Ativan dosage, forms, and strengths

Ativan is a brand-name prescription drug (generic name: lorazepam) used for the short-term management of anxiety disorders, anxiety, insomnia, or as an immediate emergency treatment for status epilepticus, a life-threatening condition in which seizures continue without let-up for five minutes or more. Ativan is also used to induce sedation before medical procedures or anesthesia. 

Lorazepam, the active ingredient in Ativan, belongs to a class of drugs called benzodiazepines that work by enhancing the effects of GABA, a neurotransmitter that slows down nerve activity in the brain. Ativan is taken orally for anxiety or insomnia. Seizure relief and procedural sedation are administered as injections by a healthcare professional.

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Ativan forms and strengths

Ativan is taken as a tablet or administered by a healthcare professional as an intravenous or intramuscular injection.

• Tablets: 0.5 mg, 1 mg, 2 mg

• Injection: 2 mg per mL, 4 mg/mL

Ativan dosage for adults

Ativan is FDA approved to treat adults and children 12 years of age and older for anxiety, anxiety disorders, stress-induced insomnia, status epilepticus, and to induce sedation before medical procedures. It is also commonly used off-label to treat alcohol withdrawal, chemotherapy-associated nausea, and as a tranquilizer for agitated patients in an emergency room or patients put on a mechanical ventilator.

Ativan dosage for anxiety disorders and anxiety

Ativan is an anxiolytic, or anxiety-reducing drug, that is used in the short-term—four months or less—to relieve the symptoms of anxiety disorders or anxiety. Anxiety disorders are characterized by debilitating long-term worrying, fear, or panic that often have no identifiable trigger or reason. Anxiety is short-term and often situational, but it, too, can interfere with daily functioning. Ativan is not, however, considered an appropriate treatment for everyday anxiety, stress, tension, or worry. The daily dose is divided into two or three doses, but a healthcare professional may instruct patients to take a larger dose at bedtime to help relieve sleeplessness caused by anxiety.

• Standard dosage for anxiety disorders or anxiety: 2–6 mg taken daily in three divided doses per day

• Maximum dosage for anxiety disorders or anxiety: 10 mg per day

Ativan dosage for insomnia

Ativan is FDA approved as a sedative to relieve insomnia due to anxiety or situational stress. The medicine will only be given in the short term, usually no more than four months.

• Standard dosage for insomnia: 2–4 mg taken before bedtime

• Maximum dosage for insomnia: Not specified

Ativan dosage for status epilepticus

Ativan is used as an emergency treatment for status epilepticus, a serious and life-threatening medical condition in which seizures continue for five minutes or longer without any recovery periods. Benzodiazepines are the first-line therapy for status epilepticus and intravenously injected lorazepam is the drug of choice because it works very quickly, usually in one to three minutes. Other anticonvulsants may be used as well. Doses will be determined and administered by a healthcare professional. Although intravenous injection is the preferred dosing method, a healthcare professional may give an intramuscular injection if an IV is not possible.

• Standard dosage for status epilepticus: 4 mg IV followed by a second dose 10–15 minutes later if necessary

Ativan dosage for procedural or pre-anesthetic sedation

Ativan is FDA approved as procedural sedation for minimally invasive procedures or to induce sedation before administering anesthetics. As a tranquilizer, lorazepam is given in doses to render the patient relaxed and sleepy. The maximum lorazepam dose for medical procedures is a single 2–4 mg dose, the same dose given at bedtime to relieve anxiety-related insomnia. For procedural sedation, Ativan will be given by a healthcare provider as an intramuscular injection two hours prior to the procedure or as an intravenous injection 10 to 15 minutes before the procedure. 

• Standard dosage for procedural or pre-anesthetic sedation: 0.05 mg per kilogram of body weight injected intramuscularly two hours before the procedure or 0.044 mg/kg injected intravenously 15–20 minutes before the procedure

• Maximum dosage for procedural or pre-anesthetic sedation: 4 mg (intramuscular injection) or 2 mg (intravenous injection)

Ativan dosage for children

Ativan is FDA-approved to treat adults and children older than 12 years of age. Dosages will not vary based on age. 

Lorazepam has not been determined as safe and effective for younger children, though healthcare professionals may prescribe it off-label to young children for anxiety, status epilepticus, chemotherapy-associated nausea, procedural sedation, or to calm agitated children in the emergency room.

Ativan dosage restrictions

For geriatric treatment, lower initial doses may be used. People older than 65 are more susceptible to Ativan side effects such as drowsiness, unsteadiness, disorientation, and sleep apnea than younger people. 

Because lorazepam is metabolized by the liver, people with hepatic impairment may be given a lower dose, but this lower dose has not been standardized. Renal impairment may also be a problem, but again, no standard for lower doses has been established.

Some people may not be able to take Ativan at all. Contraindications include people who have had serious allergic reactions to lorazepam or any of the inactive ingredients in Ativan. Patients with liver failure should not take Ativan, and people at risk for acute narrow-angle glaucoma, a serious eye disorder that can quickly lead to vision loss and blindness, should also not take Ativan. 

Ativan dosage for pets

Lorazepam injections are used as an alternative to diazepam for the emergency treatment of status epilepticus in dogs. It is also sometimes used along with other drugs to treat anxiety, phobias, fears, and aversions in both dogs and cats. 

A veterinary professional will administer the medicine in an emergency for status epilepticus. For anxiety, phobias, or similar problems, doses will be administered by mouth at home. For dogs, doses will range between 0.01 mg/kg to 0.5 mg/kg and be given to the animal one to three times a day. For cats, doses will range from 0.03 mg/kg to 0.25 mg/kg and be given one to three times a day.

How to take Ativan

Ativan is administered orally or as an injection. Ativan injections will always be administered by a healthcare professional in a clinical setting, but oral dosing typically occurs at home.

• Take the medicine as instructed by a healthcare provider. The dose may need to be changed several times until an effective dose is reached.

• Ativan comes with a medication guide. Read this medication guide and follow all the patient instructions.

• Ativan can be taken with or without food.

• Store Ativan tablets at room temperature (68°–77°F) in a child-safety closed container out of the reach of children.

• Swallow the tablet whole with a glass of water. Do not crush, chew, or break the tablet.

• Ativan tablets may be crushed if required for administration via a feeding tube.

Ativan dosage FAQs

How long does it take Ativan to work?

Ativan works very quickly, making it a commonly-used tranquilizer in emergencies as well as the drug of choice to treat status epilepticus. An Ativan intravenous injection begins working in one to three minutes; an intramuscular injection hits maximum concentration in 15–30 minutes. Taken by mouth, lorazepam should start showing effects in 15–30 minutes but hits peak effectiveness in two hours.

How long does Ativan stay in your system?

With a half-life of 14 hours, it takes the body about three days to clear Ativan from the body. Therapeutic effects tend to wear off in about six to eight hours, but side effects such as drowsiness and unsteadiness may last longer.

Drug tests, such as DUI tests, may test for the presence of benzodiazepines including lorazepam. Lorazepam is detectable in the blood for up to three days after the last dose. A urine test can detect lorazepam or its metabolites for up to six to nine days after the last dose

What happens if I miss a dose of Ativan?

Take a missed dose as soon as it’s remembered. If the missed dose is more than one hour late, skip the missed dose and wait until it is time for the next dose. Do not use extra medicine to make up for a missed dose.

How long can you take Ativan?

Ativan is not intended for long-term use. Do not take Ativan continuously for longer than four months except under the medical advice of a healthcare professional.

How do I stop taking Ativan?

Do not stop taking Ativan without talking to a doctor or other healthcare professional. Taken daily at therapeutic doses, Ativan can cause physical dependence and withdrawal symptoms when discontinued including:

• Rebound anxiety

• Depression

• Psychosis

• Memory problems

• Thinking problems

• Hyperactivity

• Unusual movements (ataxia)

• Seizures

• Suicidal thoughts and behaviors

Some withdrawal symptoms can hang on for as long as 12 months. For people abusing Ativan, withdrawal could be fatal.

When discontinuing Ativan, a doctor will slowly taper the patient’s dose to reduce the risk of withdrawal.

People may need to suddenly stop taking Ativan for several reasons: hypersensitivity, pregnancy, drug interactions, adverse reactions, or serious side effects such as seizures or respiratory depression. 

Can you overdose on Ativan?

Do not take more Ativan than prescribed. High doses of Ativan significantly slow down the central nervous system and cause sedation, unsteadiness, confusion, low blood pressure, slurred speech, as well as paradoxical reactions such as excitement, restlessness, agitation, and pressured speech. 

An overdose could be fatal, causing a patient’s breathing to slow down or stop apnea. This slowing of respiratory rate requires immediate attention and in extreme cases may result in death. Cardiac side effects and changes in other vital signs are less likely to occur when Ativan overdoses do not include ingestion of other substances such as alcohol or other medications. Ativan overdose by itself is more likely to cause mental status alterations, and possibly a coma. A severe overdose is more likely when Ativan is taken with other drugs that depress the central nervous system, called CNS depressants. These include alcohol, opioids, sleeping pills, and other benzodiazepines such as Valium (diazepam) or Xanax (alprazolam). Overdoses with these coingestants are much more likely to be fatal.

Propylene glycol toxicity can occur during overdoses with Ativan administered intravenously. This syndrome can result in skin and soft tissue necrosis (cell death), heart arrhythmias, rupture of red blood cells (hemolysis), low blood pressure, seizures, and organ failure. Propylene glycol is only present in IV formulations of lorazepam.

If an Ativan overdose is suspected, immediately seek emergency medical care.

What happens when you mix Ativan and alcohol?

Do not mix Ativan with alcohol. The combination will worsen Ativan’s adverse effects such as drowsiness, unsteadiness, mental impairment, hypotension, and slowed breathing. Too much alcohol and Ativan could cause respiratory depression, coma, and even death.

Is it safe to take Ativan during pregnancy?

Because of the possible risk of birth defects or fetal death, Ativan should not be taken during pregnancy, especially during the first trimester of pregnancy. This restriction is due to risks of birth defects, neonatal withdrawal syndrome, and fetal death, based on limited human and animal studies. A conversation with a doctor about the risks versus the benefits of taking Ativan may be appropriate during the third trimester of pregnancy. Women who are nursing should also avoid Ativan, although low-doses are likely to be safe when used short-term. Lorazepam is present in breast milk and sedation and inability to suckle have been observed in breastfeeding newborns. 

Related resources for Ativan dosages:

• Anxiety disorders

• Ativan

• Ativan injection prescribing information

• Ativan tablets prescribing information

• Benzodiazepine toxicity

• Lorazepam

• Lorazepam (Ativan)

• Lorazepam compound summary

• Lorazepam drug summary

• How long does Ativan stay in your system?

• Procedural sedation

• Status epilepticus