Medication guide

Lorazepam (Ativan / Wypax)

What is lorazepam?

Lorazepam is known as Ativan in the United States and some other countries, and Wypax in Japan (ワイパックス on Japanese packaging); in the UK the tablets are sold simply as lorazepam. It's all the same medicine. It's an anti-anxiety medicine in the benzodiazepine group: it calms an overactive nervous system, easing anxiety and tension, and it works within an hour or so. It's used for short-term relief, often just when needed.

How is it different from other anxiety medicines?

Fast: it calms within an hour or so, not the weeks an antidepressant needs
Cleared by a different route: unlike alprazolam, it isn't broken down by the liver enzyme that several HIV, COVID, and antifungal medicines block, so those medicines aren't on its list of interactions
Works as needed: it can be taken only when anxiety spikes, rather than every day
A useful bridge: it can be prescribed alongside a daily antidepressant while that slower medicine takes hold

What is it used for in Japan?

In Japan, lorazepam is approved for the symptoms that come with neurosis and stress-related physical (psychosomatic) conditions:

Anxiety and tension
Low mood
The physical symptoms of those stress-related conditions

Where lorazepam helps most is when fast, short-lived relief matters: calming a panic attack as it builds, getting through a flight or an MRI scan, or covering the weeks before an antidepressant starts to work.

How does it help?

It quietens the nervous system, so anxiety and tension ease off within an hour or so of taking it. It can also cause dependence with regular use, so whether to use it, and for how long, is decided by weighing the benefit against that risk. Used for a limited period, with an end point agreed in advance, the benefit can outweigh the risk. If it has been taken every day for a long time, the usual plan is to discuss reducing it with your doctor.

What should I tell my doctor before starting?

A few situations rule it out entirely; your doctor will choose something else if any of these apply:

Acute narrow-angle glaucoma
Myasthenia gravis (a muscle-weakness condition)

And tell your doctor first if any of these apply; these usually just need adjustments or a closer eye:

A previous bad reaction to lorazepam
Moderate or severe breathing problems
Other sedating medicines, or regular alcohol use
The epilepsy or mood medicine valproate, or the nerve-pain medicine pregabalin
The antipsychotic clozapine: the label warns the combination can seriously affect circulation and breathing
Being older: a lower dose is usual, as unsteadiness and falls are more likely
Pregnant, planning to be, or breastfeeding (see the section below)

How do I take it?

Your doctor will set the pattern: either only when needed, or on a regular short-term schedule.

Don't raise the dose or add extra tablets on your own: even on a bad day, if it feels like it's not enough, that's a conversation, not a second tablet
If you miss a dose on a regular schedule: just skip it if the next one is close. Never double up
Alcohol: avoid it, since it stacks with the drowsiness

What side effects should I expect?

Most are mild. Not everyone gets them.

Drowsiness: the most common
Unsteadiness, dizziness, or light-headedness: take care on your feet
Headache or a heavy head

If anything is bothering you, tell your doctor; there's often a way to adjust.

Finally, one thing that is rare, and avoidable:

Combined with alcohol or other sedatives, the drowsiness can run deeper than expected; if you ever feel unusually heavily sedated or your breathing feels slowed, call us the same day. Taken as prescribed, without alcohol, this is very unlikely

Will I become dependent? How do I stop safely?

It can be habit-forming with regular use, even within the approved dose, which is why it is used at the lowest helpful dose, for an agreed period, with a plan for stopping. The body gets used to benzodiazepines, the same dose can gradually do less, and stopping suddenly after regular use can cause withdrawal: rebound anxiety, sleeplessness, tremor, and, in some cases, seizures. So never stop suddenly on your own; your doctor lowers it gradually, in small steps, and as-needed use (rather than daily) keeps the risk low. Used as planned, it is a useful bridge, and the aim is that the longer-term treatment takes over.

Can I bring it into Japan?

Yes, within limits, because it's a controlled medicine here. Lorazepam is a scheduled (psychotropic) medicine in Japan: a personal supply of roughly up to a month travels with you without any advance paperwork, larger amounts need paperwork arranged before you travel, and mailing it to Japan is prohibited. It also cannot be prescribed online, at a first visit or a follow-up, until a doctor in Japan has examined you in person for that condition, so plan an in-person visit.

Can I drive while taking it?

No; avoid driving while you're taking it. Lorazepam can cause drowsiness and slow your attention and reactions, and the Japanese label instructs that patients taking it should not drive or operate dangerous machinery. This applies while the medicine is in your system, including the day after an evening dose if you feel dulled.

What about pregnancy and breastfeeding?

Avoided where possible in pregnancy, and the Japanese label says to avoid breastfeeding while taking it; tell your doctor early and we'll find the safest plan together. The label allows lorazepam in pregnancy only when the expected benefit outweighs the risk, and benzodiazepines taken regularly up to delivery can cause withdrawal symptoms in the newborn. If you're on lorazepam and planning a pregnancy, don't stop suddenly; the plan is a gradual, supported change. Our guides to medication in pregnancy and medication while breastfeeding cover the wider picture.