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Lorazepam, which most people know under the trade name Tavor, is one of the most frequently prescribed sedatives and works quickly and reliably against anxiety and tension.
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The most important point you have to know about lorazepam is the high dependence risk. Benzodiazepines should, according to professional information, generally only be prescribed for short periods, often a frame of about two to four weeks is named. A longer use should only happen with a compelling reason and after careful weighing, because the risk then rises clearly. The reason: already after a few weeks of daily intake a physical and mental dependence can develop, some people even report a habituation after an even shorter time. In Germany an estimated more than one million people are dependent on benzodiazepines, which shows how widespread and underestimated this problem is. Especially tricky is the so-called low-dose dependence: with this the dose is not even increased but the body still cannot manage without the medicine. Unlike with the classic picture of an addiction, sufferers thus do not increase the amount but stay inconspicuously at a small dose and often do not notice the dependence at all. Because the dose stays the same, this form of dependence often goes unnoticed for a long time, neither by the sufferers nor by the medical practice. Only when trying to leave the medicine out does it then show that the body has long needed it.
Even a short intake can cause dependence
Lorazepam is not a medicine for continuous use. Already after two to four weeks of daily intake a dependence can arise, which is why it should only be taken short term and under close medical guidance. If lorazepam is prescribed to you over a longer period, actively ask how long the intake is planned and what the stopping should look like. But never stop the medicine on your own or abruptly. An open question in the practice is completely normal here and shows that you handle the medicine responsibly.
Unlike with many other medicines, lorazepam cannot simply be left out after a longer intake. While a painkiller or an antibiotic can usually be stopped without problems at the end of the treatment, this is different with a benzodiazepine after a longer use. After more than about two weeks the body has got used to the active substance, and an abrupt stop can trigger severe withdrawal symptoms. The safe way is a slow, step-by-step tapering that is always planned and accompanied by the medical practice. There is no blanket instruction, because every single body reacts differently. As a rule, the dose is reduced very carefully in small steps over weeks to months. Often a small part of the dose is reduced about every one to two weeks, sometimes a switch is also made to a longer-acting benzodiazepine such as diazepam, which is easier to taper. How big the individual steps are and how much time lies between them always depends on how well you tolerate them and is adjusted if needed. Behavioural therapy, relaxation techniques and exercise help alongside. Important is patience: the slower the tapering, the milder the process usually proceeds. A too fast pace, on the other hand, often leads to complaints that make the stopping unnecessarily hard and discourage sufferers.
Never stop abruptly: that can be dangerous
Never stop lorazepam from one day to the next after a longer intake. An abrupt stop can trigger severe and in rare cases even life-threatening withdrawal symptoms such as seizures, confusion or a delirium. Strong anxiety, restlessness and sleeplessness are also common. The stopping therefore always belongs in medical hands and should happen according to an individual plan. Speak with your medical practice before you change anything. Even if you have the feeling that you no longer need the medicine, the slow tapering is the safe way.
When stopping lorazepam, many people experience that the original complaints temporarily return intensified, that is for example the anxiety, the inner restlessness or the sleeplessness. Some sleep especially badly in this phase or feel more nervous than before, which can be very distressing. This phenomenon is called the rebound effect. It arises because the nervous system has got used to the dampening effect and briefly overshoots when stopping. What is tricky about it is that this effect is easily confused with a relapse of the actual illness. Many then think they still need the medicine, but it is usually a temporary withdrawal symptom that subsides over time on its own. This confusion is one of the main reasons why some people hold on to a benzodiazepine for years, although a stopping would have long been possible. Exactly for this reason it is so valuable to have the stopping medically accompanied, because this way rebound and a real relapse can be told apart better. The medical practice can assess whether the complaints are temporary or whether the underlying illness needs to be treated further.
Like all benzodiazepines, lorazepam can make you tired and drowsy, promote dizziness and reduce attention, especially at the start of the treatment. Many of these effects ease somewhat over time but are clearly noticeable especially in the first days. Concentration and memory can also suffer. Because the reaction ability is restricted, driving and operating machines are often not possible. In older people the risk of falls is increased, and so-called paradoxical reactions can occur, with which restlessness or aggression appear instead of calming. In older people in particular, lorazepam should therefore be used especially cautiously and in a low dose, because they react more sensitively and the active substance is broken down more slowly in them. A particularly important warning concerns the combination with other dampening substances. This can intensify the effect of lorazepam so much that it becomes dangerous, which is why it should never happen without medical consultation.
| Topic | The most important in brief |
|---|---|
| Substance group | Benzodiazepine, anxiety-relieving and calming via GABA |
| Use | Acute anxiety, panic, short term sleep problems |
| Dependence | Possible already after two to four weeks |
| Stopping | Never abruptly, taper slowly with medical guidance |
| Important interaction | Alcohol and opioids: risk of respiratory depression |
Caution with alcohol and dampening substances
Do not drink alcohol during the intake of lorazepam and be careful with other dampening substances such as opioids, sleeping pills or certain painkillers. In combination the calming effect can become so strong that breathing is slowed dangerously. Especially the combination of a benzodiazepine and an opioid is considered risky. Always tell your medical practice and your pharmacy what else you take. This also applies to over-the-counter medicines and herbal preparations that you might not consider important.
Especially with a medicine with a dependence risk like lorazepam, a clear overview helps. brite helps you manage your medications, be reminded of the intake and get hints about possible interactions, for example with dampening substances. This way you also see at a glance how long you have already been taking the medicine.
The bottom line is that lorazepam is an effective medicine that helps quickly and reliably in acute situations but that demands great respect. It is not the medicine that makes anxiety generally bad or dangerous, but a tool that can be very valuable in the right situation and for the right duration. The decisive point is the duration: lorazepam is intended for short, clearly limited use, not for continuous use. Those who know this and plan the stopping in time and slowly with the medical practice can use the medicine sensibly and avoid an unwanted dependence. With an anxiety disorder, lasting sleep problems or frequent heart palpitations, the conversation about a long-term treatment that manages without a dependence risk is worthwhile, for example a psychotherapy or suitable antidepressants. Lorazepam can serve as a short-term bridge until the actual treatment takes effect.
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This article is for general information and does not replace medical advice, diagnosis or treatment. Never change the intake of lorazepam on your own and do not stop it after a longer intake without medical guidance. With severe withdrawal symptoms or shortness of breath, immediately call the emergency number.
