Key takeaways
Lexapro, Xanax, buspirone, Seroquel, and hydroxyzine are among the alternatives to Ativan for the treatment of anxiety disorders and insomnia.
Ativan contains lorazepam and works by enhancing the effects of GABA in the brain. It can lead to dependence and, if discontinued suddenly, can lead to withdrawal symptoms.
Non-prescription alternatives for reducing anxiety and aiding sleep include cognitive behavioral therapy, music interventions, lavender oil, melatonin, and valerian.
Switching from Ativan to an alternative requires consultation with a healthcare provider, a strong emotional support system, and possibly tapering the dose to avoid withdrawal symptoms.
Ativan is a brand-name prescription medication used for the short-term management of generalized anxiety disorder, panic disorder, other anxiety disorders and phobias, insomnia, or as an immediate emergency treatment for status epilepticus, nausea and vomiting, serotonin syndrome, and alcohol withdrawal. Lorazepam, the active ingredient in Ativan, belongs to a class of drugs called benzodiazepines (benzos) that work by enhancing the effects of gamma-aminobutyric acid (GABA). This neurotransmitter slows down nerve activity in the brain and causes drowsiness. Benzos are controlled substances, and it is important to note that benzodiazepines can induce dependence with subsequent rebound and withdrawal symptoms if they are suddenly discontinued. Furthermore, since Ativan has a half-life of twelve hours, prolonged fatigue and neuropsychological dysfunction are potential side effects. For these reasons, alternatives to Ativan are frequently sought and recommended.
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What can I take in place of Ativan?
When considering alternatives to Ativan, important factors to consider include:
- What specific condition is Ativan being used to treat or augment
- Important patient characteristics including other mental health concerns such as depression or bipolar disorder
- Whether the medication is intended to be used in an emergency, inpatient, or at-home setting
- Potential for abuse and patient sensitivity to the class of medication, which may include a history of drug misuse or abuse, alcohol dependence, or history of placement in treatment programs
- The use of other prescription drugs or over-the-counter medications that may result in harmful drug interactions
- Age, with special considerations for younger and older adults
Depending on the reason Ativan is being prescribed, several classes of medications could be used as alternatives to Ativan, including:
- Other benzodiazepines: Klonopin (clonazepam), Valium (diazepam), Xanax (alprazolam), midazolam, Halcion (triazolam)
- Atypical antidepressants: Remeron (mirtazapine)
- Atypical antipsychotics: Seroquel (quetiapine), Zyprexa (olanzapine)
- Selective serotonin reuptake inhibitors (SSRIs): Zoloft (sertraline), Prozac (fluoxetine), Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine)
- Anti-anxiety medications: Buspirone
- Antihistamines: Vistaril (hydroxyzine), Benadryl (diphenhydramine)
- Anticonvulsants: Neurontin (gabapentin), Lyrica (pregabalin)
Compare Ativan alternatives | ||||
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Drug name | Uses | Side Effect Examples | Dosage | Get Coupon |
Ativan (lorazepam) | Anxiety, insomnia, seizures | Drowsiness, dizziness, respiratory depression, dependency | 2-6 mg/day | Ativan coupons |
Klonopin (clonazepam) | Anxiety, panic disorder, seizures | 0.5-4 mg/day | Klonopin coupons | |
Valium (diazepam) | Anxiety, procedural sedation, alcohol withdrawal | 2-20 mg/day | Valium coupons | |
Xanax (alprazolam) | Generalized anxiety disorder, panic disorder | 0.75-4 mg/day | Xanax coupons | |
Restoril (temazepam) | Insomnia | 7.5-30 mg/day | Restoril coupons | |
Buspirone | Anxiety | Serotonin syndrome, headache, fatigue | 15-60 mg/day | Buspirone coupons |
Zoloft (sertraline) | Panic disorder, anxiety, depression | Suicidality, sexual dysfunction, sleepiness | 25-200 mg/day | Zoloft coupons |
Paxil (paroxetine) | Panic disorder, anxiety, depression | 20-50 mg/day | Paxil coupons | |
Celexa (citalopram) | Panic disorder, anxiety, depression | 20-40 mg/day | Celexa coupons | |
Lexapro (escitalopram) | Panic disorder, anxiety, depression | 10-20 mg/day | Lexapro coupons | |
Prozac (fluoxetine) | Panic disorder, anxiety, depression | 20-80 mg/day | Prozac coupons | |
Hydroxyzine | Anxiety, itching, insomnia, sedation, nausea | Impaired coordination, sedation, dry mouth | 50-400 mg/day | Hydroxyzine coupons |
Ambien (zolpidem) | Insomnia | Hallucination, complex sleep-related behavior, dependency | 5-10 mg/day | Ambien coupons |
Seroquel (quetiapine) | Generalized anxiety disorder | Neuroleptic malignant syndrome, suicidality, somnolence | 25-300 mg/day | Seroquel coupons |
Silenor (doxepin) | Insomnia | Psychiatric disturbances, suicidality, complex sleep-related behavior | 3-6 mg/day | Silenor coupons |
Belsomra (suvorexant) | Insomnia | Hallucination, complex sleep-related behavior, dependency | 10-20 mg/day | Belsomra coupons |
Top 5 Ativan alternatives
1. Lexapro
Lexapro is a member of the SSRI class of medications. This drug class is often considered first-line for anxiety and panic disorders. Compared to Ativan and other benzodiazepines, SSRIs like Lexapro are not designated as controlled substances by the Drug Enforcement Administration (DEA) because they do not have the potential for abuse. In addition, they have a more favorable side effect profile with less risk of drowsiness and dizziness. SSRIs have a longer duration of action, which makes them a good choice for long-term management, but it takes several weeks to reach full therapeutic effect. While some SSRIs and other listed alternatives are used off-label for anxiety, Lexapro has Food and Drug Administration (FDA) approval for this indication.
RELATED: Lexapro vs. Xanax
2. Xanax
Xanax (alprazolam) is another benzodiazepine used in the treatment of anxiety disorders.
While both are effective, based on a faster onset of action, Xanax is generally used more often in the treatment of panic attacks and panic disorders with associated fear disorders. Sometimes, the prescribing preference between the two will be determined by the provider’s experience and the individual’s response to treatment with one over the other.
3. Buspirone
Buspirone is an anxiolytic medication originally developed as an antipsychotic. While it was found to be fairly ineffective for that purpose, it is useful in reducing the symptoms of anxiety. Buspirone has recently become a more popular choice in the management of anxiety as it is not habit-forming. There is no risk of physical dependence or withdrawal associated with its use due to its lack of effects on the GABA receptors.
Unlike Ativan, this medication is typically not used in acute settings, as the clinical effect usually takes two to four weeks to set in. Buspirone bioavailability is increased with food, and individuals may be advised to take this medication with or without food, depending on the desired effect.
4. Seroquel
Quetiapine is sometimes used as an alternative to Ativan when anxiety is not responding to treatment with first-line medications. Seroquel is an antipsychotic medication used in the management of schizophrenia, bipolar disorder, treatment-resistant anxiety, and acute episodes of anxiety and delirium in an inpatient setting.
There are some notable differences in side effect profile and patient selection when considering Seroquel use. Seroquel is associated with increased mortality in older patients with dementia-related psychosis and an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults taking antidepressants.
RELATED: Seroquel dosage
5. Hydroxyzine
Hydroxyzine binds and stabilizes the H-1 histamine receptor, a major receptor involved in the allergic response. Its action on this receptor renders hydroxyzine useful for itching and sedating, and therefore, it can sometimes be used for sleep or anxiety. Hydroxyzine has a fast onset of action like Ativan, but it is not labeled as having a potential for abuse.
Natural alternatives to Ativan
There are several alternatives to Ativan that are not prescription medications. Many of them have demonstrated the ability to reduce periprocedural anxiety as well as anxiety from everyday stressors and to help with sleep.
Music
There is a growing body of evidence demonstrating that perioperative music-based interventions are effective in reducing anxiety, pain perception, sedative intake, and postoperative pain. Most of the evidence suggests that the music selected by the researcher is most effective, as evidence-based “relaxing” parameters such as tempo, rhythm, and melody can be better accounted for.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a well-regarded non-pharmacologic alternative for anxiety. It is a form of psychological treatment that addresses life history, ways of thinking, patterns of behavior, and coping mechanisms. CBT emphasizes the therapist/patient relationship, helping individuals better understand their psychological diagnosis and be actively involved in their treatment. For some conditions, CBT in combination with medical therapy can be more effective than pharmacologic treatment alone.
Lavender oil
Silexan is a lavender oil preparation available in 80 mg capsules. Multiple clinical trials have shown Silexan to be superior to placebo and have therapeutic effects comparable to lorazepam or paroxetine when used to treat anxiety disorders and symptoms typically associated with anxiety, such as impaired sleep, body pains, depression, and decreased quality of life.
Melatonin
Melatonin supplements are considered safe and clinically meaningful alternatives to traditional sleep aids for adults and children. Unlike more traditional options, melatonin has been shown to synchronize circadian rhythms and improve the onset, duration, and quality of sleep.
RELATED: Melatonin dosage
Valerian
Valerian is a tall, flowering plant native to Europe and Asia sold as a dietary supplement in the United States. Several studies have indicated that processed roots or stems of the valerian plant might reduce the time it takes to fall asleep and may improve sleep quality, although further research is needed. The exact mechanism by which this occurs is unknown, but likely, multiple components of the plant act synergistically.
How to switch to an Ativan alternative
Benzodiazepines are associated with significant withdrawal symptoms. It is important to note that long-term use of benzodiazepines generates concern for possible unwanted effects, including memory problems, cognitive impairment, emotional blunting, depression, worsening anxiety, and dependence.
1. Talk to your doctor
Before discontinuing any medication, it is important to discuss the reasons for changing medications, as well as the risks and benefits, with your healthcare provider. Many individuals have expressed a lifted mood with other classes of medications. There are other individuals for whom discontinuing this medication would be unsafe. If you and your healthcare provider decide alternatives to Ativan may be better options, following medical advice during the transition is important.
2. Identify and put in place a strong emotional support system
Transitioning or discontinuing any medication can be stressful. Individuals who have a strong support system of family members or friends generally do better at managing the transition and the potential for withdrawal symptoms.
3. Keep a positive mindset
Many people have fear or anxiety about changing medications. Being informed about your choices improves confidence and success with transitions. It is also important to be patient, as a successful transition and healing may take time.
4. Taper Ativan to avoid side effects
Ativan may need to be tapered (the dose slowly reduced over time) and bridged (using another medication to avoid any potential adverse effects). Abrupt discontinuation can cause convulsions, psychotic reactions, and extreme acute anxiety. Tapering helps to achieve a slow and controlled decline in blood concentration so the brain can adjust to a new state. Sudden withdrawal leaves the brain in a state of GABA underactivity, resulting in hyperexcitability of the nervous system. Ativan is considered an intermediate-acting benzo. Bridging it with a long-acting benzo such as diazepam may aid in the body adjusting to a new medication regimen.
RELATED: Ativan dosages
5. Follow your withdrawal schedule
If a withdrawal schedule is used, with timed dosage reductions, it is very important to follow the schedule exactly as it is written. It is also important not to go backward on the schedule. If life circumstances do not permit advancing a stage (reducing the dose), do not go back to higher doses; just stay at the stage you are on until it is safe to go forward.
6. Avoid substance use
Do not use alcohol or opioids when attempting to discontinue this medication or use an alternative medication. Substances with abuse potential can increase the likelihood of adverse effects, withdrawal symptoms, and transition failure.
- Clinical practice guidelines for the management of generalized anxiety disorder (GAD) and panic disorder (PD), Indian Journal of Psychiatry (2017)
- Using music interventions in perioperative care, Southern Medical Journal (2012)
- A multi-center, double-blind, randomized study of the lavender oil preparation Silexan in comparison to lorazepam for generalized anxiety disorder, Phytomedicine (2010)
- Silexan in anxiety disorders: Clinical data and pharmacological background, World Journal of Biological Psychiatry (2018)
- Effect of melatonin supplementation on sleep quality: A systematic review and meta-analysis of randomized controlled trials, Journal of Neurology (2022)
- Valerian fact sheet for health professionals, NIH Office of Dietary Supplements (2013)