Ativan's interplay with other substances: Additional medications, alcohol, and further considerations

Introduction

Ativan's Interactions: Compatibility with Other Medications, Alcohol, and Substances

Lorazepam, marketed under the brand name Ativan, is a medicinal drug commonly prescribed for managing anxiety and related sleep problems, as well as treating a severe type of seizure known as status epilepticus. Ativan might also be administered before surgery to minimize anxiety and induce drowsiness.

Just like other medications, Ativan can interact with alcohol and certain other substances. These interactions may alter the effects of Ativan.

Ativan comes in two forms: oral tablets and injections. These forms share similar interactions. To uncover more about Ativan's interactions, continue reading. You can explore further details about Ativan's usage in this article.

When to avoid Ativan

There are certain factors or health conditions that may increase the risk of harmful consequences, leading your doctor to refrain from prescribing Ativan. These are known as contraindications. Ativan's contraindications include:

Suffering from acute narrow-angle glaucoma

Ativan can elevate the pressure inside your eye. In cases of acute narrow-angle glaucoma, Ativan may exacerbate the condition. As a result, your doctor may not prescribe Ativan for you. You can discuss alternative medications with them.

Have experienced an allergic reaction to Ativan or its components

Drug class or drug name

Doctors typically avoid prescribing Ativan if you've had an allergic reaction to Ativan or any of its components. The injectable Ativan variant contains an additional ingredient: benzyl alcohol, a preservative that combats contamination and helps maintain the drug's freshness.

Taking Ativan may trigger another allergic reaction. You can consult your doctor about viable alternatives.

Drug examples

Have a history of allergic reactions to other benzodiazepines

Doctors may hesitate to prescribe Ativan if you've had an allergic reaction to other benzodiazepines, such as diazepam (Valium). Ativan belongs to the benzodiazepine family. Using Ativan while having an allergic reaction to other associated medications may elicit another allergic reaction. Your doctor can advise you on alternative treatments.

Interaction result with Ativan

Note: Prior to starting Ativan treatment, it's crucial to inform your doctor if any of these contraindications apply to you. They can evaluate whether Ativan is suitable for you.

Ativan and alcohol interaction

Avoid consuming alcohol and Ativan simultaneously. You may become more sensitive to the effects of alcohol while using Ativan. For instance, alcohol may induce fatigue and respiratory depression (depressed breathing). The effects may be intensified when combined with Ativan.

Ativan and alcohol both impair central nervous system activity, including the brain and spinal cord. Consuming alcohol along with Ativan can produce unfavorable side effects such as:

opioids

excessive drowsiness
memory loss
breathing problems
coma

Alcohol consumption with Ativan may also enhance the risk of an Ativan overdose and, in certain situations, be fatal. Learn more about Ativan overdose here.

• fentanyl (Subsys, Lazanda, Fentora, others)• hydrocodone (Hysingla ER)• methadonemorphine (MS Contin)• oxycodone (Oxycontin, Xtampza ER, Oxaydo, others)• tramadol (Ultram, ConZip)

If you have concerns or queries about refraining from alcohol during Ativan therapy, discuss them with your doctor.

Ativan interactions with other medications

can increase the risk of side effects from Ativan* and opioids†

Before commencing Ativan treatment, inform your doctor and pharmacist about all prescription, over-the-counter, and additional medications you are taking. Sharing this information with them may help prevent possible interactions.

If you have questions about potential drug interactions that may affect you, consult your doctor or pharmacist.

Below is a list of drugs that can interact with Ativan. Bear in mind that this list does not account for all drugs that may interact with Ativan. Some of these interactions are described in further detail in "Drug interactions in depth" section just below.

Drug Class or Substance | Examples | Interaction Impact with Ativan ||------------------------|-------------------------------------------------------------|-------------------------------------|| Opioids | - fentanyl (Subsys, Lazanda, Fentora, others) | Increases Ativan's side effects risk || | - hydrocodone (Hysingla ER) | || | - methadone | || | - morphine (MS Contin) | || | - oxycodone (Oxycontin, Xtampza ER, Oxaydo, others) | || | - tramadol (Ultram, ConZip) | || Sedating Antihistamines | - chlorpheniramine | Increases Ativan's side effects risk || | - dimenhydrinate (Gravol, Dramamine) | || | - diphenhydramine (Benadryl) | || | - promethazine | || Sedatives & Anxiolytics | - buspirone | Increases Ativan's side effects risk || | - lorazepam | || | - diazepam (Valium) | || | - zolpidem (Ambien) | || | - zaleplon (Sonata) | || Antidepressants | - amitriptyline | Increases Ativan's side effects risk || | - clomipramine (Anafranil) | || | - mirtazapine (Remeron) | || | - bupropion (Wellbutrin SR, Wellbutrin XL) | || | - fluoxetine (Prozac) | || Antipsychotics | - aripiprazole (Abilify) | Increases Ativan's side effects risk || | - haloperidol (Haldol) | || | - risperidone (Risperdal) | || | - clozapine (Clozaril, Versacloz) | || Anticonvulsants | - carbamazepine (Tegretol, Carbatrol, Equetro, others) | Increases Ativan's side effects risk || | - phenytoin (Dilantin) | || | - gabapentin (Neurontin) | || | - topiramate (Topamax) | || Probenecid | - (Probalan) | Increases Ativan's side effects risk || Valproate | - | Increases Ativan's side effects risk |

sedating antihistamines

Detailed Drug Interactions with Ativan

Opioids

• chlorpheniramine• dimenhydrinate (Gravol, Dramamine)• diphenhydramine (Benadryl)• promethazine

Ativan and opioids can cause severe side effects, including life-threatening situations. A boxed warning is a serious warning from the Food and Drug Administration (FDA).

Opioids are potent drugs derived from the opium poppy and include strong prescription painkillers and illegal substances, such as heroin.*

can increase the risk of side effects from Ativan* and sedating antihistamines

Interaction Consequences. Taking Ativan with an opioid may result in excessive sleepiness, breathing problems, coma, and, in some cases, death. Your doctor can provide more information.

Interaction Explanation. Ativan and opioids can both induce central nervous system (CNS) depression, which refers to reduced activity in the brain and spinal cord. They can also cause respiratory depression (slowed breathing). This combined effect can be serious.

Opioid Drug Examples. Some opioids are:

buprenorphine (BuTrans, Sublocade, Belbuca)
fentanyl (Subsys, Lazanda, Fentora, others)
methadone
morphine (MS Contin)
oxycodone (Oxycontin, Xtampza ER, Oxaydo, others)
tramadol (Ultram, ConZip)

sedatives and anxiolytics

Action Points. Due to the risk of life-threatening problems, doctors usually don't advise Ativan for users on opioids unless there are no alternatives.

If your doctor prescribes both drugs, they'll prescribe the lowest possible dosages. Inform your caregiver, household members, and close friends about your use of these medications. If you experience severe sleepiness or are in a coma, promptly notify 911 or the local emergency number. In case of respiratory problems or breathing stoppage, emergency medical assistance should be called.

• buspirone• lorazepam• diazepam (Valium)• zolpidem (Ambien)• zaleplon (Sonata)

To be safe, your doctor may ask you to have naloxone (Narcan) nasal spray on hand. It serves as an emergency treatment for possible overdoses due to opioids. Narcan reverses opioid effects, including respiratory depression. Another person must administer the medication. Your doctor can prescribe Narcan, or you can request it from your pharmacy. Contact your doctor or pharmacist for more information about Narcan.

dimenhydrinate (Gravol, Dramamine) alternative: meclizine (Bonine)
diphenhydramine (Benadryl) alternative: cetirizine (Zyrtec) or loratadine (Claritin)
doxylamine (Unisom) alternative: diphenhydramine or promethazine
promethazine alternative: chlorpheniramine or diphenhydramine
chlorpheniramine alternative: diphenhydramine or cetirizine

can increase the risk of side effects from Ativan,* sedatives, and anxiolytics

These drugs may also be found in combination products that you can buy over the counter.

Steps you or your doctor may take. Your doctor will likely not prescribe Ativan with a sedating antihistamine. Before taking any over-the-counter drugs with Ativan, be sure to check with a pharmacist whether the combination is safe.

If you have sleeping problems while taking Ativan, talk with your doctor. They can recommend the right treatment for you. You should not take any other medications to help you sleep unless your doctor recommends them.

If you need a medication for allergies, nausea and vomiting, or motion sickness, ask your doctor or pharmacist.

antidepressants

Sedatives and anxiolytics

Sedatives are drugs that cause sleepiness. They may be prescribed for sleeping problems or anxiety. Anxiolytics are drugs for anxiety. Ativan is both a sedative and anxiolytic.

• amitriptyline• clomipramine (Anafranil)• mirtazapine (Remeron)• bupropion (Wellbutrin SR, Wellbutrin XL)• fluoxetine (Prozac)

Interaction result. Taking Ativan with a sedative or anxiolytic may cause excessive sleepiness and breathing problems.

Interaction explained. Ativan and other sedatives and anxiolytics can cause CNS depression and respiratory depression. Taking the drugs together can increase your risk of these side effects.

can increase the risk of side effects from Ativan* and antidepressants

Examples of sedative and anxiolytic drugs. Some sedative and anxiolytic drugs include:

buspirone
lorazepam (Ativan alternative: temazepam, lorazepam PDR)
diazepam (Valium)
zolpidem (Ambien)
zaleplon (Sonata)

Steps you or your doctor may take. Your doctor will likely not prescribe Ativan with other sedatives or anxiolytics, especially other benzodiazepines, such as lorazepam. (Ativan is a type of benzodiazepine. Ativan also contains the active drug lorazepam.)

Because Ativan and other benzodiazepines have the same effects, taking the drugs together could make the effects more severe, possibly leading to an overdose. You can find more information about overdose and Ativan here.

antipsychotics

If you have trouble sleeping or have anxiety symptoms while taking Ativan, talk with your doctor. They can recommend the right treatment for you. You should not take any other medications to treat your symptoms unless your doctor recommends them.

Ativan and other interactions

• aripiprazole (Abilify)• haloperidol (Haldol)• risperidone (Risperdal)• clozapine (Clozaril, Versacloz)

Ativan may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Ativan.

Ativan interactions with supplements

can increase the risk of side effects from Ativan* and antipsychotics

Before you start treatment with Ativan, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

Taking Ativan with supplements that cause sleepiness may lead to excessive sleepiness. An example of such a supplement is melatonin. In general, you should avoid taking melatonin products with Ativan.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Ativan interactions with herbs

anticonvulsants

Taking Ativan with herbs that cause sleepiness may lead to excessive sleepiness. Examples of these supplements include:

chamomile
kava
lavender
valerian

• carbamazepine (Tegretol, Carbatrol, Equetro, others)• phenytoin (Dilantin)• gabapentin (Neurontin)• topiramate (Topamax)

In general, you should avoid taking these products with Ativan. If you have questions, you can ask your doctor or pharmacist.

Ativan and vitamins

can increase the risk of side effects from Ativan* and anticonvulsants

There have been no specific reports of vitamins interacting with Ativan. However, it’s possible that interactions with vitamins could be recognized in the future. So, it’s still important to check with your doctor or pharmacist before taking any of these products during Ativan treatment.

Ativan and food

Food has not been reported to interact with Ativan. If you’d like to learn more about eating certain foods during treatment with Ativan, talk with your doctor.

Ativan and vaccines

probenecid (Probalan)

No vaccine interactions have been reported with Ativan. However, you should still talk with your doctor or pharmacist before getting vaccines during Ativan treatment.

Ativan and lab tests

—

There have been no specific reports of Ativan interacting with lab tests. Keep in mind that if you have lab tests during Ativan treatment, you should tell the healthcare professional that you’re taking Ativan.

*Ativan interaction with cannabis or CBDCannabis* (often called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact** with Ativan. These products may increase the amount of Ativan in your body, which could raise your risk of Ativan side effects.

can increase the risk of side effects from Ativan*

Also, both Ativan and cannabis products can cause sleepiness. So, you may have excessive sleepiness if you take both drugs together.

Before you start treatment with Ativan, tell your doctor and pharmacist if you take cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Respiratory issues. Ativan might lead to breathing complications like shallow breathing. If you have a respiratory or lung problem, such as chronic obstructive pulmonary disease (COPD) or sleep apnea, using Ativan could worsen your condition. Discuss with your doctor if Ativan is suited for you.
Mental health history. Ativan might initiate or exacerbate depression. If you've experienced depression, consult your doctor about the suitability of Ativan. If you're currently dealing with depression, your doctor might not prescribe Ativan unless you're also using an antidepressant medication.
Previous substance abuse. If you've struggled with drug or alcohol misuse or addiction in the past, you may be more susceptible to misuse and addiction with Ativan. Your doctor will evaluate your risk before issuing the prescription.
Advanced age. Individuals aged 65 years or older may be more susceptible to side effects with Ativan. Your doctor will typically prescribe a lower Ativan dosage.
Liver or kidney problems. Individuals with liver or kidney issues might have an enhanced risk of side effects with Ativan. Your doctor will likely prescribe a reduced Ativan dosage.
Pregnancy. Ativan could have detrimental effects during pregnancy. Your doctor will not usually prescribe Ativan during pregnancy. Discuss other potential treatments with your doctor.
Breastfeeding. Ativan might pass through breast milk, potentially causing harm to a nursing child. Your doctor will likely not prescribe Ativan during breastfeeding. Talk with your doctor about alternative treatments.
Allergic reaction. If you've had an allergic reaction to Ativan, its components, or other benzodiazepines, your doctor will likely refrain from prescribing Ativan for you. Consult the "When to avoid Ativan" section for more information.
Acute narrow-angle glaucoma. If you have acute narrow-angle glaucoma (sudden increased eye pressure), your doctor is unlikely to prescribe Ativan. Refer to the "When to avoid Ativan" section for additional details.

valproate

Frequently Asked Questions about Ativan and interactions

Is Ativan compatible with ADHD drugs like Adderall or Vyvanse?

—

Ativan does not generally interact with drugs for attention deficit hyperactivity disorder (ADHD). However, combining Ativan with Adderall or Vyvanse might not be safe.

Doctors occasionally prescribe Ativan alongside Adderall or Vyvanse for individuals with ADHD who also have anxiety or sleep issues. Using these medications together as prescribed by a doctor for these purposes does not appear to be harmful.

can increase the risk of side effects from Ativan*

However, all three drugs carry a risk of misuse and addiction.* If Ativan is misused in conjunction with Adderall or Vyvanse, this may increase the risk of overdose from either medication.† You should only take Ativan with Adderall or Vyvanse if your doctor has prescribed them.

If you have additional questions about Ativan, Adderall, Vyvanse, or other ADHD medications, consult your doctor.

Can I use Ativan with Tylenol?

Yes, you can usually use Ativan in conjunction with mild pain relievers such as acetaminophen (Tylenol). Ativan does not generally interact with Tylenol.

However, it's essential to remember that Ativan works in conjunction with stronger pain medications containing acetaminophen and an opioid, such as acetaminophen/oxycodone (Oxycet, Percocet). Mixing Ativan with pain relievers containing opioids may cause serious side effects, including excessive drowsiness and breathing problems.*

Additionally, if you have a seizure disorder, your doctor may advise against using Ativan with Adderall or Vyvanse. All three drugs may cause seizures. Using more than one of these drugs could increase your risk of seizures.

Before using any pain medication with Ativan, consult your doctor or pharmacist to ensure the combination is safe. They can inform you about what you shouldn't mix with Ativan.

Is Ativan compatible with Claritin?

There's a possibility, but it's relatively unlikely. Loratadine (Claritin) is a type of allergy medication called an antihistamine. Sedating antihistamines can cause drowsiness and interact with Ativan to cause excessive drowsiness (check "Drug interactions in depth" above for more information about this).

However, Claritin is considered a non-sedating antihistamine. This implies it does not usually cause drowsiness in people who use it. However, drowsiness may occur rarely, mainly if you take more than the recommended dose.

Until you're familiar with how Claritin impacts you, it's wise to steer clear of combining it with Ativan. If Claritin doesn't cause drowsiness, it's generally thought to be safe to use in conjunction with Ativan. However, if Claritin does cause drowsiness, it's advisable to avoid it with Ativan. Your physician or pharmacist can suggest a suitable substitute.

Circumventing conflicts

You can adopt certain strategies to minimize conflicts with Ativan. Your doctor and pharmacist are pivotal figures, so reach out to them before initiating treatment. They can inform you of substances you should avoid in conjunction with Ativan. Consider carrying out the following:

Inform them of your alcohol consumption and cannabis use.
Disclose all other medications you're taking, as well as any supplements, herbs, and vitamins.
Fill out a medication log, which your doctor and pharmacist can assist you in completing.

It's also crucial to review the Ativan label and other medication supplements that might accompany the drug. The label might display colored stickers indicating an interaction. Additionally, the paperwork, often referred to as the medication guide or patient package insert, may provide details about potential interactions. (If Ativan doesn't include paperwork, you can request a copy from your pharmacist.) If you find this information challenging to understand, don't hesitate to seek clarification from your doctor or pharmacist.

You can also help prevent conflicts with Ativan by adhering to your doctor's prescribed dosage.

Additional sources

Beyond learning about potential conflicts, you might be interested in exploring Ativan further. These resources might prove helpful:

Ativan Overview. To obtain a general understanding of Ativan, you can refer to this article.
Side Effects. If you're curious about Ativan's side effects, consult this article. Alternatively, you can review the prescribing information for Ativan tablets or Ativan injections.
Dosage Particulars. To learn about the dosage of Ativan, consult this article.
Drug Comparisons. Find information about how Ativan compares with Xanax and other drugs, such as Klonopin, Valium, and Ambien.
Condition Insights. To gain more insights into your condition, you can refer to our anxiety hub and epilepsy and seizures hub.

Disclaimer:Medical News Today has made every effort to ensure that all information is factually accurate, comprehensive, and current. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Avoid consuming alcohol while taking Ativan as it can intensify the effects and increase the risk of respiratory depression.
If you have a history of allergic reactions to other benzodiazepines such as diazepam (Valium), your doctor may hesitate to prescribe Ativan due to the risk of another allergic reaction.
Individuals with epilepsy or a history of seizures should be cautious when taking Ativan as it may interact with certain anticonvulsant medications, potentially increasing the risk of side effects.