Ativan is the brand name for lorazepam, a benzodiazepine that doctors prescribe for anxiety, short-term sleep trouble tied to anxiety, and (in hospital settings) seizures and pre-procedure sedation. If you have just been handed a prescription, or you have been taking it for a while, it helps to know which Ativan side effects are expected, which ones build up slowly, and which ones need help right away.
Lorazepam works by boosting the effect of GABA, the brain’s main “calm down” chemical messenger. It attaches to a specific spot on the GABA-A receptor, which makes nerve cells less likely to fire. That calming action is what eases anxiety. It is also the source of most lorazepam side effects: drowsiness, slower reactions, memory gaps, and, at high doses or in risky combinations, slowed breathing.
This guide is organized by time first (the first few weeks versus months of use), then by who you are, because an older adult with COPD faces a different set of risks than a healthy 30-year-old.
The Ativan boxed warning, in plain English. In 2020 the FDA required all benzodiazepines, including lorazepam, to carry an expanded boxed warning, its strongest safety label. It covers three risks:
- Opioids: taking lorazepam with opioid pain or cough medicines can cause deep sedation, slowed breathing, coma, and death.
- Abuse, misuse, and addiction: these can happen even at prescribed doses, and the danger rises with alcohol or other drugs.
- Dependence and withdrawal: the body adapts to regular use, so stopping suddenly or cutting the dose fast can trigger withdrawal reactions, including seizures, which can be life-threatening.
Source: FDA Drug Safety Communication on the benzodiazepine boxed warning (September 2020).
In the first days and weeks
Most people notice side effects, if any, within the first hour or two after a dose, since lorazepam is absorbed fairly quickly. Many of these effects ease as your body adjusts over the first week or two, though some (like memory effects) do not fade much with time.
The four most common side effects
The FDA-approved Ativan tablet label on DailyMed reports data from about 3,500 people treated for anxiety. The side effects that showed up most often were:
| Side effect | How often (label data) | What it can feel like |
|---|---|---|
| Sedation | 15.9% | Sleepiness, heavy eyelids, feeling “slowed down” |
| Dizziness | 6.9% | Lightheadedness, a spinning or floaty feeling |
| Weakness | 4.2% | Tired muscles, low energy |
| Unsteadiness | 3.4% | Wobbly walking, poor balance, clumsiness |
Put another way, roughly one in six people in those studies felt noticeably sedated. That is why prescribers often start low and adjust. If you want to see how starting doses are usually chosen, our guide to typical Ativan dosing for anxiety walks through the label ranges.
Other early effects listed on the label include fatigue, headache, blurred or double vision, slurred speech, nausea, changes in appetite, and constipation.
Next-morning grogginess
Lorazepam has an elimination half-life of about 14 hours on average, according to the NIH StatPearls review of lorazepam. A bedtime dose can still be partly active when you wake up. Some people describe a “hangover” feeling: foggy thinking, slow reactions, or feeling less coordinated in the morning.
This tends to be stronger at higher doses, in older adults, and when lorazepam is combined with other sedating products. For a fuller picture of how the drug clears over time, see how long Ativan stays in your system.
Driving and other impairment
The label advises against driving or operating heavy machinery until you know how lorazepam affects you. You may not feel impaired even when your reaction time is slower than normal. Alcohol and other sedating drugs make this worse, since the label notes lorazepam lowers your tolerance to them.
Ativan memory loss (anterograde amnesia)
Benzodiazepines can make it hard to form new memories while the drug is active. Doctors call this anterograde amnesia. You might hold a normal conversation and later have little or no memory of it. This effect is part of why lorazepam is useful before surgery, but it can be unsettling in daily life.
The label lists amnesia and memory impairment among its adverse reactions. It also says that little tolerance develops to these memory effects. In other words, unlike sleepiness, Ativan memory loss does not reliably fade as you keep taking it. Memory gaps are more likely at higher doses and when alcohol is involved.
With longer use
The long-term side effects of Ativan are a separate category. They build gradually and are easy to miss because they creep in over months. The label notes that effectiveness beyond four months has not been studied in systematic clinical trials, and it asks prescribers to check periodically whether the drug is still helping each patient.
Tolerance
Over weeks to months, the same dose may calm you less than it once did. This is tolerance. It can tempt people to take extra doses, which raises the risk of every other side effect on this page. If your dose seems to be working less well, that is a conversation for your prescriber, not a reason to adjust on your own.
Physical dependence
Dependence is not the same as addiction. It means your nervous system has adapted to the drug, so removing it suddenly throws things off balance. The label says higher doses and longer use raise the chance of withdrawal reactions, and that some people have protracted withdrawal symptoms lasting weeks to more than 12 months.
Withdrawal can include rebound anxiety, insomnia, tremor, sensory changes, and, in serious cases, seizures. This is why lorazepam should only be reduced under a clinician’s supervision. A 2025 joint clinical practice guideline on benzodiazepine tapering, released through the American Society of Addiction Medicine with several other medical societies, stresses that clinicians start slowly and adjust the pace based on how each patient responds. Our Ativan withdrawal guide explains what supervised tapering looks like.
Thinking, focus, and memory
Some long-term users report slower thinking or trouble focusing. The label lists confusion, disorientation, and memory impairment among its adverse reactions. In older adults, these effects can be hard to tell apart from early cognitive decline, which is one reason geriatric experts urge caution (more on that below).
Mood changes and depression
Lorazepam can uncover or worsen depression that was already there. The label mentions “unmasking of depression,” along with euphoria and disinhibition (acting more impulsively than usual). It also states that benzodiazepines should not be used alone, without antidepressant treatment, in people with depression. If your mood drops or you start feeling flat or hopeless while on Ativan, tell your prescriber.
The dementia question: what the evidence shows
You may have seen headlines linking benzodiazepines to dementia. The research is genuinely mixed, and it helps to understand why.
- A 2015 meta-analysis in PLoS One pooled six studies and found that people who had ever used benzodiazepines had about a 49% higher risk of dementia than never-users. The authors themselves warned that the finding should be treated with caution because of the small number of studies and the possibility of reverse causation (PubMed abstract).
- A 2024 study in BMC Medicine followed about 5,400 cognitively healthy older adults in the Netherlands for an average of 11 years. Overall benzodiazepine use was not significantly linked to dementia. However, current users had smaller volumes in some brain regions, and faster shrinkage of the hippocampus (a memory center) over time (full study).
“Reverse causation” matters here. Anxiety, sleep problems, and low mood can be early signs of dementia years before diagnosis, and those are exactly the symptoms benzodiazepines get prescribed for. So some of the link may come from the illness leading to the prescription, not the other way around.
The fair summary: researchers have not proven that lorazepam causes dementia, but they have not ruled out subtle long-term effects on the brain either. That uncertainty is one more reason prescribers aim for the shortest course that does the job.
Rare but serious Ativan side effects
Ativan and breathing: respiratory depression
On its own, at usual doses, lorazepam rarely causes dangerous breathing problems in healthy adults. The risk climbs sharply when it is combined with other central nervous system depressants, especially opioids and alcohol. The label specifically warns about people whose breathing is already compromised, such as those with COPD or sleep apnea. It lists worsened sleep apnea and worsened obstructive lung disease among reported reactions.
Paradoxical reactions
Occasionally, lorazepam does the opposite of what you expect. A paradoxical reaction to lorazepam can look like rising anxiety, agitation, aggression, rage, insomnia, or even hallucinations. The label says these reactions are more likely in children and older adults, and that the drug should be stopped if they occur. Stopping, in this case, should happen with medical guidance, so call your prescriber the same day.
Suicidal thoughts
The label lists suicidal ideation and attempts among reported adverse reactions and asks prescribers to consider suicide risk in people with depression. If you or someone you care for has thoughts of self-harm, call or text 988 (the Suicide & Crisis Lifeline) right away, any time of day.
Allergic reactions and other rare effects
Allergic reactions are uncommon but possible. The label also lists rare blood changes (low platelets or white cells), yellowing of the skin or eyes (jaundice), low sodium, and low body temperature. For people on long-term therapy, the label recommends periodic blood counts and liver tests.
| Serious effect | What it looks like | What to do |
|---|---|---|
| Respiratory depression / overdose | Slow or shallow breathing, blue or gray lips, extreme sleepiness, can’t be woken, limp body | Call 911 now. For poisoning questions, Poison Control is 1-800-222-1222. If opioids may be involved, give naloxone if available. |
| Paradoxical reaction | New agitation, anger, aggression, restlessness, hallucinations, worse anxiety | Contact your prescriber the same day; seek urgent care if anyone is at risk of harm |
| Suicidal thoughts or worsening depression | Hopelessness, thoughts of death or self-harm, withdrawing from others | Call or text 988; call 911 if in immediate danger |
| Severe allergic reaction | Hives, swelling of face, lips, or throat, wheezing, trouble breathing | Call 911 |
| Liver problems | Yellow skin or eyes, dark urine, pale stools | Call your prescriber promptly |
| Severe confusion or falls | Disorientation, new falls, unusual clumsiness (especially in older adults) | Call your prescriber; seek care for any head injury |
Note that naloxone reverses opioids but does not reverse lorazepam itself. It still helps when an opioid is part of the picture, so give it and call 911 anyway.
Ativan side effects by who you are
Older adults (65 and up)
Ativan side effects in elderly patients deserve special attention. The 2023 American Geriatrics Society Beers Criteria, a widely used list of medicines that are often risky for older adults, names lorazepam among the benzodiazepines to avoid in most cases. The reasoning: older adults are more sensitive to these drugs, and all benzodiazepines raise the risk of cognitive impairment, delirium, falls, fractures, and car crashes. The recommendation is rated “strong,” with moderate-quality evidence.
The Beers Criteria do list exceptions where a benzodiazepine may still be appropriate, such as seizure disorders, alcohol or benzodiazepine withdrawal, severe generalized anxiety disorder, and anesthesia around procedures. They also say to avoid combining benzodiazepines with opioids in older adults, because of a higher risk of overdose.
The Ativan label agrees in its own way. It notes that sedation and unsteadiness became more common with age, and that the starting dose for older or frail patients should not exceed 2 mg per day, with frequent monitoring. For prolonged use in older people, it also suggests watching for symptoms of upper digestive tract problems.
Family members are often the first to notice trouble. Watch for new confusion, especially at night, unsteady walking, near-falls, or a parent who “isn’t themselves.” A hip fracture from one fall can change everything, so these signs are worth a call to the doctor.
People with lung conditions or sleep apnea
If you have COPD, severe asthma, sleep apnea, or another condition that affects breathing, lorazepam can tip a stable situation into a dangerous one, especially during sleep. The label urges caution here. Tell your prescriber about any breathing diagnosis, and ask whether a sleep study or CPAP review makes sense before starting.
Anxiety itself can cause a feeling of breathlessness, which sometimes makes it hard to know what is driving symptoms. Our article on whether anxiety can cause shortness of breath covers that overlap. Still, any slow, shallow, or labored breathing after a dose is a medical emergency.
Liver or kidney disease
Unlike many benzodiazepines, lorazepam is not broken down by the liver’s CYP450 enzyme system. Instead, it goes through a simpler process called glucuronidation, which turns it into an inactive compound that leaves through the urine. Because of that, StatPearls notes that some clinicians consider lorazepam a reasonable choice in advanced liver disease or end-stage kidney disease, used carefully.
That does not make it risk-free. The label warns that benzodiazepines may worsen hepatic encephalopathy (confusion caused by liver failure), advises caution in severe liver disease, and says lower doses may be enough. It also advises the usual precautions for impaired kidney function. If you have either condition, your prescriber may choose a lower dose and watch you more closely.
Pregnancy and newborns
According to the current label, published human data have not shown a clear link between lorazepam and major birth defects. The bigger concern is use late in pregnancy. Babies born to mothers taking benzodiazepines near delivery can have:
- Neonatal sedation: slowed breathing, sleepiness, and low muscle tone (“floppy” baby).
- Neonatal withdrawal: overactive reflexes, irritability, restlessness, tremors, and feeding difficulties.
The label advises monitoring newborns for these signs. It also mentions a pregnancy registry for people exposed to psychiatric medicines. If you are pregnant or planning a pregnancy, do not stop lorazepam on your own; abrupt stopping carries its own risks. Talk with your prescriber and obstetric team about a plan.
Breastfeeding
Lorazepam passes into breast milk. The label notes reports of sedation, poor feeding, and poor weight gain in breastfed infants, and advises watching the baby for these signs. If you are nursing, let both your prescriber and your baby’s pediatrician know, and report any unusual sleepiness or feeding trouble right away.
Teens and young adults
The label says the safety and effectiveness of Ativan tablets have not been established in children under 12, and that paradoxical reactions are more likely in children. For teens and young adults, the main concerns are paradoxical agitation, memory gaps, impaired driving among new drivers, and the risk of misuse highlighted in the boxed warning.
Parents can help by keeping the medicine locked up, counting pills, and watching for mood changes. The FDA also asks families to dispose of unused benzodiazepines properly so they do not end up in the wrong hands.
Interactions that amplify lorazepam side effects
Many serious problems with lorazepam come from combinations rather than from the drug alone. The label groups many of these under “CNS depressants,” meaning anything that slows brain activity. Here are the combinations worth knowing.
| Combined with | What can happen | Key point |
|---|---|---|
| Opioids (oxycodone, hydrocodone, codeine cough syrup, tramadol, methadone) | Deep sedation, slowed breathing, coma, death | Boxed warning; reserved for when other options are inadequate |
| Alcohol | Stronger sedation, memory blackouts, falls, breathing problems | The FDA advises not drinking while on benzodiazepines |
| Other sleep or anxiety drugs (zolpidem/Ambien, other benzodiazepines) | Stacked drowsiness, next-day impairment, complex sleep behaviors | Tell your prescriber about every sleep aid |
| Gabapentin or pregabalin | Added sedation and dizziness; breathing risk, especially with opioids | Common in pain care; ask for a full review |
| Sedating antihistamines (diphenhydramine, doxylamine, hydroxyzine) | More drowsiness, confusion, falls in older adults | Hidden in many OTC sleep and allergy products |
| Valproate (Depakote) | Higher lorazepam levels, slower clearance | Label advises cutting the lorazepam dose by about 50% |
| Probenecid | Longer-lasting lorazepam effect | Label advises cutting the lorazepam dose by about 50% |
| Clozapine | Marked sedation, low blood pressure, delirium, breathing arrest | Needs close supervision |
Alcohol deserves its own discussion, and we cover it in detail in mixing Ativan and alcohol. The same “stacking” logic applies to opioid and gabapentin combinations, which we explain in our guide to gabapentin with hydrocodone. And if you also take a sleep medicine, it may help to compare its profile in our overview of Ambien side effects.
Ways prescribers reduce side effects
Your prescriber has several tools to keep side effects in check. Knowing them helps you ask good questions. These are clinical decisions, not steps to try on your own.
- Lowest effective dose. Many prescribers start at the low end and adjust slowly, especially for older adults or people with lung or liver disease.
- Shortest useful course. Because benefit beyond four months is unstudied and dependence grows with time, many plans set a clear end point or review date from the start.
- Timing. When drowsiness is the main complaint, a prescriber may shift more of the daily dose to bedtime. The label notes that for anxiety-related insomnia, a single bedtime dose is common.
- Full medication review. Going through every prescription, over-the-counter product, and supplement can uncover sedating overlaps, like a nightly antihistamine sleep aid.
- Screening and monitoring. The 2025 tapering guideline encourages clinicians to screen for misuse and to reassess risks and benefits regularly. For long-term users, the label recommends periodic blood counts and liver tests.
- Treating the root problem. Therapy such as cognitive behavioral therapy (CBT), and longer-term medications for anxiety, can reduce how much a person relies on lorazepam over time.
- Choosing a different drug. Benzodiazepines differ in onset and duration. A prescriber may consider another option based on your needs; see how Xanax and Ativan compare and Ativan vs. Klonopin for background.
If any side effect is bothering you, the safest move is to call your prescriber or pharmacist rather than skipping doses, doubling up, or stopping suddenly.
Symptom diary: a checklist to bring to your appointment
Print or copy this checklist, jot notes for one to two weeks before your next visit, and bring it with a list of everything you take.
Daily log
- ☐ Date, dose, and time taken (exactly as prescribed)
- ☐ Anxiety level before the dose and 2 hours after (0 to 10)
- ☐ Sleepiness during the day (none, mild, moderate, severe)
- ☐ Morning grogginess after an evening dose (yes/no)
- ☐ Dizziness, unsteadiness, or near-falls
- ☐ Memory gaps (forgotten conversations, misplaced items, repeated questions)
- ☐ Alcohol, cannabis, or other sedating products used that day
Weekly check
- ☐ Does the same dose seem to work less well than it did?
- ☐ Any anxiety or restlessness between doses?
- ☐ Mood: flat, sad, hopeless, or unusually irritable?
- ☐ New snoring, pauses in breathing, or waking up gasping (ask a partner)
- ☐ Changes in appetite, bowels, sex drive, or vision
- ☐ Any urge to take more than prescribed, or running out early
- ☐ New medicines started by any doctor, dentist, or urgent care
Red flags: do not wait for your appointment
- ☐ Slow, shallow, or labored breathing, or someone who cannot be woken: call 911
- ☐ Thoughts of self-harm: call or text 988
- ☐ Swelling of the face or throat, or trouble breathing after a dose: call 911
- ☐ New aggression, hallucinations, or severe agitation: call your prescriber today
- ☐ A fall with a head injury, especially in an older adult: seek care
If you are worried about how you are using lorazepam, or about someone else’s use, the SAMHSA National Helpline at 1-800-662-4357 is free, confidential, and open 24/7.
Frequently asked questions
How long do Ativan side effects last?
Effects from a single dose usually peak within a couple of hours and fade over the following hours, though grogginess can carry into the next morning, since the half-life averages about 14 hours. Daytime sleepiness often lessens over the first week or two. Memory effects tend not to fade much with continued use. Withdrawal symptoms after long-term use are a different matter and can last much longer, which is why tapering is supervised.
Is Ativan memory loss permanent?
The short-term memory gaps that happen while lorazepam is active usually affect only the period the drug was working. Events from that window may never be fully recalled, but your ability to form new memories returns as the drug wears off. Whether years of use cause lasting changes is still being studied, as covered in the dementia section above.
Can Ativan make anxiety worse?
Yes, in a few ways. A paradoxical reaction can cause agitation or increased anxiety soon after a dose. Between doses, some people feel rebound anxiety as levels drop. And with longer use, tolerance can make the drug feel less effective. All three are reasons to talk with your prescriber, not to change the dose yourself.
Does Ativan cause weight gain?
Weight gain is not one of lorazepam’s main reported side effects, but the label does list appetite changes. Lower energy and less activity from sedation can also play a role over time. If you notice a steady change in weight, mention it at your next visit.
Can I just stop Ativan if the side effects bother me?
Not on your own if you have been taking it regularly. The FDA warns that stopping suddenly or reducing the dose too fast can trigger withdrawal reactions, including seizures. If you only took a few doses, the risk is lower, but it is still best to check with your prescriber. They can adjust the dose, switch medicines, or plan a gradual taper that fits your situation.
Medical disclaimer: This overview of lorazepam side effects is informational and cannot assess your symptoms; talk with your prescriber about anything you notice. Never start, stop, or change the dose of lorazepam or any medicine without talking to the clinician who prescribed it. In an emergency, call 911. For poisoning or overdose questions, call Poison Control at 1-800-222-1222.
References
- Ativan (lorazepam) tablets, prescribing information and Medication Guide. DailyMed, U.S. National Library of Medicine (revised 2025). DailyMed Ativan label
- U.S. Food and Drug Administration. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. September 23, 2020. FDA Drug Safety Communication
- Lorazepam. StatPearls, NCBI Bookshelf (updated May 2024). StatPearls: Lorazepam
- 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71:2052–2081. AGS Beers Criteria 2023 (PDF)
- Association between benzodiazepine use and dementia: a meta-analysis. PLoS One. 2015. PubMed 26016483
- Benzodiazepine use in relation to long-term dementia risk and imaging markers of neurodegeneration: a population-based study. BMC Medicine. 2024. BMC Medicine study
- American Society of Addiction Medicine. New guideline on benzodiazepine tapering (Joint Clinical Practice Guideline on Benzodiazepine Tapering). March 2025. ASAM announcement
- Lorazepam. MedlinePlus Drug Information, U.S. National Library of Medicine. MedlinePlus: Lorazepam
