SUMAYYA
02 September 2022
Medically reviewed by
Kajal Jain
M. Pharm
lorazepam-and-ambien-together
Table of Contents

Ativan (Lorazepam) is an effective benzodiazepine medication for occasional or short-term Anxiety, insomnia, seizures, nausea, and vomiting from chemotherapy and as preoperative medicine. It may also be prescribed off-label for Borderline Personality Disorder, Dysautonomia, and Cervical Dystonia. It is less likely to cause drug interactions but more likely to cause withdrawal symptoms than similar drugs.

Ambien (zolpidem), on the other hand, is an effective drug for insomnia, but it can be habit-forming and may cause more side effects than other sleep medicines. It is not recommended for children below 18 years of age. Nearly 70 million Americans are affected by sleep disorders every year. The symptoms of insomnia occur in almost 33% to 50% of the adult population. It is common in older adults, females, and people with medical and mental ill health.

Both drugs act differently for this disorder and have adverse effects. The question arises where these two are given in combination for the same condition. Further information about the two drugs is mentioned in this blog. Talk to the concerned healthcare practitioner in case of any questions or concerns.

What is Lorazepam?

Lorazepam is a prescription drug for the treatment of anxiety. This drug was approved for use by USFDA in 1977 and marketed under the brand Ativan (Pfizer Ltd). It belongs to a class of benzodiazepines that act on the central nervous system to produce a relaxing effect that relieves anxiety and may also be used to treat short-term insomnia.

The intravenous form of Lorazepam is used to treat seizures. This drug shows its effect by enhancing the activity of GABA neurotransmitter neurotransmitters in the brain. 

Lorazepam is not a narcotic drug but may show some narcotic effects. It is a habit-forming medicine and can make a person physically and psychologically dependent. This drug is only available with the doctor's prescription and is available in the following dosage forms:

  • Tablet
  • Solution
  • Capsule, Extended Release
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What is Ambien?

Ambien is a prescription drug for the treatment of insomnia. It belongs to a class of SedativeSedatives/Hypnotics.

Zolpidem oral tablets are available as both brand and generic medicines. It is sold with the brand names: Ambien (immediate-release tablet), Ambien CR (extended-release tablet), Intermezzo (sublingual tablet), and Edluar (sublingual tablet). Zolpidem also comes as an oral spray (Zolpimist).

The low-dose (1.75-mg and 3.5-mg) sublingual tablets are used when your sleep is disturbed at midnight and you have difficulty falling back asleep. It is quite uncertain if Ambien is safe and effective in children. 

Zolpidem tartrate (Ambien) is used for the short-term treatment of insomnia and has been shown to decrease sleep latency in controlled clinical studies for up to 35 days.

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Taking Lorazepam And Ambien Together?

You should be careful about taking these drugs in combination with other medications. Talk to your doctor if you take any medicine or herbal supplement while on these drugs.

Using Lorazepam with zolpidem may increase side effects such as confusion, drowsiness, dizziness, and difficulty concentrating. Some people, especially the elderly, may also experience impaired judgment, thinking, and motor coordination. 

Dosage consideration of Lorazepam and Ambien

Lorazepam (Ativan) Dose

The initial dose for the patient should be its lowest effective dose.

For Anxiety Disorders

  • Initial: 2-3 mg oral once every 8-12 hours per requirement; Max. dose- 10 mg/day
  • Geriatric: 1-2 mg orally divided once every 8-12 hours

Short-Term Treatment of Insomnia

  • Initial: 2-4 mg taken orally at bedtime
  • Geriatric: 0.5-1 mg orally at bedtime, which can be gradually increased as per the requirement. 

The initial daily dose should not exceed 2 mg to avoid over-sedation.

Anxiolytic/Sedation in ICU (Off-label)

  • Intubated and mechanically ventilated patients
  • 0.02-0.04 mg/kg IV
  • 0.02-0.06 mg/kg intermittent IV once every 2-6 hours as needed, OR
  • 0.01-0.1 mg/kg/hour continuous IV; not to exceed 10 mg/hour

Children: 0.05 mg/kg orally once every 4-8 hours; not to exceed 2 mg

Preoperative Sedation, Anterograde Amnesia & Anxiety Relief

  • 0.05 mg/kg IM for 1 dose to be taken 2 hours before surgery; do not exceed 4 mg (2 mg in elderly), OR
  • 0.044 mg/kg IV for 1 dose to be taken 15-20 minutes before surgery; do not exceed 4 mg (2 mg in elderly)

Dosing Considerations

  • Respirations should be monitored every 5-15 minutes before each repeated IV dose.
  • Geriatric: When a higher dose is indicated, gradually increase the evening dose before its daytime doses
  • Renal impairment: Oral dose adjustment is not necessary

IV/IM (higher dose or prolonged periods): Monitor the risk of propylene glycol toxicity. It is not recommended for severe impairment or renal failure.

  • Hepatic impairment: Oral dose adjustment is not necessary for mild-to-moderate impairment

IV/IM: It is not recommended in severe impairment or hepatic failure.

Most doctors prescribe 0.5-1 mg of Lorazepam for Insomnia. This should be taken once daily, immediately before going to bed. Its initial dose should not be increased beyond 2mg. Also, do not alter your dosage without consulting with your doctor.
It would help if you avoid drinking alcohol with Ambien or Lorazepam. Ambien with alcohol can cause drowsiness or dizziness. Similarly, drinking alcohol while taking Lorazepam can cause dizziness, drowsiness, and lack of alertness. Keep your doctor informed of your alcohol use so that they can monitor any possible side effects specific to you.

Ambien (Zolpidem) Dose

The initial dose for the patient should be its lowest effective dose. Its recommended starting dose for women is 5 mg, and for men, either 5 or 10 mg, to be taken only once every night immediately before going to bed, with the planned time of awakening of at least 7-8 hours before.

In some patients, the higher amount of morning blood levels after taking 10 mg dose increases the risk of impaired driving and other activities requiring full alertness the following day.

The maximum dose of AMBIEN is 10 mg and should be taken as a single dose before bedtime. The re-administration of a drug during the same night should be avoided.

The recommended initial dose for women and men is different because zolpidem clearance is lower in women.

Side Effects of Lorazepam and Ambien

Lorazepam (Ativan) may cause some side effects, which are mentioned below:

Common Side Effects Of Lorazepam Severe Side Effects Of Lorazepam
Unsteadiness Low blood pressure
Sleep apnea Suicidal ideation
Respiratory depression depression
Visual disturbances Anxiety
Jaundice Blood dyscrasias

 

Common Side Effects Of Ambien Severe Side Effects Of Ambien
Headache Complex Sleep Behaviours
Tiredness Serious Anaphylactic and Anaphylactoid Reactions
Vomiting, nausea CNS-Depressant Effects and Next-Day Impairment 
Lightheadedness Withdrawal effects 
Stomach pain Abnormal Thinking
Eye redness Behaviour Changes

This blog might not contain all possible side effects. Speak with your doctor for more health information related to this medicine's associated problems or adverse side effects.

Lorazepam And Ambien Together Warning

Before taking zolpidem and Lorazepam, talk to your doctor if you are allergic to them and share your medical history with the concerned doctor.

Before taking these drugs, consult your doctor if you have liver disease, kidney disease, glaucoma, lung/breathing problems, sleep apnea, mental/mood disorders, or substance use disorder.

Speak to your doctor if you are expecting a baby or planning to become pregnant. Lorazepam may harm an unborn baby. Inform your healthcare practitioner if you notice unusual symptoms in the newborn baby. Consult your doctor for more details.

Bottom Line From Practical Anxiety Solutions

Lorazepam and Ambien are both prescription drugs for treating anxiety and insomnia. Lorazepam is also used for treating seizures, nausea, and vomiting from chemotherapy and as preoperative medicine. The administration of these two drugs together can intensify the side effects, such as confusion, drowsiness, dizziness, and difficulty concentrating. Speak to your doctor before starting any medication to avoid unusual side effects.

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