How Long Does Ativan (Lorazepam) Stay in Your System?

Ativan (lorazepam) is a benzodiazepine sedative used to treat anxiety disorders. It depresses the central nervous system and, as a result, has risks when combined with other depressants or alcohol—including the possibility of fatal respiratory depression. This makes it important to understand how long lorazepam stays in your system if you've been prescribed this drug.

How Long Does It Take to Feel Ativan's Effects?

Ativan is a benzodiazepine, which means that it has sedative and hypnotic effects. The drug works by enhancing the effects of a natural chemical called GABA, which depresses the central nervous system (CNS) and leads to a calming or relaxing effect. 

Ativan can be given as a tablet, liquid concentrate, or by injection. The different routes have different timetables for when they take effect. With tablets or liquids, the peak effects are seen in two hours. An injection of Ativan begins to have effects within 15 minutes and these effects generally continue for six to eight hours.

How Long Does Ativan Last?

While it is a fast-acting drug, Ativan has a relatively long half-life. A medication's half-life refers to the amount of time its concentration in the body reduces by half which, in the case of Ativan, is every 12 hours.

This drug is metabolized primarily by the liver. It is then eliminated by the kidneys, through the urine. In all, Ativan may be present in the body up to nine days past the last use.

Blood

Ativan can be detected by blood tests six hours after ingestion. This type of test can also detect the drug for three days after the last use. The detection window may be longer for people who've been taking Ativan at higher doses for three days or more. 

Urine

Ativan is eliminated in the urine for one to six weeks, depending on how much is administered and for how long. Urine screening tests can detect intermediate-acting benzodiazepines such as Ativan up to five days after the last use.

In those who have been taking the drug regularly or at higher doses, this detection window may be longer. If testing looks for the metabolite lorazepam-glucuronide, which is produced as the drug is broken down by the body, older studies suggest that detection may take place up to eight days after the last use.

Hair

As with other substances, Ativan can be detected in hair samples for much longer than with other methods. If given a hair test, this drug can be detected for up to 30 days after use. 

Factors that can influence the level to which drugs are incorporated into or eliminated from one's hair include:

• hair color
• a person's ethnicity
• whether the hair has been treated with bleach, dye, or relaxants
• weather damage

Saliva

While no recent studies could be located in this area, older research suggests that Ativan could be detected in saliva samples up to eight hours after use. However, saliva tests are rarely used to screen for benzodiazepines such as Ativan. 

False Positive Testing

Some medications may result in a false positive urine screen for Ativan. The antidepressant medication Zoloft (sertraline) is one such drug known to cause a false positive for benzodiazepines. Efavirenz, an antiviral drug used to treat HIV, is another.

Factors That Affect Detection Time

There are a number of things that can influence how long Ativan remains in a person's system. While rates usually follow a fairly consistent timeline, some people metabolize and clear the drug more quickly than others.

Biological Factors

Some of the factors that can influence how long Ativan remains in your body include the following.

• Age: Older people tend to clear medications more slowly than younger people. This is because older individuals tend to have slower metabolisms, decreased organ function, lower blood flow, and other health issues that can affect how quickly the drug is processed and excreted.
• Kidney function: Liver impairment does not appear to have much of an impact on Ativan clearance rates; however, kidney problems are associated with prolonged drug half-life.
• Height and weight: Taller people and those at a higher weight typically clear the drug more quickly than individuals who are shorter and/or weigh less.

Dosage and Frequency of Use

Higher doses of Ativan take longer to metabolize. The drug is also detectable for longer periods in individuals who have been taking the drug for a longer period of time.

Use of Other Substances

The concurrent use of other substances can have an impact on how quickly each is processed and excreted from the body. For example, valproate (a mood stabilizer) can reduce lorazepam clearance by 40% when taken at the same time, while certain oral contraceptives can increase lorazepam clearance.

How to Get Ativan Out of Your System

After stopping Ativan use, some people want to speed up how quickly it clears their system. Since the drug is excreted through urine, staying well-hydrated by drinking plenty of fluids may slightly increase its elimination rate.

Important Information to Know About Ativan

Ativan is classified as a Schedule IV drug, which means that it has a lower potential for misuse and a lower risk of dependence than Schedule II and III drugs. But Ativan can still be habit-forming. As a result, it's usually prescribed only for short periods.

With long-term use, you can build a tolerance such that larger doses are needed to achieve the same effect. Stopping Ativan after using it for an extended period can result in withdrawal symptoms such as increased anxiety, sleeplessness, and irritability.

Overdose Risk

An overdose with Ativan is most commonly seen when taken with alcohol or opiate medications like Vicodin (hydrocodone) and OxyContin (oxycodone). This combination can be life-threatening, and it is important that your family or household members know what symptoms to look for so they can get emergency help quickly.

If you suspect that someone has overdosed on Ativan, call 911 immediately. Signs of an Ativan overdose include:

• Confusion
• Poor coordination
• Slow reflexes
• Coma
• Death

Precautions

If you take Ativan with alcohol or other medications that can depress breathing, you risk serious breathing problems, sedation, and coma. To prevent accidental overdose or other complications:

• Do not use alcohol while taking Ativan.
• Do not take any street drugs, as they may contain substances that can depress breathing.
• If you are breastfeeding, be aware that this drug passes through into your milk and may affect your baby.
• If you are pregnant or plan to become pregnant, discuss this with your doctor.
• If you are depressed or have suicidal thoughts, avoid Ativan.
• If you are older, you may experience more effects of Ativan, such as drowsiness.
• Do not smoke cigarettes or use tobacco products, as these can reduce the effects of Ativan.
• If you take or plan to take any opiate or opioid medications, discuss them with your doctor as they can result in a life-threatening reaction with Ativan. These include medications with codeine or hydrocodone (such as for a cough or pain), fentanyl, hydromorphone, Demerol, methadone, morphine, oxycodone, and tramadol.

Getting Help for Stopping Ativan

If you need help stopping Ativan use, start by talking to your physician. Physical dependence can occur, even if you take the drug exactly as prescribed. Quitting Ativan suddenly can be dangerous or even life-threatening due to the increased risk of seizures during the withdrawal process. That's why it's important to be monitored by a medical professional as you go through the withdrawal process.

In most cases, you can detoxify from the drug on an outpatient basis. There are no medications approved to treat Ativan dependence, but the standard approach is to slowly reduce the amount of the drug used over a period of time to prevent severe withdrawal symptoms. Your physician will monitor your progress as you slowly taper off of the drug.

They may also recommend other treatments, such as psychotherapy. Types of psychotherapy that may be used during drug recovery include cognitive-behavioral therapy and dialectical behavioral therapy. If you need help with your treatment, ask your provider to refer you to a psychiatrist or another mental health professional who specializes in addiction recovery.