Ativan alternatives: What can I take instead of Ativan?

Compare Ativan alternatives | Valium | Xanax | Buspirone | Seroquel | Benadryl | Natural alternatives | How to switch meds

Ativan is a brand-name prescription medication used for the short-term management of generalized anxiety disorder, panic disorder, other anxiety disorders and phobias, insomnia, or as an immediate emergency treatment for status epilepticus, nausea and vomiting, serotonin syndrome, and alcohol withdrawal. Ativan is also used to induce sedation before medical procedures or anesthesia. Ativan is a popular choice for a sedative-anxiolytic in an inpatient setting due to its rapid (one- to three-minute) intravenous onset of action and relatively straightforward side effect profile.

Lorazepam, the active ingredient in Ativan, belongs to a class of drugs called benzodiazepines (sometimes called benzos) that work by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that slows down nerve activity in the brain and causes drowsiness. Ativan is taken orally for anxiety or insomnia. For seizure relief and procedural sedation, it is administered as an injection by a healthcare professional. Benzos are controlled substances and must be prescribed by a healthcare provider with an active DEA license. 

It is important to note that benzodiazepines can induce dependence with subsequent rebound and withdrawal symptoms if they are suddenly discontinued. Furthermore, these drugs are subject to abuse, particularly in patients with a history of alcohol and substance abuse. Since most of the approved benzodiazepines for insomnia have a half-life of more than eight hours, next-day (residual) fatigue and neuropsychological dysfunction are potential side effects.

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What can I take in place of Ativan?

When considering alternatives to Ativan, important factors to consider include:

• What specific condition Ativan is being used to treat or augment
• Important patient characteristics including other mental health concerns such as depression or bipolar disorder
• Whether the medication is intended to be used in an emergency, inpatient, or at-home setting
• Potential for abuse and patient sensitivity to the class of medication, which may include a history of drug misuse or abuse, alcohol dependence, or history of placement in treatment programs
• The use of other prescription drugs or over-the-counter medications that may result in harmful drug interactions
• Age, with special considerations for younger and older adults

Depending on the reason Ativan is being prescribed, there are several classes of medications that could be used as alternatives to Ativan including: 

• Other benzodiazepines: Klonopin (clonazepam), Valium (diazepam), Xanax (alprazolam), midazolam, Halcion (triazolam)
• Atypical antidepressants: Remeron (mirtazapine)
• Atypical antipsychotics: Seroquel (quetiapine), Zyprexa (olanzapine)
• Selective serotonin reuptake inhibitors (SSRIs): Zoloft (sertraline), Prozac (fluoxetine), Celexa (citalopram)
• Anti-anxiety medications: Buspirone 
• Antihistamines: Vistaril (hydroxyzine), Benadryl (diphenhydramine) 
• Anticonvulsants: Neurontin (gabapentin)
• Barbiturates: Amytal (amobarbital)
• Antiemetics: Emend (aprepitant), Kytril (granisetron), Zofran (ondansetron), Aloxi (palonosetron), Compazine (prochlorperazine), Phenergan (promethazine), Akyzeo (netupitant-palonosetron), Varubi (rolapitant), Reglan (metoclopramide)

Top 5 Ativan alternatives

1. Valium

Diazepam is a benzodiazepine more commonly referred to by the brand name, Valium. Valium is used in the treatment of anxiety, alcohol withdrawal, and seizures. It is also a useful adjunct in the treatment of skeletal muscle spasms from local trauma, spasticity from damage to central nervous system brain cells as seen in cerebral palsy, and stiff-person syndrome—a rare movement disorder that causes muscles in the trunk and limbs to become stiff. 

Compared to other benzos, Valium has a longer action in the body, but it still has the potential for abuse.

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2. Xanax

Xanax (alprazolam) is another benzodiazepine used in the treatment of anxiety disorders. 

While both are effective, Xanax is generally used more often in the treatment of panic attacks and panic disorders with associated fear disorders. Sometimes, the prescribing preference between the two will be determined by provider experience and the individual’s response to treatment with one over the other. 

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3. Buspirone

Buspirone is an anxiolytic medication originally developed as an antipsychotic. While it was found to be fairly ineffective for that purpose, it is useful in reducing the symptoms of anxiety. Buspirone has recently become a more popular choice in the management of anxiety as it is not habit-forming. There is no risk of physical dependence or withdrawal associated with its use due to its lack of effects on the GABA receptors. 

Unlike Ativan, this medication is typically not used in acute settings, as the clinical effect usually takes two to four weeks to set in. Of note, buspirone bioavailability is increased with food, and individuals may be advised to take this medication with or without food depending on the desired effect.

4. Seroquel

Quetiapine is sometimes used as an alternative to Ativan in acute settings. Seroquel is an antipsychotic medication used in the management of schizophrenia, bipolar disorder, and acute episodes of anxiety and delirium in an inpatient setting. “Quetiapine was sometimes utilized to manage various forms of anxiety and ICU delirium,” says Jaime Gilbert, RN, a registered nurse with years of experience using the medication. “This approach was often extremely successful in managing problematic patient symptoms and the therapeutic effects of quetiapine seemed to last much longer than Ativan.” 

There are some notable differences in side effect profile and patient selection when considering Seroquel usage. Seroquel is associated with increased mortality in older patients with dementia-related psychosis and an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults taking antidepressants.

RELATED: Seroquel dosage 

5. Benadryl

More commonly known as Benadryl, diphenhydramine is notoriously known to treat allergies, as it binds and stabilizes the H-1 histamine receptor, a major receptor involved in the allergic response. Its action on this receptor renders diphenhydramine extremely sedating, and therefore a safe and readily available medication that is sometimes used for sleep. In most other countries outside of the United States, it is actually marketed as a sleep aid, not an antihistamine. At low doses, its safety profile renders it a possible choice for sleep for individuals who occasionally need help with sleep and have an aversion to more typical “sleeping pills.”

At high doses, far above what is used to treat allergies, Benadryl is sometimes used alone or in conjunction with Ativan to sedate combative patients in a hospital setting or patients with acute neuroleptic malignant syndrome or serotonin syndrome. Both are very severe, potentially life-threatening reactions associated with the use of atypical antipsychotics and polypharmacy of antidepressants. 

Natural alternatives to Ativan

There are several alternatives to Ativan that are not prescription medications. Many of them have demonstrated the ability to reduce preprocedural anxiety as well as anxiety from everyday stressors and to help with sleep. 

Music

There is a growing body of evidence demonstrating that preoperative music-based interventions are effective in reducing anxiety, pain perception, sedative intake, and postoperative pain. Most of the evidence suggests that music selected by the researcher is most effective, as evidence-based “relaxing” parameters can be better accounted for such as tempo, rhythm, and melody.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a well-regarded non-pharmacologic alternative for anxiety. CBT is a form of psychological treatment that addresses life history, ways of thinking, patterns of behavior, and coping mechanisms. CBT places an emphasis on the therapist/patient relationship, helping individuals better understand their psychological diagnosis and be actively involved in their treatment. For some conditions, CBT in combination with medical therapy can be more effective than treatment alone. 

Lavender oil

Silexan is a lavender oil preparation available in 80 mg capsules. Multiple clinical trials have shown Silexan to be superior to placebo and have therapeutic effects comparable to traditional medical treatments when used to treat anxiety disorders and symptoms typically associated with anxiety such as impaired sleep, body pains, depression, and decreased quality of life. 

Melatonin 

Melatonin supplements are considered safe and clinically meaningful alternatives to traditional sleep aids that can be used in adults as well as children. Unlike more traditional options, melatonin has been shown to synchronize circadian rhythms and improve the onset, duration, and quality of sleep. 

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Valerian

Valerian is a tall, flowering plant native to Europe and Asia sold as a dietary supplement in the United States. Several studies have indicated that processed roots or stems of the valerian plant might reduce the amount of time that it takes to fall asleep and may improve the quality of sleep, although further research is needed. The exact mechanism by which this occurs is unknown, but it is likely that multiple components of the plant act synergistically. 

How to switch to an Ativan alternative

Benzodiazepines are associated with significant withdrawal symptoms. It is important to note that long-term use of benzodiazepines generates concern for possible unwanted effects including memory problems, cognitive impairment, emotional blunting, depression, worsening anxiety, and dependence. 

1. Talk to your doctor

Before discontinuing any medication, it is important to discuss reasons for changing medications as well as the risks and benefits with your healthcare provider. Many individuals have expressed a lifted mood with other classes of medications. There are other individuals for whom discontinuing this medication would be unsafe. If you and your healthcare provider decide alternatives to Ativan may be better options, it is important to follow medical advice during the transition. 

2. Identify and put in place a strong emotional support system

Transitioning or discontinuing any medication can be stressful. Individuals who have a strong support system of family members or friends generally do better at managing the transition and the potential for withdrawal symptoms.

3. Keep a positive mindset

Many people have fear or anxiety about changing medications. Being informed about your choices improves confidence and success with transitions. It is also important to be patient, as a successful transition and healing may take time.

4. Taper Ativan to avoid side effects

Ativan may need to be tapered (the dose slowly reduced over time) and bridged (using another medication to avoid any potential adverse effects). Abrupt discontinuation can cause convulsions, psychotic reactions, and extreme acute anxiety. Tapering helps to achieve a slow and controlled decline in blood concentration so the brain can adjust to a new state. Sudden withdrawal leaves the brain in a state of GABA underactivity, resulting in hyperexcitability of the nervous system. Ativan is considered an intermediate-acting benzo. Bridging it with a long-acting benzo such as diazepam may aid in the body adjusting to a new medication regimen. 

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5. Follow your withdrawal schedule 

If a withdrawal schedule is used, with timed reductions in dosages, it is very important to follow the schedule exactly as it is written. It is also important to not go backward on the schedule. If life circumstances do not permit advancing a stage (reducing the dose), do not go back to higher doses, just stay at the stage you are on until it is safe to go forward.

6. Avoid substance use

Do not use alcohol or opioids when attempting to discontinue this medication or use an alternative medication. Substances with abuse potential can increase the likelihood of withdrawal symptoms and transition failure.