)Positive allosteric modulator
Safetyrisks and cautions, not medical advice
Lorazepam is dangerous combined with opioids or alcohol, which stack respiratory depression and can be fatal. Regular use leads to tolerance and physical dependence, and abrupt withdrawal can cause rebound anxiety, insomnia and seizures, so it is tapered rather than stopped suddenly. It also impairs memory, coordination and driving, especially in older adults. Not medical advice.
Interactionsdocumented pairs only, not exhaustive
Lorazepam is cleared by glucuronidation rather than the cytochrome P450 system, which spares it the CYP3A4 interactions that complicate midazolam and alprazolam. Its serious interactions are pharmacodynamic instead.
Opioids carry a boxed warning for good reason: the combination produces profound sedation, respiratory depression, coma and death, and it accounts for a large share of benzodiazepine-related fatalities. Alcohol, sedating antihistamines, barbiturates, gabapentinoids and skeletal muscle relaxants all add to the same effect. Clozapine deserves separate mention, with reports of marked sedation, excessive salivation, hypotension, ataxia and respiratory arrest when the two were started together.
Two drugs do alter lorazepam's clearance, both by inhibiting glucuronidation. Probenecid roughly halves it, and valproate raises lorazepam concentrations substantially; in both cases the sedative effect arrives deeper and lasts longer than expected.
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Subjective profileweighing the evidence above
Excellent for acute anxiety, seizures and alcohol withdrawal, and it should stay a short-term or as-needed drug for exactly that reason. Tolerance and physical dependence build quickly with regular use, withdrawal can bring seizures, and combining it with alcohol or opioids is how people stop breathing.
Resources
This entry is here for reference.
Research
- 1.Exploration of Extended-Release Lorazepam: Implications for Safe Nurse Practitioner Practice
- 2.Benzodiazepines revisited--will we ever learn?
2 listed here; entry last updated August 2026
Reviews
My notesprivate to this device
FAQ
What is lorazepam used for?
It treats anxiety, provides sedation, and is used in emergencies for seizures and alcohol withdrawal.
Why is it favored in acute care?
It is metabolized without active metabolites, giving a comparatively predictable duration that is convenient in hospital settings.
Can you stop it abruptly?
Not safely after regular use; sudden discontinuation can cause severe withdrawal including seizures, so it is tapered under medical guidance.
Adverse effects
- Drowsiness and impaired coordination
- Memory impairment
- Tolerance and dependence with regular use
- Dangerous with alcohol or opioids