Lorazepam (brand name Ativan) is a benzodiazepine medication prescribed for anxiety, insomnia, and certain types of seizures. The drug slows down activity in the central nervous system (CNS), producing a calming effect beneficial for short-term symptom management. Lorazepam is a Schedule IV controlled substance in the United States, meaning it has accepted medical use but carries a risk for dependence and abuse. Taking excessive amounts or combining it with other substances can lead to severe and potentially lethal complications, including overdose.
How Lorazepam Affects Vital Functions
The danger of a Lorazepam overdose stems from its impact on the central nervous system (CNS), which governs vital functions. Lorazepam enhances the effects of gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the brain. By binding to the GABA-A receptor complex, the drug amplifies GABA’s natural calming effect, decreasing neuronal excitability.
When the dose is too high, this inhibitory action causes excessive CNS depression. This suppresses the part of the brain controlling automatic functions, such as breathing. This condition, known as respiratory depression, causes breathing to slow or become shallow, leading to insufficient oxygen levels. A fatal outcome occurs when the respiratory drive is so severely suppressed that breathing stops entirely, resulting in hypoxia, coma, and death.
Recognizing the Stages of Overdose
Signs of a Lorazepam overdose range from mild intoxication to a life-threatening medical emergency. Severity progresses as the drug concentration in the body rises, making early recognition important for timely medical intervention.
Mild to Moderate Signs
An overdose often begins with noticeable changes in mental state and physical coordination. Extreme drowsiness and lethargy are common initial indicators. The person may also experience confusion, difficulty thinking clearly, or disorientation. Physical symptoms include slurred speech and a lack of coordination, medically termed ataxia, which causes stumbling or an unsteady gait.
Severe and Life-Threatening Signs
As the overdose deepens, signs become more severe and require immediate emergency care. The most dangerous symptom is slow or shallow breathing (respiratory depression), which is the main cause of death in benzodiazepine overdoses. The person may develop a bluish tinge to their lips or fingernails (cyanosis), indicating a severe lack of oxygen. In the most severe cases, the person can become unresponsive, lose consciousness, and progress to a coma. Dangerously low blood pressure (hypotension) and a weak pulse are also associated with a critical overdose, as the cardiovascular system struggles under CNS depression.
Factors That Increase Overdose Risk
While an overdose on Lorazepam alone is possible, the risk of severe toxicity and death increases significantly when other substances or pre-existing conditions are involved. The greatest risk factor is combining Lorazepam with other central nervous system depressants. This polysubstance use, especially with alcohol, opioids, or sedating medications like sleeping pills, amplifies the depressant effects on the respiratory system. Alcohol and opioids slow down breathing, and combining them with Lorazepam creates a compounding effect that overwhelms the body’s ability to regulate respiration. Concurrent use of benzodiazepines and opioids is a documented cause of sedation, coma, and death.
Risk Factors
Other factors that increase risk include:
Pre-existing respiratory conditions, such as Chronic Obstructive Pulmonary Disease (COPD) or sleep apnea, which compromise breathing capacity.
Older patients are also at higher risk because their bodies metabolize drugs slower, allowing the medication to remain active at high concentrations for longer periods.
Resuming a previous high dose after a period of abstinence, as tolerance may have decreased.
Emergency Response Protocol
If a Lorazepam overdose is suspected, contact emergency medical services by calling 911. Time is a factor in preventing permanent injury and death from respiratory failure.
While waiting for help to arrive, it is important to gather information to relay to the emergency responders. This information should include the name of the drug taken, the amount ingested, and the approximate time the person took the dose. It is also important to specify if any other substances, particularly alcohol or opioids, were consumed.
The priority is to keep the person safe and monitor their breathing. If the person is unconscious, they should be placed in the recovery position to prevent them from choking on vomit. Under no circumstances should attempts be made to induce vomiting.
Medical interventions at the hospital will focus on supportive care, such as maintaining a clear airway and providing mechanical ventilation if breathing is severely impaired. A benzodiazepine reversal agent called flumazenil may be considered to counteract the effects of Lorazepam, though its use is often limited due to the risk of triggering seizures, especially in patients who use the drug regularly. In cases where opioids were also involved, Naloxone will be administered by emergency personnel to reverse the opioid’s effects.