Ativan (Lorazepam) Tapering And Weaning Schedule

Medically reviewed by

Dr. Richard Foster, LICDC-CS

March 8, 2019

Ativan (lorazepam) is a strong sedative medication. Individuals often take benzodiazepines like Ativan to relieve anxiety and relax. Ativan can be habit-forming, especially for individuals who abuse the drug by taking larger than recommended doses.

Dependence on Ativan can develop quickly once someone begins to abuse the medication. It is also possible for people who take Ativan as recommended by the doctor to become dependent on the drug if it is taken for more than six weeks at a time.

There are a handful of tapering methods an individual can use when they wish to stop their Ativan use. Weaning off of this medication can be challenging to do alone. It is never recommended to abruptly stop taking Ativan as this can result in the sudden onset of unpleasant withdrawal symptoms.

Getting Ready To Taper Off Of Ativan (Lorazepam)

After someone decides that they want to stop taking Ativan (lorazepam), it is vital that they prepare for a tapering process. To start, individuals should contact their doctor to make sure they are physically capable of undergoing the tapering process.

Individuals who have taken Ativan for a long time may not be approved by their doctor to taper off of Ativan entirely and may have to go through a trial period of reduced dosage to see if they can handle it.

Making sure that an individual is physically capable of stopping Ativan is an essential first step. Once that is done, it is necessary to prepare for the tapering process mentally. Enlisting the help of friends, family, support groups, and, in some cases, a therapist, can help ensure someone completes the tapering process.

Clinical psychologists from addiction treatment programs can be particularly helpful as they are aware of the stages of benzodiazepine withdrawal and the symptoms someone can experience during their tapering period.

Finally, to prepare to wean off of Ativan, it is essential that an individual has a healthy mindset. The tapering process works best when done in a slow and meaningful way, not all at once. Individuals who are aware of this and will be more patient with themselves and learn to identify their own needs throughout the process.

It is important to note that each individual will have their way of doing things and just because one method worked for someone else, doesn’t mean that it will work for everyone. Coming off Ativan for good is a process with a lot of trial and error. Addiction specialist may be able to help individuals navigate the trials they encounter.

How To Taper Off Ativan (Lorazepam) Safely

Ativan (lorazepam) is an intermediate-acting benzo medication with peak effects occurring about two hours after ingestion. It is important to slowly decrease the amount of Ativan to avoid uncomfortable withdrawal symptoms.

There is no single way to taper off of Ativan. Several tapering methods have been shown to be effective, which is why it is essential to consult with a medical professional or addiction specialist before starting the process. Some ways to taper off of Ativan (lorazepam) include dry tapering, tapering strips, and micro-tapering.

Dry Tapering

Dry tapering is perhaps the most common tapering method due to its simplicity. Individuals who dry taper often use a pill cutter or shave a piece of Ativan tablet off to weigh it on a scale. There are a few ways to dry taper, including micro-taper and more substantial cut-and-hold tapering. Individuals who have a particularly difficult time reducing their Ativan dose may switch to using a longer acting benzo such as Valium to help reduce or eliminate withdrawal symptoms.

Tapering Strips

Because it can be challenging to break Ativan tablet into smaller doses, tapering strips were designed to administer lower doses sublingually (under the tongue). This method has only become available in certain areas and may or may not be available depending on someone’s location. If someone decided to use this method, they might be advised to slow down the rate at which they decrease their dose even further.

Micro-Tapering

Micro-tapering is a version of dry-tapering that can help individuals evenly distribute Ativan throughout the day. Individuals who begin to experience withdrawal symptoms between doses may find this method helpful. While micro-tapering, individuals reduce their daily doses by very small amounts that gradually add up to five to 10 percent reduction over a months time.

Coming Off Of Ativan (Lorazepam): Example Weaning Schedule

Depending on the amount of Ativan (lorazepam) someone is used to taking, starting doses will vary. Weaning schedules like the following have been useful for individuals who want to stop taking Ativan. However, it is crucial that individuals take their own needs into account and adjust accordingly.

If severe anxiety or depression occurs while reducing Ativan, it is best to stop or reverse the weaning process until symptoms dissipate. The following is an example of a dry weaning schedule from the Ashton Manual with a starting dose of 40 mg of Ativan:

• Week One: Ativan will be taken twice a day. Half (20 mg) in the morning and the other 20 milligrams at night. Individuals will continue with this pattern for one or two weeks, depending on their sensitivity to reducing their Ativan dose.
• Week Two: During this time, individuals will reduce their morning dose by two milligrams. Reducing their total daily dose to 38 mg. Individuals should continue this pattern for another week.
• Week Three: At this point, individuals will reduce their morning by two mg as they did during the previous week but they will also reduce their evening dose by two milligrams. Taking 16 mg in the morning and 18mg at night, for a total of 32 mg daily.

Moving forward, individuals will decrease their morning dose until they are only taking the medication at night. From there, individuals will reduce their evening dose until they no longer require the medication.

It is essential that each reduction is done at the individual’s pace. Some people may be able to reduce the amount of Ativan they take at a faster rate than others. Once someone has eliminated their morning dose, further decreases should be done in two-week intervals to ensure personal comfort.

When someone gets to the point of taking a 5 mg dose at night, they may consider decreasing their dose by 0.5 mg instead of 2 mg, especially if they have an increased sensitivity to reducing Ativan.

How Long Does It Take To Wean Off Of Ativan (Lorazepam)?

How long it will take to wean off of Ativan will depend on the individual and their unique circumstances. Those who have been taking Ativan for years at a time will need more time to come off the medication in a comfortable way.

Reasons To Taper Off Of Ativan (Lorazepam)

Extended use of Ativan (lorazepam) can result in adverse outcomes, including decreased short-term memory, emotional turmoil, depression, increased anxiety, physical symptoms, and dependence.

Some research has also indicated that most benzodiazepine medications stop being effective after four or more consecutive weeks of use. Clinical trials have suggested that individuals who have been on Ativan for a long time feel better once they no longer taking the medication.

Many people may continue to abuse Ativan because they are trying to avoid going through withdrawal. However, as long as there is an effort to come off of Ativan mindfully, individuals can prevent most, or all, of the unpleasant withdrawal symptoms that they fear.

Treatment Options For Ativan (Lorazepam) Withdrawal

People tapering off of Ativan (lorazepam) can expect to feel anxiety and insomnia, which is why they are more likely to successfully come off of Ativan with the help of formal addiction treatment. Participating in individual or group therapy during the tapering process also increases the chance of coming off the drug safely.

It is crucial that anyone who decides to taper or wean off Ativan take their own needs into account. The additional support of an inpatient program could make the difference while withdrawing from benzodiazepines like Ativan.