Lorazepam

Is lorazepam safe?

Taken for a few days or weeks at a modest dose, by someone who does not drink heavily or take opioids, lorazepam is reasonably safe and often very helpful. An overdose of lorazepam alone rarely kills a healthy adult. The risks grow with time and with company: dependence builds with daily use, withdrawal can be dangerous, and mixed with opioids or alcohol it can stop breathing. We score it 41, a point above alprazolam (Xanax) and well above opioids such as oxycodone.

Sold as Ativan since 1977, lorazepam is used for anxiety, for sleeplessness caused by anxiety, before operations, for alcohol withdrawal and, by injection, to stop prolonged seizures.

How it differs from Xanax

Both are Schedule IVControlled substanceA medicine or drug that the law restricts because it can be misused or cause dependence. Countries group them into schedules or classes.More in the glossary benzodiazepines with the same boxed warningBoxed warningThe strongest safety warning the US FDA puts on a medicine's label, printed inside a black border at the top.More in the glossary, but they behave a little differently:

	Lorazepam	Alprazolam
Peak level	About 2 hours	About 1 to 2 hours
Half-life	About 12 hours	About 11 hours (range 6 to 27)
Broken down by	Glucuronidation (not CYP enzymes)	CYP3A4CYP450 enzymesA family of liver enzymes that break down many medicines. When another drug or supplement speeds them up or slows them down, drug levels change.More in the glossary
Forms	Tablets, injection, extended-release capsules	Tablets, extended-release tablets

Because lorazepam avoids the CYP3A4 enzyme, antifungals, antibiotics and HIV drugs that sharply raise alprazolam levels have little effect on it. That is why its interactions score is slightly better. Valproate and probenecid do slow its clearance, and the label calls for cutting the dose by about half with either. Clozapine plus lorazepam has caused marked sedation, delirium and respiratory arrest.

Doses: the US and UK labels differ

	US label	UK (MHRA)
Anxiety	Usually 2 to 6 mg a day in divided doses; range 1 to 10 mg	Maximum 4 mg a day
Insomnia from anxiety	2 to 4 mg at bedtime	Maximum 2 mg a day
Older or frail adults	Start at 1 to 2 mg a day	Lower doses
Duration	Use beyond 4 months not studied	2 to 4 weeks, including tapering

The MHRA cut the UK maximum in 2007, noting that 10 mg of lorazepam equals about 100 mg of diazepam. The US label still allows up to 10 mg. The safe dose is the one your prescriber sets, and the longer you take it, the more a later taper matters.

Dependence and withdrawal

In 2020 the FDA extended the benzodiazepine boxed warningBoxed warningThe strongest safety warning the US FDA puts on a medicine's label, printed inside a black border at the top.More in the glossary to cover abuse, misuse, addiction, physical dependenceDrug dependenceThe body's adaptation to a drug taken regularly, so that stopping it suddenly causes withdrawal symptoms. It is not the same as addiction.More in the glossary and withdrawal. The label says the risk of dependence rises with higher doses and longer use, and that stopping abruptly or cutting the dose quickly can cause withdrawal reactions that can be life-threatening, including seizures. Some people develop protracted withdrawal, with symptoms lasting from weeks to more than 12 months.

The label asks for a gradual, patient-specific taper and says to pause or step back if withdrawal symptoms appear. In January 2026 the MHRA announced stronger UK warnings on packs and leaflets for benzodiazepines, gabapentinoids and Z-drugs, and asked prescribers to agree a plan for reducing or stopping treatment before it starts.

With opioids or alcohol

Benzodiazepines and opioids suppress breathing in different ways, and together the effect is much worse than either alone. A CDC study of 23 US states found that 92.7% of benzodiazepine overdose deaths in the first half of 2020 also involved an opioid, mostly illicit fentanyl, and deaths from illicit benzodiazepines rose more than fivefold from the year before. Tablets sold as lorazepam outside pharmacies may be counterfeit.

Signs of a dangerous overdose include extreme sleepiness, confusion, slurred speech, poor coordination, slow breathing and being hard to wake. Call emergency services. If opioids might be involved, give naloxone: it will not reverse lorazepam but can reverse the opioid part. US Poison Help is 1-800-222-1222.

Who should be careful

Talk to your doctor or pharmacist before taking lorazepam if you take an opioid, zolpidem or another sleeping pill, gabapentin or pregabalin, or drink regularly; are over 65, because sedation and unsteadiness increase with age and falls can break bones; have sleep apnoea or lung disease; have depression or a history of substance use; or are pregnant. Do not drive until you know how it affects you. A low score is not a reason to stop a prescribed medicine on your own; withdrawal is one of the main risks.

How we scored it

Track record (90) is strong after almost 50 years of use. Dependence (15) and regulatory warnings (20) sit in the lowest band because of the 2020 boxed warningBoxed warningThe strongest safety warning the US FDA puts on a medicine's label, printed inside a black border at the top.More in the glossary. Interactions (30) score a little better than alprazolam's because lorazepam avoids the CYP enzymes, but opioids and alcohol remain dangerous. Overdose marginOverdose marginHow far a normal dose is from a harmful one. A wide margin means an accidental extra dose is unlikely to cause serious harm.More in the glossary (40) and serious side effects (50) reflect a drug that is seldom fatal alone but often harmful in combination.