Ativan

Ativan is a prescription medication used to treat anxiety disorders, symptoms of anxiety, and anxiety associated with depression. Ativan belongs to a group of drugs called benzodiazepines, which has a sedating effect on brain activity.

This medication comes in tablet and liquid form and can be taken 1 to 3 times per day, with or without food.

This medication is also available in an injectable form to be given directly into a vein (IV) or muscle (IM) by a healthcare professional.

• Ativan injection given through the vein is used to treat a seizure emergency called status epilepticus
• Ativan injection to be given into the muscle is used to help you relax before having surgery.

Common side effects of Ativan include sedation, weakness, and unsteadiness, and these may be seen more frequently with age.

Ativan can also cause confusion, nausea, and low blood pressure.

Ativan can cause dizziness and drowsiness. Do not drive or operate heavy machinery until you know how Ativan affects you.

Do not drink alcohol while taking this medication.

Ativan is a prescription medicine used to treat the symptoms of anxiety, anxiety disorders, and anxiety associated with depression.

Ativan injection given through the vein is used to treat a seizure emergency called status epilepticus

Ativan injection to be given into the muscle is used to help you relax before having surgery.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

• Hikma Pharmaceutical

• Valeant Pharmaceuticals North America LLC

Serious side effects have been reported with Ativan. See “Drug Precautions” section.

Common side effects of Ativan (oral solution and tablets) include:

• sedation
• dizziness
• weakness
• unsteadiness

Common side effects of Ativan (injection) include:

• low blood pressure
• drowsiness
• skin rash
• nausea
• vomiting

It is very important that you immediately contact your doctor if you develop any of the following symptoms:

• Anaphylactic (severe allergic) reactions 
• A serious allergic reaction which causes swelling of your face or throat (angioedema) 
• Develop signs of jaundice (yellowing of the skin or the whites of the eyes)
• Difficulty breathing
• Thoughts of harming or killing yourself 
• Changes in your mental state

This is not a complete list of Ativan side effects. Ask your doctor or pharmacist for more information.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• alcohol
• antipsychotics such as aripiprazole (Abilify), haloperidol (Haldol), quetiapine (Seroquel), or clozapine (Clozaril)
• sedatives such as zolpidem (Ambien), eszopiclone (Lunesta), or zaleplon (Sonata)
• anxiolytics such as clonazepam (Klonopin), alprazolam (Xanax), or temazepam (Restoril)
• antidepressants such as fluoxetine (Prozac), escitalopram (Lexapro), or citalopram (Celexa)
• opioid analgesics such as oxycodone (OxyContin), morphine (MS Contin), or hydrocodone/acetaminophen (Norco), methadone (Methadose)
• antihistamines such as diphenhydramine (Benadryl) or promethazine (Phenergan)
• anticonvulsants such as phenytoin (Dilantin), carbamazepine (Tegretol, Equetro), or phenobarbital, valproate (Depakote)
• birth control pills
• probenecid; the dose of Ativan should be reduced by 50% if also taking probenecid

Ativan Injection:

• You should tell your doctor if you are taking a drug called scopolamine, which may be used for gut problems or before an operation.

This is not a complete list of Ativan drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with Ativan including:

• Worsening or unmasking preexisting depression. Ativan is not recommended in those with primary depression (depression not related to life stressors) or psychosis that has not been treated.
• Respiratory depression (increased difficulty in breathing). Special precaution is encouraged for those with underlying breathing disorders such as COPD or sleep apnea.
• Impaired mental function. Tell your healthcare provider right away if you have some or all of the following symptoms...
  • memory loss, confusion, disorientation
  • extremes in moods (very sad or very happy)
  • suicidal thoughts or desires, especially those diagnosed with depression
• Physical or psychological dependence, tolerance, or abuse risk. Risk increases with higher dosage and longer duration of therapy, those with personality disorders, and for those with a history of drug or alcohol abuse.
• Liver dysfunction. Use of Ativan with decreased liver function may require dose adjustment or may worsen encephalopathy (brain damage caused by a dysfunctional liver).
• Paradoxical reaction. A reaction that results in over stimulation rather than a calming effect may occur when using Ativan, especially in elderly patients or in children. Discontinuation is advised if this occurs.

Ativan can cause dizziness and drowsiness. Do not drive or operate heavy machinery until you know how Ativan affects you.

To avoid withdrawal side effects (insomnia, anxiety, irritability), do not stop taking Ativan suddenly. Discuss with your doctor about slowly decreasing the dose before stopping use of this medication altogether.

Do not take Ativan if you:

• have had an allergic reaction to any benzodiazepines, to Ativan, or to any of the ingredients
• have glaucoma

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of Ativan, there are no specific foods that you must exclude from your diet when receiving Ativan.

Before taking Ativan, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• have had an allergic reaction to any benzodiazepines, to Ativan, or to any of the ingredients within the Ativan doses
• have seizures or a history of seizures
• have glaucoma
• have lung, heart, or liver disease
• have a history of depression or psychosis
• have a history of alcohol or drug abuse
• have liver or kidney problems
• are pregnant or plan to become pregnant
• suffer from breathing problems
• are breastfeeding
• if you are having surgery, including dental surgery
• if you use tobacco products. Cigarette smoking may decrease the effectiveness of this medication

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Ativan falls into category D. Ativan may harm your unborn baby as there is evidence of risk to the unborn baby based on studies in humans or adverse reaction data, but this medication may be given to a pregnant woman if her healthcare provider believes that its benefits to the pregnant woman outweigh any possible risks to her unborn baby.

Tell your doctor if you are breastfeeding or plan to breastfeed.

You should not take Ativan if you are breastfeeding. It may be excreted in your breast milk and may harm your nursing child.

Take Ativan exactly as prescribed.

This medication comes in tablet or liquid form and can be taken 1 to 3 times per day, with or without food.

Ativan concentrate (liquid) comes with a specially marked dropper for measuring the dose. Ask your pharmacist to show you how to use the dropper. Dilute the concentrate in 1 ounce (30 milliliters) or more of water, juice, or carbonated beverages just before taking it. It also may be mixed with applesauce or pudding just before taking the dose.

This medication is also available in an injectable form to be given directly into a vein (IV) or muscle (IM) by a healthcare professional.

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of Ativan at the same time.

Take Ativan exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

Oral Forms (oral solution and tablets):

The usual range is 2 to 6 mg every day taken in divided doses, but the daily dosage may vary from 1 to 10 mg/day:

• For anxiety, most patients start with 2 to 3 mg total, given two to three times per day.
• For insomnia due to anxiety, a single daily dose of 2 to 4 mg may be given, usually at night before bedtime.
• For elderly patients, a starting dose of 1 to 2 mg per day is recommended, and may be adjusted as needed and tolerated.
• The dosage of Ativan should be increased gradually when needed to help avoid adverse effects.
• The dosage of Ativan should be decreased gradually when appropriate to help avoid adverse effects during a withdrawal period.

In general, Ativan should be used for short periods only (2 to 4 weeks). Your doctor will want to determine the need for continued therapy after this time period.

Injection:

• Status epilepticus
  • The recommended dose of Ativan injection for the treatment given as an IV injection (through the vein) is 4 mg given slowly (2 mg/min) for patients 18 years and older. If seizures continue or recur after a 10- to 15-minute observation period, an additional 4 mg intravenous dose may be slowly administered.
• Preanesthetic
  • The recommended initial dose of Ativan as an intravenous injection (through the vein) for sedation and relief of anxiety is 2 mg total, or 0.02 mg/lb (0.044 mg/kg), whichever is smaller. Some patients will need larger doses as high as 0.05 mg/kg up to a total of 4 mg.
  • The recommended dose of Ativan as preanesthetic (before surgery) as a intramuscular injection (muscle) is 0.05 mg/kg up to a maximum of 4 mg.

If you take too much Ativan, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If Ativan is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

Symptoms of overdose include sleepiness, confusion, coma, respiratory and cardiovascular depression, and hypotension. Emergency medical treatment is required.

Tablets:

• Keep tightly closed in container.
• Dispense in a tight container.
• Store tablets at room temperature.
• Keep this and all medicines out of the reach of children.

Oral solution:

• Store in a refrigerator at 2°-8°C (36°-46°F).
• Protect from light
• Discard opened bottle after 90 days.

Injection:

• Store injection (for IM or IV) in a refrigerator. Protect injection from light.