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- Ativan (lorazepam) vs. Librium (chlordiazepoxide): What's the difference?
- What are Ativan and Librium?
- What are the side effects of Ativan and Librium?
- What is the dosage of Ativan and Librium?
- What drugs interact with Ativan and Librium?
- Are Ativan and Librium safe to use while pregnant or breastfeeding?
Ativan (lorazepam) vs. Librium (chlordiazepoxide): What's the difference?
- Ativan (lorazepam) and Librium (chlordiazepoxide) are benzodiazepines used to manage anxiety disorders, before anesthesia for sedation, and to prevent and treat alcohol withdrawal.
- Ativan is also used for the short-term relief of symptoms of anxiety or anxiety associated with depression, to treat panic attacks, short-term and long-term treatment of insomnia, in combination with other medications to prevent nausea and vomiting resulting from chemotherapy, and for treating seizures (status epilepticus).
- Side effects of Ativan and Librium that are similar include drowsiness and dizziness.
- Side effects of Ativan that are different from Librium include weakness, unsteadiness, depression, amnesia, loss of orientation, headaches, sleep disturbances, low blood pressure (hypotension), impotence (erectile dysfunction, or ED), changes in appetite, and sleep apnea.
- Side effects of Librium that are different from Ativan include impaired muscle control, confusion, skin problems, fluid retention (edema), menstrual irregularities, nausea, constipation, movement disorders, and decreased sex drive.
- Withdrawal symptoms such as agitation, insomnia, seizures, tremors, muscle cramping, vomiting, and sweating may occur if you suddenly stop taking Ativan.
What are Ativan and Librium?
Ativan (lorazepam) is a benzodiazepine, a drug class that also includes diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), and flurazepam (Dalmane). Ativan is used to manage anxiety disorders, for the short-term relief of symptoms of anxiety or anxiety associated with depression, to treat panic attacks, short-term and long-term treatment of insomnia, in combination with other medications to prevent nausea and vomiting resulting from chemotherapy, and for treating seizures (status epilepticus). Ativan also is administered before anesthesia for sedation and used for prevention and treatment of alcohol withdrawal. Research shows that excessive nerve activity in the brain may cause anxiety and other psychological disorders. Research also shows that Ativan and other benzodiazepines may act by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter, in the brain to reduce activity.
Librium (chlordiazepoxide) is a long-acting benzodiazepine used to manage anxiety disorders, and provide short-term relief of anxiety symptoms, withdrawal of acute alcoholism, and for preoperative apprehension and anxiety. Librium has anti-anxiety, sedative, appetite-stimulating, and weak pain relieving properties. Research shows that Librium may enhance or increase the activity of GABA, a neurotransmitter, a chemical that cells in the brain use to suppress the activity of other cells.
What are the side effects of Ativan and Librium?
- Like all benzodiazepines, Ativan can cause physical dependence. Suddenly stopping therapy after a few months of daily therapy may be associated with a feeling of loss of self-worth, agitation, and insomnia. If Ativan is taken continuously for longer than a few months, stopping therapy suddenly may produce seizures, tremors, muscle cramping, vomiting, and sweating.
The most common side effects associated with Ativan are:
Other side effects include:
- A feeling of depression
- Loss of orientation
- Sleep disturbances
- Low blood pressure (hypotension)
- Impotence (erectile dysfunction, ED)
- Changes in appetite
- Sleep apnea
Possible serious side effects include:
- Extrapyramidal symptoms
- Respiratory depression
- Suicidal ideation/attempt
Reported side effects include:
- Impaired muscle control (ataxia)
- Skin problems
- Minor menstrual irregularities
- Movement disorders
- Decreased desire for sexual activity (decreased libido)
Serious side effects that have been reported are:
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What is the dosage of Ativan and Librium?
- The dose of Ativan is tailored to the patient's needs.
- The usual dose for treating anxiety is 2 to 6 mg orally every 8 to 12 hours as needed.
- Insomnia is treated with 2 to 4 mg given at bedtime.
- For the treatment of mild to moderate anxiety disorders or symptoms: 5 to 10 mg by mouth 3 to 4 times daily.
- For the treatment of severe anxiety disorders or symptoms: 20 to 25 mg by mouth 3 to 4 times daily.
- For the management of preoperative apprehension and anxiety: 5 to 10 mg by mouth 3 to 4 times daily on days preceding surgery.
- For the treatment of anxiety symptoms in children age 6 years to adolescents: the usual daily recommended dose is 5 mg 2 to 4 times daily.
- Dosage may be increased to 10 mg per day given in 2 to 3 divided doses if necessary.
- Librium is not recommended for use in children below the age of 6 years.
- The usual recommended dose is 5 mg 2 to 4 times daily.
What drugs interact with Ativan and Librium?
- Ativan and all benzodiazepines accentuate the effects of other drugs that slow the brain's processes such as alcohol, barbiturates, narcotics, and tranquilizers, and the combination of Ativan and these drugs may lead to excessive sedation. There have been cases of marked sedation when Ativan was given to patients taking the tranquilizer loxapine (Loxitane); it is unclear if there is a drug interaction, but use caution if Ativan and loxapine are used together.
Librium is metabolized or broken down by a group of enzymes in the liver known as the cytochrome P450 3A4 enzymes. Drugs that inhibit these enzymes reduce the metabolism of Librium and have the potential for causing side effects.
Examples of CYP3A4 inhibitors are:
- amiodarone (Cordarone)
- Anti-retroviral protease inhibitors (some types of anti-HIV medications)
- fluconazole (Diflucan)
- itraconazole (Sporanox)
- ketoconazole (Nizoral)
- voriconazole (Vfend)
- miconazole (Monistat)
- cimetidine (Tagamet)
- clarithromycin (Biaxin)
Additionally, inducers of the CYP3A4 enzymes may increase the activity of these enzymes and cause blood levels of Librium to decrease.
Examples of CYP3A4 inducers are:
Librium has depressant effects on the central nervous system. Medications which have similar activity may increase the risk for drowsiness, respiratory depression, and other CNS depressant effects. Therefore, avoid using Librium with alcohol, kava-kava, other benzodiazepines, and opiates.
Are Ativan and Librium safe to use while pregnant or breastfeeding?
- Ativan and other benzodiazepines have been associated with fetal damage, including congenital malformations, when taken by pregnant women in their first trimester. Ativan is best avoided if at all possible in the first trimester and probably throughout pregnancy.
- Ativan is excreted in human milk and should be avoided during pregnancy.
- Librium is classified as FDA pregnancy risk category D. Due to the risk of potential harm to the fetus, use of Librium during pregnancy is not recommended.
- This medication is thought to be excreted into breast milk. Due to the lack of conclusive safety data, use in nursing mothers is not recommended.
Ativan (lorazepam) and Librium (chlordiazepoxide) are benzodiazepines used to manage anxiety disorders, before anesthesia for sedation, and to prevent and treat alcohol withdrawal. Ativan is used for the short-term relief of symptoms of anxiety or anxiety associated with depression, to treat panic attacks, short-term and long-term treatment of insomnia, in combination with other medications to prevent nausea and vomiting resulting from chemotherapy, and for treating seizures (status epilepticus). Librium a long-acting benzodiazepine used to manage anxiety disorders, and provide short-term relief of anxiety symptoms, withdrawal of acute alcoholism, and for preoperative apprehension and anxiety.
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Related Disease Conditions
Anxiety is a feeling of apprehension and fear characterized by symptoms such as trouble concentrating, headaches, sleep problems, and irritability. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. Treatment for anxiety may incorporate medications and psychotherapy.
Alcoholism and Alcohol Abuse
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law. It can cause myriad health problems, including cirrhosis of the liver, birth defects, heart disease, stroke, psychological problems, and dementia. Counseling and a few medications can be effective for alcoholism treatment.
Panic attacks are sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. A person experiencing a panic attack may believe that he or she is having a heart attack or that death is imminent. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms: racing heartbeat, faintness, dizziness, numbness or tingling in the hands and fingers, chills, chest pains, difficulty breathing, and a feeling of loss or control. There are several treatments for panic attacks.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Seizures Symptoms and Types
Seizures are divided into two categories: generalized and partial. Generalized seizures are produced by electrical impulses from throughout the brain, while partial seizures are produced by electrical impulses in a small part of the brain. Seizure symptoms include unconsciousness, convulsions, and muscle rigidity.
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