Lorazepam (brand name “Ativan”) is a benzodiazepine drug that hit the market in 1977 and is commonly prescribed to treat anxiety. Although it is a highly effective treatment option for anxiety when used over a short-term, it is regarded as problematic when taken over an extended duration. Long-term usage of lorazepam is linked to dementia, memory impairment, and dependence.
In addition, the drug is associated with rapid onset of tolerance, abuse, and addiction; benzodiazepines are among the most addictive drugs on the market. That said, when used under the supervision of a medical professional, risks of abuse and addiction can be minimized. Upon ingestion of lorazepam (Ativan) or other benzodiazepines, users report notable increases in physical and psychological relaxation.
The relaxant effect derived from lorazepam is a result of enhancement of GABAergic neurotransmission (specifically at the GABAA receptor) via opening of chloride ion channels. Enhancing GABA is known to depress CNS activation, thereby facilitating a sedative/hypnotic response and reduced anxiety. Due to the multitude of problems stemming from long-term lorazepam usage, many users have decided to discontinue the drug and want to know how long it stays in their system before they are fully detoxified.
How long does Ativan (Lorazepam) stay in your system?
If you’ve fully stopped taking (Ativan) lorazepam, you’re probably concerned with getting it out of your system as quickly as possible. Upon cessation of usage, most people experience an array of Ativan withdrawal symptoms that should be monitored by a medical professional. Abrupt discontinuation of this drug could trigger seizures and/or death; this happens with any agent that elicits potent effects on GABAergic processes.
Some sources suggest that the average half-life for Ativan is an approximate 12 hours. This means that after taking your last dose, it could take 2.75 days for the drug to have been fully eliminated from your system. Other sources suggest that a more accurate half-life for the drug may be slightly longer at 15.7 hours. Assuming the elimination half-life were 15.7 hours, it would take nearly 3.59 days to fully excrete the drug from your system.
It is also important to understand that the active metabolite of lorazepam glucuronide has a longer half life of 18 hours. To fully eliminate this metabolite from your system will take longer than the drug itself. Lorazepam glucuronide will remain in your system and can be detected in your urine for up to 4.13 days post-ingestion.
Factors that may influence how long Ativan (Lorazepam) stays in your system
It is important to realize that there are some individual factors that may have a slight/subtle influence on how quickly Ativan is cleared from your system. These factors help explain why certain individuals are able to clear the drug quicker from their system in comparison to others. Examples of such factors include: a person’s age, genetics, how often they used the drug, etc.
If two people were to take the same dosage of Ativan at the exact same time, how could one possibly clear it from their system at a slightly quicker rate than the other? The speed by which a drug is cleared can be influenced by individual factors such as a person’s age, height/weight, and genetics.
Age: Studies have shown that age can influence the rate at which Ativan is excreted from the body. Individuals who are older tend to exhibit 22% slower clearance rates when compared to younger people. It is unclear exactly as to why elderly (age 65+) don’t excrete Ativan as quickly as younger users, but there are a number of theories including: organ functionality, blood flow, metabolic rate, health conditions, etc.
Body height / weight: Some speculate that a person’s body height and weight could have a subtle influence on elimination time. Specifically, a person’s height and weight in relationship to the dosage of Ativan ingested may have an impact. If a short/light person takes the same dose of Ativan as a tall/heavy person – it is thought that it may take longer for the smaller individual to excrete the drug. There is evidence that being overweight can speed up Ativan clearance.
Genetics: Differences in ability to metabolize Ativan may stem from genetics. Certain individuals may rapidly metabolize the drug as a result of genes that regulate specific liver enzymes and/or kidney function. Others may be poor metabolizers of Ativan and therefore may take slightly longer to fully excrete it (as well as its metabolites).
Kidney function: Research has shown that liver impairment doesn’t have a significant impact on the body’s ability to excrete Ativan. However, it is thought that kidney functionality could alter how quickly the drug is excreted. If you suffer from renal abnormalities, consider that they may slow the excretion rate of Ativan and its metabolites.
Metabolic rate: Some theorize that individuals with a fast basal metabolic rate may process drugs (like Ativan) quicker than those with slower-than-average BMRs. This could be due to the fact that individuals with quicker metabolic rates expedite the breakdown of Ativan. That said, this is an unproven theory and may be inaccurate.
Dosage (High vs. Low)
The dosage of Ativan a person takes can influence how long the drug stays in their system. Ativan is commonly prescribed within the range of 1 mg per day to 6 mg per day. In rare cases (among those that have built up tolerance), dose up to 10 mg per day are taken. Dosage is thought to have a slight influence on how quickly the body is able to metabolize and excrete Ativan.
Someone who just took 0.5 mg will likely clear Ativan from their system at a faster pace than someone who ingested 6 mg. Research indicates that larger doses of Ativan elicit longer-lasting (and more potent) effects compared to smaller doses. This is likely due to the fact that the body’s ability to efficiently metabolize a drug decreases as the dose increases.
The difference in clearance times between an individual who ingested a small dose (0.5 mg) and a person who ingested a large dose (6 mg) remains unclear. Some sources speculate that it could take hours or days – depending on the magnitude of discrepancy between doses.
Frequency of use
The frequency at which someone uses Ativan may also influence how long it stays in their system. An individual who takes Ativan 3 times per day will obviously have a longer clearance time than someone who took the drug just once in the morning. This is due to the fact that if a person takes Ativan three times per day, the third time they take it will likely be in the afternoon or evening.
As a result, their body will have only just begun to metabolize the dose they took later in the day. The individual who took the drug just once in the morning will be further along with the drug metabolism. Though studies have shown that long-term/frequent users don’t tend to “accumulate” Ativan in bodily tissues, it is apparent that tolerance could occur.
Frequent/long-term users of Ativan are most likely to build a tolerance to the drug’s effect, and ultimately will likely have increased the dosage multiple times. Higher dosages are cleared at a slower rate from the system compared to lower ones. For this reason, frequent users may require a longer term before they are fully detoxified.
Other drugs / supplements
Whenever taking Ativan, it is important to realize that simultaneous ingestion of other drugs or supplements could influence its absorption, metabolism, and speed of systemic clearance. Research has shown that ingestion of alcohol can impair glucuronide conjugation of Ativan, reducing clearance rates by 18% (in some cases). It is also important to consider that if you’re taking any other drugs (or supplements), they could be inhibiting or prolonging Ativan metabolism and clearance.
Other substances may be expediting the breakdown of Ativan and its clearance rate. Though the degree to which co-ingestion of various exogenous substances influences clearance rate of Ativan isn’t well-understood, it is a concept to consider. For most individuals, other drugs (or supplements) will not significantly alter clearance rates.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/6111408
- Source: http://www.ncbi.nlm.nih.gov/pubmed/6116659
- Source: http://www.ncbi.nlm.nih.gov/pubmed/36252
How Ativan (Lorazepam) Metabolized and Excreted (Details)
When orally ingested, Ativan is absorbed slowly as a result of its poor lipid solubility. The drug then binds to proteins (up to 90%) and reaches plasma levels in direct proportion to the dose administered; the greater the dose – the greater the plasma levels. Oral administration of 2 mg Ativan will yield a peak serum concentration of 20 ng/ml approximately 2 hours post-ingestion.
The serum concentration will consist of 50% active ingredient lorazepam, and 50% biologically inactive metabolite lorazepam-glucuronide. The metabolite lorazepam-glucuronide is formed when lorazepam is metabolized in the liver via conjugation with glucuronic acid. Glucuronidation is facilitated primarily by UGT2B15 enzymes, meaning that very few pharmacological agents interfere with its clearance.
Following the peak serum concentrations 2 hours after ingestion, lorazepam levels will continue to diminish with half-life of 12 hours; 50% of the drug will be excreted within this period. Since the metabolite lorazepam-glucuronide is considered fairly water-soluble, it is distributed throughout the body and has a longer elimination half-life than lorazepam (approximately 18 hours). It is estimated that approximately 74.5% of a lorazepam dose is excreted as “lorazepam-glucuronide” by the kidneys and eliminated through urine.
An estimated 13.5% of lorazepam is eliminated as various minor metabolites. Within just 5 days post-ingestion, it is thought that nearly 95% of a lorazepam dose will have been fully eliminated via urine and feces. The lorazepam-glucuronide metabolite is usually completely eliminated from a person’s system (or remains undetectable) after one week (7 days).
- Source: http://www.ncbi.nlm.nih.gov/pubmed/10938
- Source: http://www.ncbi.nlm.nih.gov/pubmed/30762
- Source: http://www.ncbi.nlm.nih.gov/pubmed/23554428
- Source: http://www.ncbi.nlm.nih.gov/pubmed/8232
Types of Ativan (Lorazepam) Drug Tests
There are several types of tests that could be administered to detect the presence of Ativan (Lorazepam). Traditional drug tests like the SAMHSA-5 aims to detect only drugs like marijuana, cocaine, amphetamines, opioids, and PCP. As a result, you probably won’t be tested for Ativan (or other benzodiazepines). That said, an extensive drug test could certainly detect the presence of benzodiazepines (including Ativan).
Urine tests: Research indicates that lorazepam can be detected in a person’s urine for over 144 hours after ingestion (6 days). It is thought that in frequent users, the detection window from a urine sample may exceed a week. It is also necessary to consider that if a urinalysis aims to detect the metabolite lorazepam-glucuronide, it may be detected for up to 9 days after ingestion.
Blood tests: It is known that Ativan can be detected in the bloodstream within 6 hours of ingestion and up to 3 days thereafter. This means that you would likely need to remain Ativan-free for several days in order to be considered “clean” on a blood test. Among those that were taking high doses of Ativan for at least three consecutive days, it could take even longer than a 3 days to clear the drug from your bloodstream. Since blood tests are highly-invasive and less convenient when compared to urine tests, they are seldom used to determine whether someone had ingested Ativan.
Hair tests: To detect drug ingestion over a longer-term, hair tests can be utilized. This type of testing requires that individuals provide a sample of hair (usually from their head) that is between 3 cm and 6 cm in length; the longer the sample, the better. A properly conducted hair test can reveal whether someone has ingested Ativan for up to 4 weeks (1 month) after exposure.
Saliva tests: A study revealed that the detection window of lorazepam in oral fluid (saliva) was approximately 8 hours. Although saliva testing is seldom conducted to detect the presence of Ativan (and other benzodiazepines), an individual will could test positive for over 8 hours (+/-). Though saliva tests may be highly convenient for detecting recent drug ingestion, other modalities of testing (usually urine) are preferred.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/15451084
Who could get tested for Ativan (Lorazepam)?
There are a variety of individuals that may be subject to benzodiazepine testing. As a result, Ativan could certainly be detected. Detection of Ativan could result in getting turned down for a job, getting fired from a job, or permanently suspended from athletics.
- Athletes: Though benzodiazepines will significantly impair athletic performance, some athletes may struggle with drug addiction and/or dependence. To ensure that these athletes are adhering to collegiate, professional, and/or international drug regulations – they are frequently subject to extensive testing. Should the drug test reveal the presence of Ativan, it could result in a suspension (or even worse).
- Employees: Employers have a right to test their employees for the presence of CNS depressants like Ativan. If an employee is operating heavy machinery and/or operating some sort of motor vehicle, they need to be alert. Drugs like Ativan decrease alertness and can provoke drowsiness on the job – resulting in critical errors, injuries, and/or death. Should someone such as a truck driver test positive for Ativan, they’ll likely be fired.
- Drug rehab clients: Someone struggling from drug addiction (especially benzo addiction) may be in rehab attempting to overcome it. In rehab, clients may be subject to extensive drug testing to ensure that they’ve remained “clean” throughout the process. Should Ativan be detected, the individual may require a longer stay at the rehabilitation facility.
- Military personnel: In the military, it is imperative to maintain focus and stay drug-free. Military personnel are often subject to extensive drug testing to ensure that they are not operating any machinery, equipment, or vehicles under the influence. Furthermore, since Ativan impairs learning and memory, it would likely be detrimental if ingested by military personnel. Someone who is caught with Ativan in their system could get de-listed.
Tips to clear Ativan (Lorazepam) from your system
Though most people will absorb, metabolize, and excrete Ativan from their system at a similar pace – it may be possible to slightly expedite clearance rates. Below is a list of tips that may help with drug clearance for certain individuals.
- Stop taking it: If you really want to clear Ativan from your system as quickly as possible, you’ll need to stop taking it sooner than later. Discontinuation should be done with the help of a medical professional. The longer you take the drug, the more prolonged the elimination period.
- Alter urinary pH: For many drugs, the pH of your urine can influence the rate of elimination. Individuals with a highly acidic urinary pH tend to excrete drugs quicker than those with a highly alkaline urinary pH. Alkaline urine tends to slow excretion and promotes reabsorption of the drug and its metabolite (lorazepam-glucuronide).
- Hydration / Diet: Drinking a lot of water isn’t known to speed up drug excretion. However, staying hydrated and eating a diet rich in antioxidants could help ensure that the dug gets eliminated as quickly as possible. Dehydration and/or a suboptimal diet may extend clearance for longer than necessary.
- Exercise: Exercising will boost your metabolic rate, which could influence the speed by which the drug is eliminated. Staying in shape also increases circulation, helps your body detoxify, and your nervous system adjust to functioning without the drug. Consider going for a light jog each day to help your body clear this exogenous chemical.
- Supplements: Some supplements could enhance the metabolism of Ativan. If you’ve contemplated taking supplements to help with detoxification, talk to your doctor to ensure that there won’t be any contraindications. Supplements known as “inducers” could ensure that your body processes Ativan with the greatest possible efficiency.
Have you ever been drug tested for Ativan (Lorazepam)?
If you’ve been drug tested for the presence of benzodiazepines, share details of the experience below. Discuss why you were being tested (e.g. for work) and whether you ended up passing (testing negative) or failing (testing positive). To help others better understand your situation, mention how long you had been off of Ativan prior to the test, the dosage you had been taking, and the type of drug test that was administered. How long do you think it took for the drug (and its metabolites) to be fully (100%) eliminated from your system?