Ativan and Alcohol – Dangers of Mixing The Two Substances

How Does Alcohol Work?

When alcohol is consumed, it passes from the digestive tract into the bloodstream, where it is transported throughout the body, including to the brain.¹

Once the alcohol enters the brain, it affects a number of different neurotransmitters—specifically, inhibitory (GABA) and excitatory (glutamate) neurotransmitters. It binds to GABA receptors and enhances the activity of that neurotransmitter, while reducing glutamate’s effect on NMDA receptors. In sum, it increases the effect of inhibitory neurotransmitters and reduces the effect of excitatory neurotransmitters.^1,2

Alcohol use is also associated with increased dopamine activity in the brain. This increase in dopamine is accompanied by a sense of pleasure and reward, which can reinforce drinking behavior.¹

How Does Ativan (Lorazepam) Work?

Ativan (lorazepam) is a benzodiazepine. This class of drugs includes (among others):

• Valium (diazepam).
• Xanax (alprazolam).
• Librium (chlordiazepoxide).
• Klonopin (clonazepam).
• Restoril (temazepam).
• Halcion (triazolam).

Like other benzodiazepines (and alcohol), Ativan works by increasing the effect of the inhibitory neurotransmitter GABA. It binds to a distinct site on GABA receptors throughout the central nervous system, which results in increased GABA-mediated receptor activation, heightened inhibition of nerve signals, and decreased nervous excitation in the brain.³

Ativan is prescribed for the management of anxiety and, less frequently, for the short-term treatment of insomnia. It also may be used to treat seizures or administered as an IV sedative before anesthesia. It is usually taken as an oral tablet, but it can also be delivered via injection.^4,5

What Are the Effects of Mixing Ativan and Alcohol?

Ativan is a Schedule IV controlled substance, and its use can lead to abuse and dependence. Though benzodiazepines such as Ativan can be abused on their own, they are often abused with other substances, such as opioids and alcohol. In studies, 3% to 41% of alcoholics state that they abuse benzodiazepines to heighten the effects of alcohol or lessen the effects of withdrawal.^4,6

Because Ativan and alcohol have similar effects on the brain and body, ingesting both within the same timeframe can heighten those effects, sometimes with deadly consequences. They both inhibit the central nervous system and can lower heart rate and breathing. The effects of the two combined can be greater than if they were consumed alone. The combination can cause severe drowsiness, breathing problems, coma, and death.^4,7

The Centers for Disease Control and Prevention found that in 2010, alcohol was involved in 27.2% of benzodiazepine-related emergency department visits and in 21.4% of benzodiazepine-related deaths.⁸

Benzodiazepines can also be prescribed to manage alcohol withdrawal.⁵ People undergoing such withdrawal management may be at particular risk of overdose if they resume drinking.

How Is an Overdose of Ativan and Alcohol Treated?

An overdose requires immediate medical attention. Call 911 if you suspect a potential overdose in yourself or someone nearby.

Treatment for an Ativan overdose includes monitoring of vital signs as well as airway maintenance and breathing support, if needed. Norepinephrine may be administered for blood pressure support, in the event of severe hypotension. Emergency room staff may perform gastric lavage (stomach pumping) or give the person activated charcoal, which can prevent further absorption of any drug already taken orally.⁴

Flumazenil, a benzodiazepine receptor antagonist, can reverse the effects of an Ativan overdose. It may be used as part of overdose treatment. However, there is a risk of seizures, especially in people who have been taking Ativan long term.⁴

Treatment for an alcohol overdose includes:¹⁰

• Administering fluids with vitamins and glucose to prevent further dehydration, correct any alcoholism-associated nutritional deficits, and maintain blood sugar levels.
• Endotracheal tube placement and mechanical ventilation, in the event of severe respiratory depression.
• Flushing the stomach with a nasogastric tube.
• Hemodialysis, if indicated, in cases of severely elevated blood alcohol levels.

The best way to avoid overdose is to stay away from alcohol when taking Ativan. When taken together, the effects of both substances are exacerbated and can be fatal.

If you are abusing Ativan, alcohol or other drugs, seek help today. Addiction recovery programs can help you safely detox and set you on the path to recovery.

Sources

1. McGill University. How Drugs Affect Neurotransmitters: Alcohol.
2. Victoria State Government. (2012). Alcohol and the Brain.
3. National Cancer Institute. Lorazepam.
4. Food and Drug Administration. (2016). Ativan C-IV (lorazepam).
5. National Alliance on Mental Illness. (2019). Lorazepam (Ativan).
6. Longo, L., and Johnson, B. (2000). Addiction: Part I. Benzodiazepines—Side Effects, Abuse Risk and Alternatives. American Family Physician, 61(7), 2121-2128.
7. Moyer, M. (2012). Deadly Duo: Mixing Alcohol and Prescription Drugs Can Result in Addiction or Accidental Death. Scientific American.
8. Centers for Disease Control and Prevention. (2014). Alcohol Involvement in Opioid Pain Reliever and Benzodiazepine Drug Abuse-Related Emergency Department Visits and Drug-Related Deaths—United States, 2010.
9. Pennsylvania Department of Drug and Alcohol Programs. Alcohol poisoning or overdose.
10. Cleveland Clinic. (2017). Alcohol Poisoning: Management and Treatment.