Ativan (lorazepam) vs. Versed (midazolam): What’s the difference?
- Ativan (lorazepam) and Versed (midazolam) are benzodiazepines used for sedation before surgical procedures and to treat insomnia.
- Ativan is also used to manage anxiety disorders, for the short-term relief of symptoms of anxiety or anxiety associated with depression, to treat panic attacks, in combination with other medications to prevent nausea and vomiting resulting from chemotherapy, and for treating seizures (status epilepticus). Ativan also is used for prevention and treatment of alcohol withdrawal.
- Side effects of Ativan and Versed that are similar include drowsiness and dizziness.
- Side effects of Ativan that are different from Versed include weakness, unsteadiness, depression, amnesia, loss of orientation, headaches, sleep disturbances, low blood pressure (hypotension), impotence, changes in appetite, and sleep apnea.
- Side effects of Versed that are different from Ativan include nausea and vomiting.
- Withdrawal symptoms such as agitation, insomnia, seizures, tremors, muscle cramping, vomiting, and sweating may occur if you suddenly stop taking Ativan or Versed.
What are Ativan and Versed?
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 activity of nerves in the brain may cause anxiety and other psychological disorders. Ativan and other benzodiazepines may act by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter, in the brain to reduce activity.
Versed (midazolam) belongs to a class of medications called benzodiazepines, which produce a calming effect on the central nervous system. Benzodiazepines may work by increasing the effect of a certain natural chemical (GABA) in the brain. Versed is used in children before a procedure or anesthesia to cause drowsiness, decrease anxiety, and cause forgetfulness of the surgery or procedure. Versed may also be used short-term for sleep problems (e.g., trouble sleeping, "night terrors").
What are the side effects of Ativan and Versed?
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
This medication may cause withdrawal reactions, especially if it has been used regularly for a long time or in high doses. In such cases, withdrawal symptoms (such as shaking, sweating, vomiting, abdominal/muscle cramps, seizures) may occur if you suddenly stop using this medication. To prevent withdrawal reactions, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details, and report any withdrawal reactions immediately. Though very unlikely, abnormal drug-seeking behavior (addiction) is possible with this medication. To lessen the risk of becoming addicted, do not increase the dose, take it more frequently, or take it for a longer time than prescribed. Talk with the doctor if this medication stops working well. Properly stop the medication when so directed. Avoid eating grapefruit or drinking grapefruit juice while being treated with this medication unless the doctor instructs you otherwise. Grapefruit can increase the amount of certain medications in the bloodstream. Consult the doctor or pharmacist for more details. This medication is not intended for chronic administration.
Remember that the doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. If any of the following side effects persist or worsen, notify the doctor or pharmacist promptly:
Tell the doctor immediately if any of these unlikely but serious side effects occur:
- Rapid, slow, or shallow breathing
- Mental or mood changes (for example, agitation or aggressive behavior)
- Uncontrollable movements (for example, shaking or tremor)
- Slow or fast heartbeat
- Vision changes (for example, blurred vision)
Seek immediate medical attention if any of these rare but very serious side effects occur:
- Trouble breathing
- Itching or swelling (especially of the face, tongue, or throat)
- Severe dizziness
- Trouble breathing
This is not a complete list of possible side effects. If you notice other effects not listed above, contact the doctor or pharmacist.
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What is the dosage of Ativan vs. Versed?
- 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.
A health care professional will prepare and measure your dose. Take this medication by mouth as directed by your doctor. It is usually given as a single dose before a procedure or anesthesia.The dosage is based on your medical condition, response to therapy, weight, and other medications you may be taking. Versed is not intended for chronic administration.
Why do we sleep?
What drugs interact with Ativan and Versed?
- 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.
The doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring them for you. Do not start, stop, or change the dosage of any medicine before checking with the doctor or pharmacist first.
This drug should not be used with the following medications because very serious interactions may occur:
- HIV protease inhibitors (for example, ritonavir, saquinavir, and atazanavir)
- sodium oxybate
If you are currently using any of these medications listed above, tell the doctor or pharmacist before starting midazolam.
Before using this medication, tell the doctor or pharmacist of all prescription and nonprescription, or herbal products you may use, especially of:
- drugs affecting liver enzymes that remove midazolam from your body such as azole antifungals including itraconazole and ketoconazole
- macrolide antibiotics including erythromycin and cimetidine
- rifamycins including rifabutin and rifampin
- St. John's wort
- certain anti-seizure medicines including carbamazepine and phenytoin
- calcium channel blockers including diltiazem and verapamil
- certain SSRIs including fluoxetine, fluvoxamine, nefazodone, conivaptan, and aprepitant
Tell the doctor or pharmacist if you also take drugs that cause drowsiness such as:
- certain antihistamines (for example, diphenhydramine)
- anti-seizure drugs (for example, phenobarbital)
- medicine for sleep or anxiety (for example, alprazolam, diazepam, and zolpidem)
- muscle relaxants
- narcotic pain relievers (for example, codeine, and morphine)
- psychiatric medicines (for example, chlorpromazine, clozapine, amitriptyline, and trazodone)
- a certain herbal product (kava)
Check the labels on all your medicines (e.g., cough-and-cold products) because they may contain drowsiness-causing ingredients. Ask the pharmacist about using those products safely. This list does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
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Are Ativan and Versed 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.
- Versed is not recommended for use during pregnancy. It may harm an unborn baby. Infants born to mothers who used similar medications for an extended time have had withdrawal symptoms such as irritability, abnormal/persistent crying, vomiting, or diarrhea. Consult your doctor for more details.
- Versed passes into breast milk. Consult your doctor before breast-feeding.