Interesting Article On Lorazepam

Discussion in 'Fibromyalgia Main Forum' started by joeb7th, Apr 5, 2007.

  1. joeb7th

    joeb7th New Member

    A problem with lorazepam?


    Professor C Heather Ashton DM, FRCP

    School of Neurosciences
    Division of Psychiatry
    The Royal Victoria Infirmary
    Queen Victoria Road
    Newcastle upon Tyne NE1 4LP

    The Ashton Manual · Professor Ashton's Main Page

    Last October's (1987) BBC2 Brass Tacks programme spotlighted addiction to lorazepam. Is the drug so bad, or is it just one tranquilliser problem among many? A leading medical authority assesses the evidence.

    Among the benzodiazepine tranquillisers, lorazepam – marketed in the UK under the trade names Ativan and Almazine – has acquired a particularly bad public reputation for causing drug dependence and withdrawal symptoms.(1,2) Clear scientific evidence is lacking, but clinical impressions in general support lorazepam's bad press,(3,4) and in a recent study, 20 out of 50 patients consecutively referred for help with benzodiazepine withdrawal were receiving lorazepam.(5)

    Why does lorazepam seem to cause greater problems than other benzodiazepines? There are several reasons:

    Lorazepam is extremely potent: its anxiety-relieving activity per milligram is estimated to be up to 10 times that of diazepam [Valium].(6) A patient taking what appears to he a small to moderate dose of lorazepam (typically 1mg three or four times a day) may actually be taking the equivalent of 30-40mg diazepam, a very considerable dose. The high potency of lorazepam has not been fully appreciated by medical practitioners. It is thought to result from the especially high affinity of this drug for benzodiazepine receptors in the brain, coupled with a slow rate of disassociation after binding to these receptors.(7) Other potent benzodiazepines, such as triazolam and alprazolam, give rise to similar withdrawal problems.

    The problem of potency is compounded by the tablet strengths in which the drug is supplied. Since its introduction, lorazepam has only been available in 1 mg or 2.5mg tablets. It is not uncommon for patients to be prescribed three 2.5mg tablets daily, roughly equivalent to 75mg diazepam, a dose greatly in excess of that required for most anxiety states. At such high dosage, relative to other benzodiazepines, it is not surprising that problems of dependency and difficulty in withdrawal are pronounced with lorazepam.

    The tablet strengths in which lorazepam is supplied also make slow withdrawal difficult. lf someone decides to reduce dosage, the smallest decrement of lorazepam that can practically be achieved is 0.5mg, obtained by halving a 1 mg tablet. This cut (approximately equivalent to 5mg diazepam) may represent a sizeable proportion of the daily dose – enough to precipitate a withdrawal reaction.

    Withdrawal symptoms are most severe when blood concentrations of benzodiazepines are falling.(8) Lorazepam is eliminated from the body moderately quickly (within 10-20 hours blood concentrations fall to half the peak level obtained from a single dose)(9). Even with chronic dosing, blood concentrations are likely to fall appreciably between each tablet. Such falls can be enough to precipitate withdrawal symptoms, and concomitantly patients may develop a craving for the next tablet which they know will alleviate the discomfort. Other rapidly eliminated benzodiazepines, such as triazolam, produce similar acute withdrawal effects.

    Lorazepam is traditionally prescribed for daytime anxiety-reduction (ie, as an anxiolytic), in contrast to many other benzodiazepines which are given as night-time hypnotics (eg, nitrazepam, Mogadon). Possibly patients deemed by their doctors to require daytime treatment have more severe anxiety and are more susceptible to dependence on tranquillisers than those judged to need only a hypnotic.

    All benzodiazepines produce, to a greater or lesser extent, the same problems as lorazepam. However, benzodiazepine withdrawal is generally smoother and more convenient with diazepam,(10) which is less potent, has a very much slower rate of elimination,(11) and is available in smaller tablet strengths (diazepam 2mg tablets are roughly equivalent to 0.2mg of lorazepam). There is thus a trend for long-term lorazepam users to he transferred to diazepam, which is then slowly withdrawn.(12) Recent observations of 35 patients on lorazepam for up to 16 years show that diazepam substitution can usually be accomplished without difficulty.(13) Over three-quarters of these patients felt better or reported no change in symptoms after changing to diazepam. Eight experienced temporary drowsiness or increased anxiety, but these symptoms could usually be overcome by individual adjustments to dosage.

    Helping patients to withdraw from lorazepam, diazepam, or other benzodiazepines. does not of course solve the tranquilliser problem. Although total prescriptions for benzodiazepines are now declining, their use as hypnotics continues rise,(14) and new anxiolytics, are being introduced. Despite present optimism, it is hard to conceive of any drug which effectively relieves anxiety and insomnia yet does not carry a risk of dependence and withdrawal effects. The challenge for medicine, and indeed for society in general, is to find alternative, non-pharmacological, long-term methods for managing stress and anxiety.

    Coleman V. Life without tranquillisers. London: piatkus, 1985.


    In 1986 in Great Britain, pharmacies dispensed 3,149,000 prescriptions for lorazepam.

    Some quotations from BBC2's Brass Tacks programme broadcast on October 20, 1987:

    "When somebody comes into my office and says that they've been trying to stop their lorazepam, my heart sinks because I know I shall have twice as much of a problem as getting them off, say, Valium: the symptoms are more severe, they're more persistent, more bizarre, and people are much more distressed by them ... I feel that this compound should not now be prescribed because of the problems which may arise in some patients." – Professor Malcolm Lader, member of the Committee on the Review of Medicines.

    "We have much more difficulty getting people off Ativan than we do heroin, mainly because with heroin ... within a couple of weeks they're off and then the problem is staying off. But with Ativan it's much more prolonged and they take up a lot more time in terms of treatment than do heroin users." – Jim Corcoran, Torbay Drug Addiction Team.

    "There's no scientific evidence to indicate that one particular tranquilliser is worse than another ... To act just against one would he wrong because there is a problem with the whole group." – Professor Michael Rawlins, member of the Committee on the Safety of Medicines and chair of its Subcommittee on Safety, Efficacy and Adverse Reactions.

    The Ashton Manual · Professor Ashton's Main Page
  2. gidgetsmom

    gidgetsmom New Member

    Gosh, I hope my PCP doesn't see that!

    I'm only allowed one tablet a day, and I usually break that in half.

    He will usually give me one refill, and then I have to "take a break to prevent addiction".

    I have taken the .5mg one pill a day, on and off for 7 years, and have NEVER abused it or asked for a higher dose because I know if I do he will not prescribe it ever again.

    Although I do agree it does have a nasty "rebound anxiety" when stopped, even by tapering down, I don't understand a dr.'s anxiety about prescribing it to patients that have proven to be responsible with it's use over a long period of time.

    The article mentioned one point that I question tho. It says "since it's introduction lorazepam has only been available in 1mg or 2.5mg. tablets."

    Maybe before the year 2000, this might have been true. But I have taken it since 2000 and the .5mg has been available since then.
  3. fivesue

    fivesue New Member

    Drugs affect everyone differently...I can go days without any and then a few days on one or two and then none.

    I don't seem to have the withdrawal problems listed in that article. That doesn't mean it's not just means that I don't seem to be affected that way.

    But, I'm glad to know that. I will watch my reactions now and see what goes on when off for several days. I did have a bout with anxiety but an increase in Lexapro helped and my ingestion of Lorazpam went to almost nothing.

    Thanks for the info.

  4. netnut

    netnut New Member

    Sue I agree with you.

    I think it all depends on a persons own body chemistry if they are going to have a problem with addiction or dependence with medications.

    I have been on both Ativan and Klonopin before with no problems. For a while I was on them at the same time.

    My PCP started me on Ativan on 2/18/03 the day my son left for Marine bootcamp. I had a doc appt that day and was in tears of worry about him and he wrote that script and told me he felt all military moms should get I took 1 mg a day for about 2 and a half years. Sometime in there my psychiatrist added .5 mgs of klonopin.

    Back in July of 2005 I lost insurance and I came off all meds cold turkey. That included pain meds, the benzos, and some mood stabilizers. I never had the first sign of withdrawal. My pain increased..yes. I cant sleep as well anymore...sure. I had to find a free clinic to get my mood stabilizers back. But I had no withdrawals.

    I realize I am lucky I dont develop dependence.
  5. LostHearts

    LostHearts New Member

    I take Klonopin at nightime and lorazepam during the day, but only if I am having a really bad time of it. In other words, PRN. Sometimes I need quite a calming down before I bounce off the walls.

    Never had any problem, but then as stated, the lorazepam is taken as needed. I can go for a week or two without taking a pill. However, I've no idea what can happen if I took both on a daily basis.
  6. joeb7th

    joeb7th New Member

    It's amazing how little we know about these drugs, then when something phsyical and emotionally traumatic happens to us in our life these are recommended to us right away and because we trust our physical and emotional docs we jump right into them.

    I had no idea how potent and dependent I would get on these. Nor what the down the road price or sacrifice would be from taking these. I also didn't know how important it was to take them regularly ( every day ) once you do get dependent on them and what they can make you feel like if you don't follow an incredibly strict regimen with these.

    Still a theory at this point but after taking Lorazepam up to 2 mgs a day for awhile and then wanting to gut this out and cut back on them and not realizing what I might be in for, I would go 3 to 5 days and not take this stuff.

    As I then mentioned here, in the last 2 and 1/2 months I was going through what truly seemed like life and death torturous entire body explosions of pain, soreness, weakness, flu like symptoms with some nausea and extreme emotional panic and deep depression and feeling like I could die with tense muscles, insides acting scary haywire, heart jumping, whole body saying " YOU ARE DYING!"

    Then I would run to the ER's and they would do their 3 or 4 basic tests of urine, blood pressure or maybe blood sugar and even electrical and right after these coming back normal, get super agitated at me and humiliatingly kick me out.

    They would look at my previous 15 ER records in the last year and a half which showed anxiety and come in and sternly say " take these two ativans" wait awhile, get dressed, call your wife and "you can GO."

    I wonder why no ER doc "ever" considered that I might have been mismanaging my lorazepam dosages and going through truly torturous and explainable withdrawals. If they had known this, maybe then they wouldn't have gotten so angry at me like I was exaggerating or running in just for attention.

    Just amazing to me how something this simple could be missed and the end result is humiliating treatment of the innocent patient who doesn't have a clue as to why they are feeling like they are dying!

    If someone came into an ER and told the ER doc they were having withdrawal symptoms from heroin, I think they would actually get more serious, respectful and caring treatment!

    I may very well have been going through Lorazepam withdrawals with similar to heroin withdrawals and suffering but I didn't know this...and yet my treatment was humiliating..."Go call you wife, take this ativan, get dressed, and get out" " We have more serious patients to deal with here!"

    What has been coming to me in my constant forced evaluations of my tortured existence, is a desperate, hopeful theory that I might FINALLY be seeing a pattern of not taking this Lorazepam for awhile and then having these death feeling withdrawal attacks.

    If this is what has truly been happening to me, I must ask the question, is this what a heroin addict goes through? Dear God.

    As the original posted clinical study article at the top of this page says, the withdrawals for Lorazepam can equal the intensity of heroin withdrawals and these lorazepam withdrawals can come on fairly quickly as this chemical lowers in your blood stream so soon.

    Now, I was taking 2 mgs once and rarely twice a day. Now I am going to try breaking one of these in half and taking one in early morning and one later in evening...then go a couple weeks and try to half this again. But I have a feeling that eventually I am going to need professional help to get totally off of these. And it may take years.

    But let me tell you, the last withdrawal from this, if that's what it was, I have never felt so depressed and dying in my entire body, soul and head in my life.

    I have fainted several times since I first got sick in Dec. 2005. In a way, that wasn't as bad as these withdrawals. Scary...oh my goodness yes. You first break out into a tremendous sweat and then you just pass out. But when you come to, you are just confused and weak. It takes a day to truly come out of a good fainting.

    But these withdrawals...

    The physical feelings were so scary weird and the emotional feelings and depression so deep I got so scared I just curled up on my bed, shut my eyes and prayed. Eventually I took a 2 mg of Lorazepam and gradually throughout the night this dissipated until the next morning where I could felt I could function somewhat.

    Gaaaad. There is soooo much to deal with and learn about the tranquilizers and anti-depressents and other meds. It's like you are forced to take an intense 4 year course on this depressing subject and you feel frantic and like you are dying during it all.

    Getting through all of this deserves a medal...or at least an honorary college degree of some sort. It's like surviving a torturous years long prison camp environment.

    [This Message was Edited on 04/06/2007]
  7. fivesue

    fivesue New Member

    So well put. WE don't know until we take these meds what the consequences to our bodies will be. We may become dependent, etc. And, withdrawal sometimes is like death.

    I withdrew from Effexor and Cymbalta...and let me tell you, I felt like I was dying. I did have help from some other meds to get off those, but it was still the most hellish experience I can recall.

    My best to you are you figure this out. Cutting the dose in half is a good idea. I would never recommend anyone just quit something cold turkey.

    Thank you again for the article.

    Best wishes for a good weekend.

  8. joeb7th

    joeb7th New Member

    Thank you for your response. JB
  9. redtex

    redtex New Member

    with protracted withdrawal lasting months sometimes. look before you leep on to these drugs.
  10. joeb7th

    joeb7th New Member

    12 to 18 weeks for benzos? With protracted symptoms for months afterwards? OMG.

    Looks like one would need prfessional help for this.

    if they could afford it and or their insurance company would pay.
  11. bigpapi

    bigpapi New Member

    I'm new...hello to everyone...looks like a friendly place with alot of info.....

    I certainly think patients and doctors need to be well informed before they make a medication choice....and not all people taking the same med have the same issues..I've had bad side effects and long term withdrawal symptoms while tapering certain meds, but some people who take the same med have different experiences.

    Am I reading this right? Was that article published in 1988?

    I'm not saying this means the info is totally outdated, but I would like to see an article that is more recent.
    Anyone know of one?

    Unfortunately, patients and doctors don't always have ALL the facts...we really need to be better informed about the medications we take (even supplements and over-the-counter meds)

    [This Message was Edited on 04/06/2007]
  12. joeb7th

    joeb7th New Member

    It would be nice to have more current info on this subject. However, what newer sites I accessed don't say a lot more than this 1988 article.

    Lorazepam addiction and other benzo addictions just are tough to kick, especially Lorazepam and I believe Xanax.

    Looks like either you get lucky and can do this yourself or you at some point will need professional help to get off of these tranquilizers.

    I don't know if I can do this myself. I do know that if I was rich I would find the best treatment center I could and get in there immediately.

    Money can do wonders in this country for speeding up things like this and getting the best care.

    But, I'm unemployed without even disability and in super debt like so many of us here and we are on our own with this. So, we brace up and hope for the best.
  13. bigpapi

    bigpapi New Member

    When I read your story it reminded me of a friend who had a similiar time trying to go off klonopin...the docs didn't want to believe her, so they kept trying to diagnose her with different things....she was in agony with long term withdrawal symptoms..

    I hope you feel better soon.


  14. nightngale

    nightngale New Member

    Have you ever been tested via tilt table test for autonomic dysfunction? That may explain the fainting, a drop in blood pressure. And panic like feelings, including heart palps.
    Try googling postural othorstatic intolerance. I think I mentione this to you a while back...but it was so long I cant find it.,
  15. darude

    darude New Member

    When I first got sick 4 years ago doc put me on ativan. I was on it for 6 months and went to ER five times during that period!!!!! I went off it cold turkey and went into seizures so I then tapered down and it took about a year!!! Before going on this med I had a brain scan which was normal. After tapering off this stuff I had another Scan and they found a pituitary mass and 40 lesions!!! Coincidence mmmm don't know!!! Anyway once off it I felt a lot better but I do feel it could have caused some permanent damage. I recently took one tablet for another brain scan and had all the old symptoms for about a week. Awful stuff as far as I'm concerned.
  16. darude

    darude New Member

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