Have you heard of Ativan (generic name lorazepam), and of the risks of benzodiazepines drugs in older adults? Is an older person you care for taking prescription medication for sleep, anxiety, or “nerves”?
Would you like an easy, practical tool to help someone stop a drug whose risks often outweigh the benefits?
If so, I have good news: a wonderful new patient education tool has been created by a well-respected expert in geriatrics, Dr. Cara Tannenbaum. Best of all, her recently published study proved that this tool works.
As in, 62% older adults who received this tool — a brochure with a quiz followed by key information — discussed stopping the medication with a doctor or pharmacist, and 27% were successful in discontinuing their benzodiazepine. The brochure includes a handy illustrated guide on slowly and safely weaning a person off these habit-forming drugs.
This is big news because although experts widely agree that long-term benzodiazepine use should be avoided in older adults, getting doctors and patients to work together to stop has been tough. It is, after all, generally easier to start a tranquilizer than to stop it!
But through a patient education brochure, Dr. Tannenbaum’s team was able to make this tricky process much more doable for older adults, their families, and their doctors.
The must-read information brochure on Ativan and older adults
If your older relative is taking Ativan (generic name lorazepam), I highly recommend you read Dr. Tannenbaum’s brochure. It provides really good information about these drugs, and includes practical tips on how to address sleep and anxiety issues without using drugs.
She has given me permission to post a copy on this blog, so click below to view and download:
You May Be At Risk: You Are Taking a Sedative-Hypnotic
Note: It can be dangerous — as well as physically very uncomfortable — to suddenly stop benzodiazepines. Discontinuing benzodiazepines should involve a gradual lowering of the dose. This process should always be done with the supervision and support of a healthcare professional.
Other sedatives to consider stopping
The brochure above covers Ativan along with other benzodiazepines, such as Valium, Xanax, Klonopin, and Restoril (generic names diazepam, alprazolam, clonazepam, and temazepam, respectively). It also covers commonly-used sleeping pills such as zolpidem (brand name Ambien)
Why it’s important to try to stop benzodiazepines
Benzodiazepines are a commonly used type of tranquilizing medication. These drugs are usually prescribed for sleep, anxiety, or agitation.
However, benzodiazepines are much riskier than many older adults realize. For instance, research has found these drugs:
- Worsen balance and thinking;
- Increase the risk of falls, and of fractures;
- Can make dementia symptoms worse;
- Are linked to a higher risk of dying within a few years.
Because of these problems, in 2013 the American Geriatrics Society’s Choosing Wisely list included benzodiazepines as one of the “5 Things Physicians and Patients Should Question,” when it comes to healthcare for older adults.
But unfortunately, benzodiazepines are easily habit-forming, meaning that the body becomes dependent on them quite quickly. (And occasionally, some patients develop problematic abuse of these drugs.)
So it’s important to offer an older adult the right approach, and a lot of support, when it comes to getting off these drugs.
I especially recommend avoiding benzodiazepines in people with memory concerns or a dementia such as Alzheimer’s disease. Benzodiazepines act on the same brain receptors as alcohol, and they almost always keep people with dementia from thinking at their best level.
Studies have also found that people who take benzodiazepines have an increased risk of developing dementia.
Is it ever okay for an older adult to take benzodiazepines?
Benzodiazepines, like all drugs and medical interventions, need to be considered by balancing their likely benefits with their burdens and harms.
There are some older patients — often with severe chronic anxiety — who seem to overall benefit from a low dose of these drugs.
Ideally, benzodiazepines should be used as a last resort, after making a serious attempt to treat insomnia and anxiety with non-drug approaches. These can include techniques such as cognitive-behavioral therapy, regular exercise, and stress-reduction techniques. For people with dementia, providing caregivers with coaching on managing difficult behaviors can also help.
I do have some older patients who are on benzodiazepines. I don’t like it, but usually we’ve tried other things, discussed the risks with the family, and concluded that this balance of benefits versus risks is acceptable. We also usually work to find the lowest possible dose.
Tips for caregivers
If your older loved one is taking a benzodiazepine:
- Do make sure you and the older person are properly informed about the side-effects, risks, and alternative options for treating insomnia or anxiety. Dr. Tannenbaum’s brochure is a terrific resource for this.
- Do talk to the doctors about attempting a taper off the drug. It’s usually worthwhile in the long-run. Even a reduction in dose can help reduce side-effects and risks.
- Don’t try to suddenly stop the benzodiazepines. Reducing these medications should be done gradually, and under medical supervision.
If your older loved one complains of insomnia or anxiety:
- Do question things if the doctor proposes a benzodiazepine or other tranquilizer as a solution. Ask for help with lifestyle changes and cognitive therapy instead. Remember that these drugs are much easier to start than they are to stop!
Questions about benzodiazepines in older adults? Please post in the comments below!
Update October 2015: I just came across an important study report. In a randomized trial to help older adults taper off benzodiazepines for insomnia, 76 older adults were assigned to one of three 10-week interventions: supervised benzodiazepine taper, cognitive-behavioral therapy for insomnia, or a combination of the two. All three groups were able to decrease their benzodiazepine use, and 63% of participants were drug-free at 7 weeks. In other words, it IS possible to learn to sleep without these medications, even if you’ve been taking them for years.
Update June 2017: Here are two additional resources to help if you want to learn more about tapering benzodiazepines:
- The “Ashton Manual” is a detailed online resource, created an English psychopharmacology professor who is an expert on benzodiazepines. Find it here: Benzodiazepines: How they work and how to withdraw.
- This article describes a journalist’s experience trying to taper off benzodiazepines, and her frustrations with medical professionals who seemed to underestimate the risks of using these drugs: I Tried to Get Off Ativan.
I cared for a lovely little old lady [ think she was 96] who just loved getting her blue pill at night time. She gave a beautiful smile as she took it, and would hold my hand and say “thank you dear, now I get to have wonderful dreams and forget this life”
So it does have its place, for the right person .
Agree with all stated in the blog tho for those who haven’t had 96 candles on their birthday cake
Thanks for sharing this sweet story. I, too, have found that many older adults love their benzodiazepine. (Heck, I’ve met people of all ages who are fond of this line of medication; almost everyone appreciates a little relaxation.)
As I say in the post, I think the key is to realize that these medications do come with risks and side-effects, so it’s important to be informed and consider alternatives.
But it’s certainly possible to weigh the benefits and risks, and then decide to continue the medication.
Please help me
Unfortunately, it’s not possible to provide much help online, beyond providing useful resources and perhaps suggesting some questions to ask your usual doctors. If you are concerned about benzodiazepine use, I recommend printing a copy of Dr. Tannenbaum’s brochure and discussing it with your usual health provider. Good luck!
(And of course, in case of emergency or severe symptoms, go to the nearest emergency room or call 911.)
I am so impressed with the information you are providing. I am 60 yrs old & have been taking lorazepam for over 13 years. My doctor has me take hydroxyzine as well. It is for sleep. My memory has been impaired and I am eager to get off both medications to stop the harm to my brain. Thank you Dr Kernisan for addressing this problem.
PS I must admit it was a relief to have something to ensure I would sleep but the memory loss is motivating me to try and get off the sleep cocktail. Thank you.
Thank you for sharing your story! I’m glad the information is helpful, and great that you’ve decided to work on this issue.
Your situation unfortunately is not uncommon. People often start medications for sleep when they are going through a stressful period in mid-life, and then their doctors never quite get around to revisiting the issue. However if you tell your doctors of your concerns and ask for help in stopping or at least minimizing these medications, they should be able to assist you.
Also, I’m sorry to say there are usually no easy and fast ways to learn to sleep without these medications. That said, with enough coaching and help many people do learn to sleep without medications. Often therapy helps — such as cognitive behavioral therapy — as well as incorporating relaxation techniques and exercise. (Note that exercise may mainly help sleep only after one has stuck with it for a few months.)
For more ideas on how to handle insomnia without drugs, try reading something like The Insomnia Workbook (you might find it at your public library). It’s written by a sleep medicine psychologist and has lots of good ideas.
Good luck! Getting off sleep medication takes time and persistence, but for most people it’s good for health in the long run.
I take two of the benzo’s for sleep; one for restless leg syndrome and one for insomnia per a sleep specialist that gives me the prescriptions. I’ve noticed the Temazepam seems to cause memory loss and I’m concerned…very concerned. I’ve been on these two drugs for a long time (4 years at least). Thanks for the schedule to discontinue them. I’m in my early 70’s and don’t want to take them anymore. I will talk to the sleep doctor too and tell her of my desire to quit them. I also use the lowest dose of the hormone patch and now I’m concerned about that too.
Great that you are being proactive about this. If you are concerned about your memory then I would definitely encourage you to discuss your concerns with your doctors. It is often possible to taper off benzodiazepines, but this should only be done under medical supervision. Good luck!
My father was on these for years and years .He never had to up his dose , didn’t suffer side effects and his doctor was more than happy for him to continue .My mum took nothing at all and died horribly of vascular dementia.My dad had a good death at 86 , my mother , dreadful at 90.
I think it really depends on the individual, the effects of these drugs .It was of a massive help to my father who was on 3 mg a day,and was perfectly with it ,mentally , when he passed away .
Sorry to hear of your mother’s difficult death. Agree that it does depend on the individual. However initially as clinicians — and even as patients — we can’t tell how an individual will respond over the long term, so we should start by working with what we know from observing groups.
(For instance, we all know people who smoked regularly and lived to their 90s, but they are exceptional. If someone is 40 and smoking, we cannot tell if they will be among the exceptional ones or not, although better analysis of genes and cellular activity might enable this soon.)
For benzodiazepines, my experience has been that most patients and families have been told very little about the downsides, and they haven’t been encouraged to consider alternatives. Ideally, people would be better informed before proceeding, or continuing on these drugs.
I will say that in some cases, the benefits seem to outweigh the risks. So I don’t want to say it’s *never* reasonable for older adults to take benzodiazepines. But given that they increase fall risk and worsen thinking, it’s worth thinking carefully before continuing with them long-term.
My elderly mother has been on ativan for years. We are her caretakers. She has an colostomy and has constant pain and bloating. Last time we took her in to the hospital they said she must get off her ativan and ambien for sleep. They weened her off of it and it was rough but worth it. She came home a new person that was happy and ate well and was in great spirits. 1 month later he put her back on the meds because he said it was unfair to take her off of them 🙁 she is now back right whete she started, sad and when no appetite and has continual cramping and bloating.
Hm, this sounds odd. Sounds like someone (a doctor I presume) put your mother back on her Ativan and Ambien? Was there a reason other than “it’s unfair to take her off?” And does your mother make medical decisions for herself?
I can’t tell what happened in this particular situation, but unfortunately, it is common for doctors to push ahead without adequately discussing things with patients, unless families and patients push back and insist on further discussion before proceeding with a medication change. This is tiring and uncomfortable for patients, but right now it’s often necessary.
If you think your mother really was better off her medications, you should bring it up with the doctor or consider a second opinion. You can also ask whether a slower taper might be possible; this might be less “rough” than the first one was. Good luck!
My wife (73) was started on antidepressants and clonazepam 13 years ago. Ever since, she was unable to get rid of the clonazepam habit although different doctors tried to reduce/wean her away. Particularly in the past 3 years she has been suffering immensely and virtually unable/unwilling to even get out of bed. The maximum dosage that she was given at any time in the past was 1.5 mg in three divided doses. Currently we are trying 0.75mg per day but it is making her condition/suffering worse.
I have a simple question: Is it possible to reduce her suffering by increasing the dose to say, 2 or 3 mg and continue same for the rest of her life or increase it even a little more, say 4 mg after a few years? I have only one objective and that is to reduce her suffering. Kindly give your advice/comments.
Sorry to hear of your wife’s difficulties. Unfortunately, it’s impossible for any doctor to answer your “simple question” online, you will need to work with someone in person. In particular, to answer your question a clinican would first have to review your wife’s medical history and especially understand what are the current causes of her suffering and other health difficulties. Only then would it be possible to advise regarding the dosage of her clonazepam and your other options for improving her well-being.
Now, you can probably get much better help by finding the right type of clinician. Many doctors do not have the right expertise provide your wife with the kind of help that’s likely to be a good fit.
Given the situation you describe, I would recommend you consider a consultation with a palliative-care specialist. Palliative care is a medical specialty that focuses on relieving suffering and difficult symptoms, and also emphasizes a comprehensive approach to help patients reach their most important goals.
Last but not least, you mention your objective for her but of course it’s vital to consider HER objectives for her health and wellbeing.
I hope you will be able to find a suitable clinician to help you. You can learn more about palliative care here: Get Palliative Care.
Thank you so much for your detailed reply and advice. I will follow up on consulting a palliative care specialist here in Hyderabad, India.
I have been taking Lorazepam since 1982, at night or in the morning if I feel edgy .25 mg as I bite the .5 in half. I never take .5 mg in a 24 hour span. It seems to take the edge off or allow me to sleep fine. My doctor has retired and I have been forced to look elsewhere. The doctors I have encountered say I must get off it asap as it is so bad for you (I have friends that take 16 times a day what I take). I have cut down to .12 mg every second or third day. The edginess has returned along with mild headaches and if I wake up after 3 hours sleep and am up till the next night, so needless to say I am frustrated being 59 years old, being sent for random blood samples to test for drug abuse which they say is now mandatory in Canada for Ativan use. I was fine on this drug 35 years, is it really that harmful
At 59 years old most people aren’t yet having difficulties with their memory or balance. But these issues become a concern for many older people, and it will only get harder to taper off your benzodiazepine as you get older. So although you are not taking a very big dose, it’s probably still worthwhile for you to find a way to stop using it, especially since your doctors are encouraging you to do so.
Did you read the brochure on tapering off these types of medications? (See here.) The brochure recommends a very slow taper that takes 16 weeks. You may want to ask your doctors for help implementing a similar taper.
I would also encourage you to ask your doctor for help implementing other approaches to help you with insomnia and edginess. Cognitive behavioral therapy for insomnia has an excellent track record, and is even available online through Sleepio and SHUTi. We have more information on treating insomnia here: 5 Top Causes of Sleep Problems in Seniors, & Proven Ways to Treat Insomnia.
Good luck!
Hi Leslie. I was prescribed Xanax about 12 years ago because I was having severe panic attacks when my son was serving overseas. I never upped my dose but eventually they stopped working as I felt worse with each day & finally traced it to the fact that I had hit tolerance on them. That is the 1st time that I researched these horrible drugs & I was shocked at what I found out, to say the least. I tried to talk to my Dr about this & she just thinks I’m being ridiculous. Anyways, for whatever reason, my last appointment with her, she informed me that she will no longer prescribe Xanax to her patients & she gave me a script for Lorazepam. I began my 1st cut at that time because she didn’t realize that they are not equivalent meds & she gave me the same amount of pills. I am desperate & determined to get off of this medication because it is greatly affecting my quality of life! It has gotten to the point that I will not do anything unless it is absolutely pressing. My relationships are suffering (except for the ones with my kids & grandkids because they are pressing) my hygiene, my job, my diet, my housekeeping (& I had OCD before this started & my house was always immaculate) my cognitive ability is awful, my memory is getting worse, my libido is nonexistent, I don’t seem to care about much, my emotions are blunted AND I experience a myriad of physical & mental symptoms from one minute to the next. Ugh!!! Sorry to rant on but I can’t seem to discuss this without my frustration getting the best of me. Anyway, I stumbled across your article & have a question about your taper schedule. I guess that I really don’t understand it. I see that it starts with a half dose on Monday, full dose on Tuesday, etc. I am currently at .5 milligrams 3 x a day. So when you are saying half dose, does that mean to only take .75 on the half days? I keep reading to reduce by .10 or .15 at a time. Any advice that you can give me would be greatly appreciated! Thanks…
Sorry to hear you are concerned about your benzodiazepine use, but glad to see you are being proactive about addressing this.
First and foremost: I do not recommend that you or any other benzo user attempt to taper on their own. The handout is meant to provide some sensible starting guidance to an older person and their clinical team. The described taper should be suitable for most people, but it’s important to review it with someone who is in a position to consider your particular health history, and adjust the plan if necessary. Some patients do need additional psychological support or other additional clinical assistance, to keep their symptoms manageable while they taper benzodiazepines.
Now, admittedly some doctors may not have the latest knowledge of how to help patients taper their benzodiazepines. If your doctor doesn’t seem willing or able to help you address this issue, you may want to find another provider to assist you.
Regarding the taper schedule in the handout, it’s probably easiest to use when people have been taking the same dose of benzodiazepine, once a day. A clinician could help you figure out how to apply it to your situation.
Usually, benzodiazepine tapers are meant to reduce the total weekly dose by 15-25%, every 2 weeks. (This is what the taper in the handout shows.) Your current dose is 0.5 x 3 x 7 = 10.5 mg per week. So a reduction of 15% would mean taking about 9mg/week, and then in 2 weeks, your clinician would probably recommend a further reduction of 15-25%.
Some people do experience benzodiazepine withdrawal symptoms when reducing by 15-25% every 1-2 weeks. In this case, the solution is to attempt an even slower taper (i.e. reducing by a smaller percentage every 2 weeks). You can find good information and slower taper schedules in the “Ashton Manual” online: Benzodiazepines: How they work and how to withdraw.
Again, I would strongly urge you to get help from your doctor or another clinician. You can bring the handout to the visit, as it often helps clinicians to see the recommended taper schedule. Good luck!
My mother was diagnosed with cancer and put onto Diazepam at a low dose to start with. She was starting to act a bit odd after a few weeks on the diazepam she seemed to be delusional and unable to recall things from her short term memory, then she started to recall things none of the family were aware of. Mum was given a terminal diagnosed some weeks later and slowly but surely her meds increased. She was then on Oxynorm too. Mum’s behaviour was scary and we were told it was not the diazepam because that was for relaxation and she could have as much as she like as and when she liked. It was thought that it may have been the oxynorm and that because on occasion she took up to 70mg of that throughout the day/night in total, she may have been overdosing. The oxynorm was stopped dramatically but the diazepam carried on and was up to 50mg at some points, wavering around the 30mg most days but some were 40mg and some 50mg. My started to get angry and delusional about things her family were doing and not trusting us. She was accusing us of things that were not true but the medical people told us it was just the drugs adjusting. We were so frightened and scared but it all seemed to be the norm. Suddenly we were told that mum didn’t want to take diazepam any longer and as such after taking it for a good couple of months or more she was suddenly stopped it. She grew more and more agitated and angry but then occasionally she was given the odd 5 mg or 10mg to calm her down but then she would have nothing for days on end and would grow more and more delusional. Convinced we had been trying to kill her. Is it possibly that all that could be down to the diazepam? Mum had over her life time suffered depression and each time she went to the Doctor with depression the doctor gave her either valium or atavan or zanax, clonozopine or sanex and similar and every time she took them, after a few days of mixing them with her whisky she would end up trying to kill herself and delusional and even psychotic. I know she was being given alcohol with the diazepam and Oxynorm/oramorph during her terminal phase so wondered if she could have been experiencing a heightened effect of the drug when on them with alcohol and then massive withdrawal when she suddenly stopped. Thank you for taking the time to read this
Thank you for sharing your story. It sounds like your family went through a lot of difficult and frightening times when your mother was taking these medications. (Depression in a parent is difficult, too.)
Benzodiazepines such as diazepam and lorazepam do relax many people, but they can also paradoxically agitate or confuse others, especially older adults. So I think it’s quite possible that your mother’s worsening was related to her benzodiazepines.
And then yes, even if they were making her worse, the body does become dependent on them. So suddenly stopping or reducing them usually causes significant withdrawal symptoms. In someone whose mind has been weakened, I would not be surprised if withdrawal made a person’s delusions or confusion worse. (Benzodiazepine withdrawal can also sometimes cause life-threatening stress to the heart and other organs, so these drugs should always be tapered down.)
An opiate such as morphine (in oramorph) or oxycodone (in oxynorm) does sometimes cause confusion in older adults, so it’s possible that this was contributing at times.
Honestly, it sounds like your mother had some underlying changes to the brain which made her vulnerable and prone to developing confusion and delusions. In such people, they can get mentally worse when they take mind-altering drugs, when they suddenly stop mind-altering drugs, and when they are experiencing uncontrolled pain or some other trigger for delirium.
I’m sorry you had to go through such a hard time with her. I can’t tell from your comment whether she is still alive or not. If she is, I hope the doctors have found a way to keep her feeling better. If she’s no longer with you, I wish you the best in grieving her and recovering from this experience.
I have been taking Lorazepam for a couple of months, on and off. just 1 mg. No more than that per day, and some days none at all….but now I want off of them because of all the bad stuff I have been reading. I went to the mental clinic and talked to a therapist before I started taking these pill…I was supposed to see the Dr. at the clinic..but it takes weeks to see him. So I really don’t have a prescription for them, but a friend gave me a whole bottle of hers. I never finished the bottle and now I don’t want to. I take them for anxiety and sleep problems, and they helped..but I think I can do something different to address these problems. I am 63 years old, and I am going to see the Dr. at the clinic in a couple of days… I have stopped taking them cold turkey, and having high anxiety and cannot sleep..what should I do. I have considered taking one just to get some sleep. Do you think the Dr. will help me…even though I never got a perscription for them??
Most people find lorazepam to be very effective in reducing insomnia or anxiety symptoms in the short-term, so I’m not surprised that you found they helped. But yes, it’s generally not a good idea to rely on this type of drug, because it’s habit-forming, and creates risks and problems in the longer-term. So I think it’s good that you’ll be seeing a doctor and asking for help.
Quitting cold turkey is often uncomfortable and can potentially be dangerous. Don’t delay in going to urgent care or the emergency room if you are feeling really unwell.
You should certainly request medical help in reducing/stopping your lorazepam use and in finding better ways to manage your symptoms. Doctors are often reluctant to prescribe a controlled substance to someone who got them without a prescription, but hopefully someone will be willing to help you with this issue.
For what it’s worth, I consider 1mg to be a pretty large dose. Many older adults experience symptoms relief with 0.5mg or even 0.25mg. However when the body gets used to 1mg doses, smaller doses may provide noticeably less relief.
Good luck getting help with this medication!
Mom (87 yo) has been on 2 mg of lorazepam (L) for many years (?15). For the past 4 months, everyday she wakes up different, with some new strangeness. She was acting so bizarre, but they told me it was a UTI. I thought it was due to a tolerance on the L. The PA told me to reduce her dose by 1/2 mg every third day which I did. She developed aspiration pneumonia and I asked the hospital staff to stop her L since it was time on the given schedule. None of the behavior got better, it just remained bizarre, but she stopped sleeping. So we thought if we put her back on her full dose we could stabilize her and then slowly…slowly ween her off. But back on her full dose, she has now developed partial seizures. Her pcp wants to put her on antipsychotic drugs which I said no to. I am in a small town where I am already seeing the “best doctor”. I am so scared I am poisoning her by giving her L everyday! Please advise! Or just list the options you see available to me. I am desperate for help.
This does sound like a difficult situation. A few thoughts:
– for someone who has been on 2mg, going down by 1/2 mg every third day is a lot. Many people will experience significant withdrawal symptoms. I would recommend looking at the brochure this article links to. A slow taper over 3-4 months is more likely to be successful, the slower the better.
– If a person is having difficulty sleeping or other problems related to a decrease in lorazepam dose, it might be better to increase the dose a little bit, rather than jump back to the original dose.
– The seizure issue sounds a bit odd to me. Benzodiazepines are actually effective anti-seizure medications, although that’s only rarely the main reason they would be prescribed. Are the doctors quite sure she is having seizures and not some other problem? If she is indeed having seizure medication, then it would be appropriate to consider prescribing something specifically to control the seizures. This is usually managed by neurologists, preferably those with experience managing seizures.
At age 87, my guess is that some of your mother’s strange behavior may be due to developing some form of dementia. If you can slowly taper down her benzodiazepine, that might help her think a little better. But realize that she might experience irritability and withdrawal symptoms in the short term.
Don’t worry too much about poisoning her. It’s not ideal that she’s on this drug, but it’s not something that usually can be changed quickly.
You may also find it helpful to read the section on weighing benefits and burdens, in this article about anticipating an older parent’s decline: How to Plan for Decline in Alzheimer’s Dementia:A 5-Step Approach to Navigating Difficult Decisions & Crises with Less Stress. Even if your mother doesn’t have Alzheimer’s or dementia, the general principles on figuring out what to do will apply.
Good luck!
I have been taking ativan (lorazapam) 3mg per day for about two years and I really want to get off of them. Do you have any advise for me. I am 67 years old and pretty healthy guy. Did physical labor my whole life. Depression runs in my family. My father and some of my brothers and a sister have had some troubles as well. Not my Mother. Thank you.
Congratulations on deciding to address your lorazepam use. For many older adults, the effort it takes to taper off benzodiazepines is worthwhile, since a drug like lorazepam slows brain function and increases fall risk.
I would recommend printing Dr. Tannenbaum’s brochure and then bringing it to your usual health providers. It can be difficult and even dangerous to attempt to decrease or stop lorazepam on one’s own, so you should definitely find a clincian to assist you. Here is the brochure:
You May Be At Risk: You Are Taking a Sedative-Hypnotic
As you’ll see in the brochure, experts recommend that clinicians consider a slow taper over 18 weeks. Some people need to take it even slower.
Regarding your depression, I would strongly recommend you discuss this with your health providers as well. Depending on your symptoms and the rest of your medical situation, they might recommend you start an anti-depressant or a certain type of therapy. (Therapy can help treat anxiety or insomnia as well, which might crop up as your body adjusts to being on a lower dose of the tranquilizer lorazepam.)
You are really smart to address this now, because in my experience, the older people are, the harder it can be for them to taper off daily benzodiazepines. Good luck!
Thanks very much for your advise.
It was about 8 years ago when I started to have acute problems with confusion and long/short term memory loss. I was in my late 50’s. My wife had to quit work to help me with self care. I was on a blend of clonazepam, adderal, and the maximum dose of zyrem (a powerful hypnotic). I complained repeatedly to my prescribing doctor. He would become angry and told me that I would have to be on these medications “the rest of your life”. He even tried to force me to have electro shock therapy. My cognitive testing showed me to be very impaired. My MRI showed reduced brain volume, enlarged cerebral ventricles and small vessel disease (hyperintensities). Still the neurologist said that it was depression and that I should continue taking the same drugs. (He is a friend of my prescribing doctor) Just 7 weeks ago, a new doctor looked at the same findings on a new MRI and diagnosed me as having “vascular dementia”. She refused to discuss my drug history. Question! What is the relationship of these various drugs to vascular dementia? Who is doing research on this problem? Thanks so much for being a advocate.
I don’t know that these drugs have been studied in relation to vascular dementia per se.
Cerebral small vessel disease is associated with depression and with cognitive impairment. However, I am surprised that the doctor would diagnose you with a form of dementia without considering your medication use, because dementia is in part a diagnosis of exclusion and we are supposed to exclude other medical, medication, or mental health problems that could be causing cognitive impairment.
You might find these articles helpful:
How We Diagnose Dementia: The Practical Basics to Know
Cerebral Small Vessel Disease: What to Know & What to Do
Also, as it sounds like your symptoms started early, I would recommend getting evaluated by a specialized memory clinic, or by someone else with very specific expertise in evaluating early-onset cognitive problems. Good luck!
Hello I was diagnosed with diabetes in October of 2013 at the age of 17 years old. I had my first panic attack in the e.r as they were trying to lower my blood sugar. I didn’t know what anxiety/panic attack were at that time so my doctor put me on Alprazolam *Can’t recall dosage. Was on it for two years, then I ran out of it & had to go to the emergency room to get a refill. They didn’t give me a refill because they said my doctor had to approve & it was a weekend, so they gave me one in the e.r until I saw my doctor. Well the one they gave me in the e.r looked different then the one I usually took & later that day I started having bad panic attacks, bad thoughts. So when I went to my doctor the next day I told them & they switched me to Lorazopam 0.5 mg. I’ve been on Lorazepam for about 2 years, going into 3. They have been helping me and what not, but since last year December they stoped working. I take 0.5 mg and it calms the anxiety but I’ve developed depression, and seems like it does no effect the body anymore, it doesn’t let me feel relaxed like I use to. I would like to get off this medication I am now 21 & turn 22 on April 21st. What do you recommend? I’ve seen a handful of people on YouTube who have over come it, but also a ton of people who say they tried it and failed. A man who goes to my church was on lorazepam 0.5 mg for sleep for 8 years & he is now 5 years sober & he said it was hell, but I’ve seen others say that if you tapper slow 2-3 years you will not feel anything. Please help, I am willing to pay any sort of money for someone to lead me in the right direction. I guess my plan is to get off it & once I’m completely off it, if my anxiety is still there over one panic attack I can try herbal teas. Because i never had anxiety and now that I’ve been on this medication seems like I’ve developed it. Sorry for all the questions, God bless.
Sorry to hear you’ve had all these health challenges, and early in life, too.
It sounds like you’ve developed some tolerance to your lorazepam, so it’s not offering you as much relief as before. I’m glad you are thinking of how to safely taper off this medication, rather than asking for more.
You absolutely will need to work with health professionals to do this. Dr. Tannenbaum’s brochure outlines a sample tapering schedule that takes 16-18 weeks, but many people need to decrease their dosage even more slowly. You should also ask your health providers to help you find other ways to manage your anxiety and also your depression. Certain kinds of therapies can be very effective, and you might also benefit from treatment with an antidepressant as well.
One problem people sometimes run into is that therapy is hard to find or not covered by insurance. Also most doctors visits (you will need to see a clinician who can prescribe your tapering doses of lorazepam) are often quite rushed.
If you are willing and able to pay money, you might be able to pay a psychiatrist or therapist out of pocket, to get the extra support that will make your effort more likely to succeed. A psychiatrist who is also willing and able to do cognitive-behavioral therapy or other forms of therapy would be good. (Psychotherapists usually can’t prescribe medications.)
Good luck and don’t give up! This is an important thing you are doing for your health. It will take time and probably be hard, but in the long run it will be worthwhile.
The thing that worries me about anti depressants, is how about if I get addicted/defendant on it as well? Are they called ssri? Because I heard those were even harder to get off? I’ve seen the Ashton method, tapper off from Lorazopam 0.5 mg and switch to Valium that has a longer half life then tapper from that? I’m just really scared.
Anti-depressants are not habit-forming in the same way as benzodiazepines, and are much less risky to one’s health. They can also be safely tapered off in many people, especially if it’s done in a thoughtful way over an adequate period of time. Yes, I have occasionally encountered some people who have had great difficulty getting off SSRIs, but often these are people who have been on them for years and years, often due to persisting depressive symptoms.
It’s also often possible to treat depression and anxiety symptoms without medication, and you should be sure to discuss these options with your doctors.
I am familiar with the Ashton manual. You will need to work closely with a clinician to determine whether using a longer-acting benzo such as Valium is a good idea for your situation. Good luck!
I have been on low doses of Lorazapam for many years (I am 86) and would love to get off this medication but am finding it very, very difficult. How do I get Dr. Tannebaum’s brochure?
Kudos to you for trying to address this. It is indeed difficult, but doable. I have linked to the brochure in the article, where it says “You May Be At Risk: You Are Taking a Sedative-Hypnotic.” Here is the URL for the brochure:
http://www.criugm.qc.ca/fichier/pdf/BENZOeng.pdf
If you are finding it difficult to taper off the lorazepam, talk to your health provider about making the taper even slower. It is sometimes helpful to switch to a liquid formulation of lorazepam, as this can make it easier to whittle down the dose.
You should also be sure to talk to your health provider about other ways to manage any insomnia, anxiety or other issues that might be related to your lorazepam use (or taper). Good luck!
Dear Doc, I have been on Ativan 1mg 3 times daily and 1 mg clonazepam at night for sleep. I’m trying to wean to a half tablet of Ativan during the day, not sure about a sleep replacement (don’t want costipation). What makes this process easier?
Kudos to you for trying to address your benzodiazepine use.
I would highly recommend you read Dr. Tannenbaum’s brochure and then discuss it with your usual doctor.
Generally, what makes this process is easier is:
– reducing the dose of daily benzodiazepine SLOWLY, by 15-25% every 2 weeks or so
– getting help addressing insomnia or anxiety or whatever problem the benzodiazepine has been helping to control
I address proven ways to treat insomnia in this article: 5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia
Please do not attempt to taper on your own, it can be dangerous. Whichever clinician has been prescribing your benzos should be willing to work with you on a suitable taper. Good luck!
Hi thanks for this fourm. I was first perscribed Ativan 35 years ago when I was 22, I was suffering from anxiety attacks, my doctor wrote a prescription for 1mg 3 to 4. Times a day, I took them as perscribed and I found that I didn’t have many anxiety or panic attacks anymore and when I did experience one it was much less severe. I thought my prayers were answered. That was 35 years ago,for.the past 35 years I’ve been taking the Ativan faithfully every day, I never took more than the dose perscribed by my doctor. I knew nothing about Ativan when I started taking it, when I asked my doctor about it ,he wasn’t concerned and just kept writing me more perscriptions. In the past year or so I’ve read about Ativan and tried to taper off it, I felt terrible and the anxiety started to return. My doctor is retiring in 4 months,and I want to get off Ativan, I live in an area where there is a doctor’s shortage very difficult to find a doc if you don’t have one. The emergency rooms at the local hospitals and clinics won’t write a perscription for anything like Ativan. Not sure what to do,I’m 56 now and Ativan has helped me most of my life with panic and anxiety. Now its going to be more difficult for me to get and I understand there are long term side affects. Hope you can help.
Well, I think it’s great that you are interested in revisiting this, but after 35 years taking Ativan, you will definitely need help from a clinician. Generally the slower the taper, the more tolerable and the more likely it is to be successful. Please do look at Dr. Tannenbaum’s brochure and you may also want to look at the Ashton Manual, which also has sample taper schedules, many of which are quite slow.
Probably the most urgent thing for you to do right now is: ask your doctor to help you find a new doctor. Many providers are leery of prescribing Ativan to patients they don’t know well. It could be very helpful for your current doctor to contact your new one and relay his/her experience prescribing Ativan to you (presumably you have been “good” and have not given your doctor cause to worry that you were abusing or selling your pills. If there is a shortage of docs taking new patients, perhaps your current doc can intercede and help you get in with someone. Or perhaps you can get on the waitlist for someone’s practice.
Your concerns are probably well-founded; if you don’t have a regular doctor who knows and trusts you, you might have a difficult time obtaining your Ativan, much less getting the necessary support to manage a taper.
I suppose if you can’t find a new primary care provider, another possibility would be to look into options for substance-abuse treatment. Please understand, I’m not saying you are an abuser as it really does not sound like you are. However such clinics are experienced in helping people manage a substance dependency (you are dependent right now) and might be willing to help by providing a controlled substance and working with you on a taper…they will surely find you much easier to deal with than those patients who do have a history of abusing and overusing controlled substances. Good luck!
Been tapering Ativan for five weeks started on 5 mg one half years ago prior to that was in Xanax quit Xanax and got terrible stomach and chest pain now Ativan .5 then to 1 mg then to 1.5 mg wanted to stop lots of stomach issues and chest pain have had a lot of antibiotics last three years for h phylori and c diff now been weaning five weeks down to .25 Ativan horrible stomach chest and back pain daily troubles with food what to do keep weaning or quit
I hope you are doing this taper under the supervision of a medical professional. As per Dr. Tannebaum’s brochure, tapers should be slooowwwww. If intolerable symptoms emerge, it’s often not a good idea to continue the taper and instead, it might be necessary to stay at a given dose for a while.
I would definitely recommend talking to your health provider about your stomach and back pains. Especially if they are severe, you should not delay. They may be related to your taper but they also could be due to a variety of other serious conditions. Your provider will also be able to advise you on what to do about your tapering, given your symptoms. Good luck!
I’ve been on benzodiazepines since 1967 when I suffered from virtual non-stop panic attacks and extreme anxiety. Without them I never could have earned a living nor had a near normal life. I started with Valium but after 15 or so years my then retiring psychiatrist had read the “news” that Valium was addictive and he didn’t want any of his patients addicted to a drug after he retired. I was at that time (1983) taking 10mg of Valium 4x a day). He gave me a pamphlet (my god, I wished I had kept it) about a newer ‘improved’ benzodiazepine called Ativan’ that was ‘not addictive” like Valium….(sigh)…..what did I know…I trusted my doctor and believed him…..I started on 2mg 3 x a day…..and never needed any increase. I never felt ‘high’ or any other side effects. Now, at age 70…on generic lorazepam I freaking out (can you tell I’m from the 1960’s?, lol) over two things…..my local Costco has changed manufacturers of the lorazepam they sell from Watson to Leading Pharma (which online forums regard as pretty poor)…..but in researching this I’ve come across so many really negative and scary reviews about the difficulty of either obtaining or getting off lorazepam. At 70 years old, I really don’t wish to start a decade long fight to get off a prescription med that may affect my memory or balance but would definitely change my life from focusing on living and caring (I’m a care giver to my wife with severe post polio syndrome…I do all the cooking, cleaning, shopping, wash, etc and still working to a limited degree) to a life of worrying where my next pill will be coming from. I’d like to just live out my life taking the meds I’ve never abused but never asked to be taking in the first place…but content to just maintain my anxiety and focus on living my remaining years. Getting old has enough issues without additional worries about a condition that has ruled my life getting so much worse without a drug that helped make it tolerable. I’ve always looked at it as a diabetic taking metaformin. Any encouragement whatsoever or am I doomed to spend the rest of my life to start trying to get off an addicted drug?
Thanks for sharing your story. Well, I can certainly see why you are reluctant to rock the boat or change something that has been working for you, especially since you are putting a lot of energy into caring for your wife. It’s not necessarily unreasonable for you to want to continue as you are, but there are some downsides for you to consider.
First, you very well may have difficulty finding a provider who is willing to continue prescribing your lorazepam. 6mg per day is not a small daily dose, either.
Second, as you get older, you’ll likely become more vulnerable to experiencing benzo side effects…or if you have a fall or some memory concerns, you may become more interested in avoiding benzo-related side-effects.
So, although I can see why you’d prefer to not contemplate a taper or discontinuation, I would still encourage you to consider it. If nothing else, your health provider may feel better continuing to prescribe your lorazepam if you start by making a good faith effort to at least reduce your dose somewhat.
This approach might help your clinician feel better about prescribing your benzo long-term, because if ever they are called upon to justify “how could you keep prescribing that benzo to that older person” they can say “well I did recommend taper and discontinuation and we tried it carefully but then the patient experienced too many difficulties and we concluded that the burdens of continuing to attempt the taper outweighed the potential benefits.”
Presumably a lower daily dose would be less risky for you, if you found your symptoms could be managed with a lower dose. We generally try to use the minimum dose necessary when it comes to medication.
You could absolutely ask for the reduction to be done extremely slowly, given your concerns.
I certainly am sorry that you were put on these medications years ago, it is unfair that this has become your problem to deal with, but there it is. Good luck!
Getting off of Benzos destroyed my life for 4 years. I switched to Valium because it is key that you taper with a benzo with a long half life. I tapered but 1 year and it took me another 3 years to return to a passibly normal state. Constant fear, full body ticks, days on end in bed, my brain bouncing around in my skull. It was just day after day, week after week, year after year. I got divorced, had to send my daughter to live with her Dad during the worst parts. I am forver grateful fot holfimh It all started when I had a panic attack after returning from Indonesia. My doctor actually told me that drugs he gave me were not addictive. Im finally free. I never waivard even once.
Whatever you do, stay away from Benzos and Z drugs: they are not worth it.
Thanks for sharing your story. Yes, these drugs are often much harder to discontinue than people realize, in part because health providers often don’t discuss this issue before starting people on these medications. I’m glad you were able to persist and finally get off the benzos.
I am 84 years old and have been on ativan for approx. 15 years.. The dosage I am on is 0.5 mg only at bedtime.. In the past couple of years I have noticed several changes eg: memory loss, confusion, irritability, muscle weakness etc etc and I desperately want to get off of this drug. I want to reduce the dosage but because the pill is so small, I have difficulty in cutting it into a smaller dosage. I would appreciate any suggestion that you may have for me.. Thank you
Lorazepam (brand name Ativan) does exist in liquid form. This can be easier to work with, when tapering down to small doses. I would recommend discussing your desire to taper your lorazepam with your prescribing clinician, so that they can assist you and prescribe a liquid form if appropriate.
If you’re concerned about your memory or other changes, I would also recommend bringing this up with your usual doctors so that they can do an appropriate evaluation. You should not assume all of this is due to lorazepam, as there are many reasons that someone your age might develop such symptoms.
I describe the most common causes of changes to memory or thinking in this article:
Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check.
Good luck!
Last year I realized a 75 year old family member was addicted to Ativan and kept it secret. What a terrible revelation. Falls…sleeping every day past noon…balance issues…dizziness…I am grateful they never had a car accident. I had NO IDEA what was really going on. At least if someone is a drinker there are well-known signs.
Why in the world are doctors so willing to write scrips for these dangerous drugs? Why isnt every patient given a detailed explanation of the risks? It is unethical in my opinion.
I wonder how big drug companies are not forced to be more TRANSPARENT. I think these drugs are just as destructive as opioids. They lead to a very poor quality of life and wreak chaos on unwitting family members.
Your thoughts would be appreciated.
Sorry to hear about your family member. You’re right, it’s unfortunate that for a long time doctors were quite willing to prescribe these medications and there wasn’t enough transparency about the risks.
Honestly, I think most doctors who were prescribing benzodiazepines to older adults simply had no idea that it could be so risky or problematic. It seems that doctors create their prescribing and medical practice habits fairly on during their training, and then those can be hard to change. We are very lucky to have lots of pharmacological options but at the same time, pharma is a business and they are more interested in getting doctors to prescribe than to talk about the risks and maybe prescribe less.
So, it’s important for older adults and families to be informed and ask lots of questions. I do believe that most health providers are well-intentioned, but they are busy and no one has more of a stake in getting things right than do patients and families. Hope things work out with your older relative’s Ativan use.
Hello,
My 89 year old mother has been taking 2MG (Mylan) Lorazepam 4X/ day for over 30 years. Mylan is discontinuing the drug and she has to switch manufacturers. She just tried a 2MG (Leading) Lorazepam and experienced enhanced side effects of stomach upset, “woozieness” and nasal congestion (?). She has degeneration in her spine and knees, but has more recently been experiencing more “minor” falls. Her muscle degeneration along with long-term Lorazepam use could be making this worse. She lives alone and this worries me. Her doctor was out today, but I think they may consider lowering her dose to 1MG with this “new” manufacturer to see if she gets lessened side effects.
I’m not sure what to do next. She is really dependent on this drug and is literally freaking out that she can no longer get the particular brand of generic that her body is used to. Any suggestions? – Thank you
Hm. Honestly, I don’t know much about the difference between different generic lorazepam formulations.
8mg of lorazepam per day is a lot for someone who is 89 and it certainly might reduce her fall risk if she can taper down or off. But going from a 2mg dose to a 1mg dose is a big drop, I would expect a person to experience a lot of discomfort due to that drop and that might be contributing to her “freaking out.”
I would recommend talking to her doctors about a smaller reduction, at least for now, and then your mother could consider working with her health professionals on a slow taper.
It is safer for people her age to not be on benzos, but this safety benefit has to be weighed against the work and quality of life impact of reducing the drug. Good luck!
Hello Doctor:
Thanks you very much for giving hope to many people to come out of this addiction. I am on 2 medications Ativan 2 mg and lonazep 0.5 mg . The first one for about 12 years and the second about 6 years . I am 62 yrs old with a history of diabetes, heart disease and hypertension with hypothyroidism . I would like to come out of this anxiety drugs and not sure which one to address first . Ativan or lonazep ? Can you please give some idea to wean away from these drugs ? I am single and don’t have much support from family or friends. I don’t have a clue how to proceed . Could you please help. I am desperately seeking guidance and help.
Thanks and regards
Mahendra
I had to look up lonazep, looks like it is clonazepam, which has the brand name Klonopin in the US. Clonazepam is longer acting than lorazepam (brand name Ativan).
By far the best way to explore and manage a taper is to do so under the supervision of a health professional. They would be able to talk with you and help determine which is better to taper first. In some cases, the shorter-acting benzo (lorazepam for you) is first converted to a roughly equivalent dose of longer-acting benzodiazepine, and then the longer-acting benzodiazepine is very slowly tapered down. The “Ashton Manual” describes some slow benzo tapers (including the substitution to longer-acting benzos) here: SLOW WITHDRAWAL SCHEDULES.
While doing this, it’s also very important to work on non-drug ways to manage any anxiety, insomnia, or other problem that was being controlled by the benzo.
The more slowly your benzo dose is reduced, the more likely it is that the withdrawal will feel tolerable. Do try to find professional help. good luck!