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 patient education tool has been created by a well-respected expert in geriatrics, Dr. Cara Tannenbaum. Best of all, a randomized trial has 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.
Why it’s important to try to stop lorazepam & other benzodiazepines
Ativan (generic name lorazepam) is a tranquilizing medication in the group called benzodiazepines (also known as “benzos”). These drugs are usually prescribed for sleep, anxiety, or agitation.
Lorazepam (brand name Ativan) is a fairly popular benzo, as the effect lasts for what is considered a “medium” length of time (the half-life is 10-20 hours).
Other benzodiazepines that are sometimes prescribed include:
- Long-acting benzos, such as Valium and Klonopin (generic names diazepam and clonazepam, respectively),
- Fast-acting tranquilizers such as Xanax (generic name alprazolam), which has historically been prescribed for panic attacks,
- Restoril (generic name temazepam), which has often been prescribed for sleep.
However, benzodiazepines are much riskier than many older adults realize. Common side effects include drowsiness and unsteadiness when walking. Research has also found that these drugs:
- Worsen balance, memory, and thinking;
- Increase the risk of falls, and of fractures;
- Can make dementia symptoms worse;
- Can easily cause physical or psychological dependency (or even addiction)
- Are linked to a higher risk of dying within a few years.
Benzodiazepines can also cause death if there is an accidental (or intentional) overdose, as high doses will slow down breathing to dangerously low levels.
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. They are also included on the Beer’s List of medications older adults should avoid or use with caution, and are at the top of my own personal list of “4 Types of Medication to Avoid if You’re Worried About Memory.”
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.
For these reasons, geriatricians almost never prescribe a drug like Ativan to older adults, and we’re big fans of trying to get our older patients to taper off of benzodiazepines, whenever possible.
The must-read information brochure on Ativan and older adults
If you or your older relative is taking Ativan (generic name lorazepam) — or any type of sedative or tranquilizer — I highly recommend you read Dr. Tannenbaum’s brochure. It provides excellent information about these drugs, and includes practical tips on addressing sleep and anxiety issues without using drugs.
You can get a copy of the brochure — which includes a sample taper schedule — here: 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 always 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).
Frequently asked questions about Ativan
Here are some of the questions people sometimes ask me about Ativan:
Q: Is 0.5mg of lorazepam a low dose, and is a lower dose safer?
A: 0.5mg of lorazepam is a very common dosage, and is probably the most common starter dose. The risk of side effects goes up with the dose, so yes, 0.5mg is a little safer than 1mg, and 0.25mg will be even less risky than 0.5mg.
Along with the dose of the tablet, it’s also important to consider the schedule that is prescribed. It could be prescribed just at bedtime, or sometimes it’s prescribed “as needed” two or three times per day, for anxiety (or even agitation, especially in people who have Alzheimer’s or a related dementia).
In general, the greater the total quantity of lorazepam that a person consumes every 24 hours, the greater the risks.
I’ll be honest: no matter what the dose or schedule, I consider this to be an unsafe medication for older adults, and would only recommend using it when all other alternatives have been tried first. If it must be used, it’s best to use the smallest doses that have an effect, the fewest times per day.
Q: Is it ever okay for an older adult to take a benzodiazepine?
A: 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.
But 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 Alzheimer’s, providing caregivers with coaching on managing difficult dementia 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.
Q: I can’t sleep when I don’t take Ativan. How am I supposed to get off of it?
A: It’s not always easy to taper off benzodiazepines, but research shows it’s definitely doable.
For instance, 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.
Again, if you’d like to taper off a medication such as lorazepam (brand name Ativan), please print out Dr. Tannenbaum’s brochure and bring it to your health provider, so that you can discuss tapering off together. You can find the brochure here: You May Be At Risk: You are Taking a Sedative-Hypnotic.
Q: Is it ok to use Ativan in Alzheimer’s, to manage sleep or agitation?
A: In geriatrics, we do NOT recommend using Ativan (generic name lorazepam) in people with Alzheimer’s, other forms of dementia, or any type of memory loss. That’s because it tends to make their memory and thinking even worse, and also increases the risk of falls.
Benzodiazepines also sometimes make people with cognitive impairment paradoxically agitated, by disinhibiting them. (This effect is also seen with alcohol: it can relax and quiet people, but also can make some people rowdier.)
That said, it is very common for people with Alzheimer’s to have trouble sleeping, or to sometimes become agitated and upset, and historically doctors have prescribed lorazepam or other benzodiazepine tranquilizers for these purposes. Unfortunately, this is not a safe approach. (Also unfortunate: there is basically no safe and easy way to medicate behavior problems in Alzheimer’s, as I explain in this article: 5 Types of Medication Used to Treat Difficult Dementia Behaviors.)
I’ll say it again: Ativan and other benzodiazepines should ONLY be used as a last resort, after all safer options have been exhausted.
Last but not least: I’ve found it’s more difficult to taper off benzos in people with cognitive problems. This is because to successfully taper off, the older person may have to tolerate some increased stress or difficulty sleeping in the short-term…and this can be very difficult for people who are already dealing with memory and thinking problems. (The stress of trying to taper often makes their memory and thinking worse in the short-term, even though being off benzos generally helps memory in the longer term.)
If you are caring for someone with Alzheimer’s or a related dementia, and are struggling with sleep issues, I explain options for managing this concern here: How to Manage Sleep Problems in Dementia.
Tips for aging adults & family caregivers
If you or your older loved one is taking a benzodiazepine:
- Do make sure you 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!
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.
But again, probably the most practical and usable resource for older adults is Dr. Tannenbaum’s brochure, which is specially designed to help older adults reduce their use of risky benzodiazepines such as lorazepam (brand name Ativan) and other commonly prescribed sedative/tranquilizers.
If you or someone in your family is taking this type of medication, please print it out and bring it to your doctor. Again, it’s here: You May Be At Risk: You are Taking a Sedative-Hypnotic.
Good luck making your medications safer!
This article was first published in 2014, and was significantly updated in March 2023.
Clarrissa says
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.
Leslie Kernisan, MD MPH says
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.
Richard says
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?
Leslie Kernisan, MD MPH says
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!
Teresa says
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
Leslie Kernisan, MD MPH says
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!
Carl says
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.
Leslie Kernisan, MD MPH says
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!
Ken says
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?
Leslie Kernisan, MD MPH says
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!
Rosella Rhine says
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?
Leslie Kernisan, MD MPH says
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:
static/file/caregiving_ten_tips.authcheckdam.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!
Roberto Albino says
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.
Leslie Kernisan, MD MPH says
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.
Roberto Albino says
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.
Leslie Kernisan, MD MPH says
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!
George Post says
Thanks very much for your advise.
Mike Miller says
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.
Leslie Kernisan, MD MPH says
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!
George P says
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.
Leslie Kernisan, MD MPH says
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!
Debi says
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.
Leslie Kernisan, MD MPH says
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!