Mixing Ativan and Alcohol

White ativan pills spilling out of a prescription bottle

Ativan — the brand name for the medication lorazepam — is a sedative-hypnotic drug from the drug class known as benzodiazepines. Ativan is approved by the FDA for the short-term symptomatic management of anxiety disorders and anxiety related to depression. Ativan is also sometimes used off-label without FDA approval as a sedative for insomnia and for preventing seizures in alcohol withdrawal syndrome.

Although Ativan is a medically useful medication, it has a high abuse potential. Ativan has dangerous interactions with other drugs of abuse, especially opioids and alcohol. The dangerous interactions between Ativan and alcohol go well beyond the combined effects of their use; both have dangerous withdrawal effects that can be worsened when withdrawing from both drugs together.

Data shows that when benzodiazepines are abused, it is almost always in the setting of polysubstance abuse (using more than one substance), and 24.7% of these people mix alcohol with benzodiazepines.

Data from the CDC have shown that mixing alcohol and benzodiazepines is responsible for more than a quarter of ER hospital visits for benzodiazepine abuse, and one-fifth of benzodiazepine-related deaths. 

How Ativan and Alcohol Interact

Alcohol inhibits the body’s ability to metabolize Ativan so that Ativan accumulates in the body and circulating levels of the drug increase to well above those present when taking Ativan on its own. When the alcohol intake is more than low-level (a drink or two), this inhibition is total.

Ativan and alcohol both act on the same brain chemicals — the neurotransmitters known as GABA and glutamate — and slow brain functions. Therefore, mixing Ativan and alcohol results in slowed cognition, impaired reaction times, slowed speech and movements and reduced level of consciousness.

A detailed study of the effects of combining alcohol and benzodiazepines on driving showed that combining the two greatly lowers the amount of alcohol needed to be consumed to reach an unsafe blood alcohol concentration (BAC). For example, combining a benzodiazepine with alcohol at a BAC of only 0.03% results in a level of impairment equivalent to a BAC of 0.08%, which is at or above the legal impaired driving limit in most areas.

Side Effects of Mixing Ativan and Alcohol

The main Ativan side effects are due to its sedative-hypnotic effects and include:

  • Grogginess and drowsiness
  • Dizziness
  • Confusion and impaired cognition
  • Rebound insomnia after the drug wears off
  • Poor coordination and balance
  • Blurred vision
  • Impaired memory and short-term amnesia
  • Possible birth defects in pregnancy

The side effects of Ativan are magnified when it is used with alcohol and are often more prominent in the elderly. The side effects of Ativan and alcohol are very similar due to their similar mechanism of action on the brain, making their combination dangerous.

Can Mixing Ativan and Alcohol Kill You?

Ativan overdose on its own is not usually lethal, but this changes when Ativan is mixed with alcohol. When people die of acute overdose from alcohol, it is usually from respiratory suppression – the drug simply stops the brain from telling the body to breathe, and the individual dies. Ativan and other benzodiazepines increase the respiratory suppression effects of other drugs so that people can die from a much lower dose of alcohol.

The CDC has published data from 2010 looking at emergency room (ER) visits and deaths from mixing benzodiazepines and alcohol. In 2010 in the 13 states were data was collected, there were:

  • 408,021 emergency room visits related to benzodiazepine abuse, with 111,165 (27.2%) of these involving alcohol 
  • The percentage of ER visits that involved benzodiazepines and alcohol was highest among persons aged 45–54 years (31.1%)
  • ER visits involving benzodiazepines and alcohol were more common among men than women
  • Among deaths from benzodiazepines, people aged 60 years and up had the highest percentage of alcohol involvement (27.7%)
  • Ativan was the most common benzodiazepine involved in the ER visits for benzodiazepine and alcohol mixing (34.6%)
  • Ativan was the most common benzodiazepine involved in deaths for benzodiazepine and alcohol mixing (24.4%)

These data reflect the fact that the additive effects of central nervous system (CNS) depression of Ativan and alcohol presents a significant risk for harm, overdose and Ativan and alcohol death. If other CNS depressant drugs are included in the mix — especially opioids — the risk is further elevated.

Data has also demonstrated that the combination of benzodiazepines and alcohol have detrimental effects on driving safety than just alcohol alone. The mixture of benzodiazepines and alcohol is involved in 51.7–64.3% of motor vehicle accidents, DWI convictions, and other driving offenses.

Overdosing on Ativan and Alcohol

The combination of alcohol and Ativan produces an additive effect on brain function. The dose required to produce an overdose from either drug is lowered when Ativan and alcohol are used together. If another CNS depressant drug is added to the mix, this effect is further magnified. This is especially the case when opioids are used with Ativan and alcohol.

Overdosing on Ativan and alcohol can have harmful consequences. The loss of coordination and slowed movements can cause falls and other accidents. The sedation can be so powerful as to cause household accidents, such as falling asleep with the stove on, falling asleep while smoking or sleeping through a fire alarm. If you suspect that you or a loved one is overdosing on Ativan, alcohol or any other substance, it’s crucial that you call 911 as soon as possible. 

Ativan and Alcohol Withdrawal

Ativan and alcohol both produce significant withdrawal effects. Alcohol is one of the most dangerous drugs of abuse to withdraw from. Ativan also carries a significant risk of adverse withdrawal effects. The effects of both drugs are magnified when used together, making adverse effects more likely.

Because of their mutual effect on slowing brain function, both alcohol and Ativan carry a significant risk of brain hyperexcitability when these drugs are stopped or reduced after regular use. The most significant result can be seizures, which can occasionally be fatal.

Getting Help for Ativan and Alcohol Addiction

Getting alcohol addiction help and Ativan addiction treatment is important for successful recovery. Not using these drugs without addressing the underlying causes and effects of the substance use can be difficult, if not impossible. This is the function of addiction treatment programs.

Both alcohol and Ativan have significant withdrawal syndromes that are not only difficult to endure but also carry the potential for harm. Proper medical supervision when withdrawing from these drugs is a wise measure. Supervised detox is even more crucial when the drugs have been used together. Medical detox programs provide the safest and most comfortable way to withdraw and detoxify from these substances and transition into treatment.

The Recovery Village Ridgefield provides the expertise and specialized care for the best opportunity for successful long-term recovery and a return to good health and function. If you have concerns about Ativan and alcohol or any other substance use in yourself or a loved one, please feel free to contact us for a confidential discussion with one of our staff.

Centers for Disease Control and Prevention (CDC). “Alcohol involvement in opioid pain reliever and benzodiazepine drug abuse–related emergency department visits and drug-related deaths — United States, 2010.” Morbidity and Mortality Weekly Report (MMWR), October 10, 2014. Accessed August 19, 2019. 

Food and Drug Administration (FDA). “Ativan (lorazepam).” September 2016. Accessed August 19, 2019.

Maxwell, Hillary, et al. “The additive effects of alcohol and benzodiazepines on driving.” Canadian Journal of Public Health, September/October 2010. Accessed August 19, 2019.

Schmitz, Allison. “Benzodiazepine use, misuse, and abuse: A review.” Mental Health Clinician, May 2016. Accessed August 19, 2019.

Tanaka, Einosuke. “Toxicological interactions between alcohol and benzodiazepines.” Journal of Toxicology: Clinical Toxicology, April 29, 2002. Accessed August 19, 2019.