Lorazepam can affect anxiety and the central nervous system, while reducing or stopping it after regular use can produce withdrawal symptoms including a fast heartbeat. Palpitations should still be evaluated in context rather than automatically blamed on the medication.
Ativan is the brand name for lorazepam, a benzodiazepine prescription medicine used primarily to treat anxiety disorders and for short-term relief of anxiety symptoms. Heart palpitations are particularly relevant when lorazepam is reduced too quickly or stopped after regular use because benzodiazepine withdrawal can include anxiety, increased blood pressure and a fast heartbeat. However, palpitations while taking lorazepam or during a taper are not automatically caused by the medicine. Anxiety, caffeine, other medicines and genuine heart rhythm disorders can produce similar symptoms.
Do Not Stop Lorazepam Suddenly After Regular Use
Continued benzodiazepine use can lead to physical dependence. Abrupt discontinuation or a rapid reduction in dose can trigger acute withdrawal reactions.
Withdrawal may include anxiety, insomnia, tremor, restlessness, increased blood pressure and tachycardia. More severe reactions can include seizures, delirium, hallucinations and other serious neurologic or psychiatric symptoms.
If you have been taking lorazepam regularly, do not abruptly stop it or substantially change the dose on your own. A clinician should determine whether tapering is needed and individualize the plan.
What Is Ativan (Lorazepam)?
Ativan is a brand name for lorazepam, a prescription medication in the benzodiazepine class.
Benzodiazepines enhance the activity of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the central nervous system. This produces effects such as reduced anxiety, sedation and muscle relaxation.
In current U.S. labeling, oral lorazepam is indicated for the management of anxiety disorders or for the short-term relief of anxiety symptoms, including anxiety associated with depressive symptoms.
Different lorazepam formulations may be used in other clinical situations. For example, injectable lorazepam has specific uses in hospital and procedural medicine. That does not mean patients should use oral Ativan interchangeably for those conditions.
Is Ativan Meant Only for Very Short Treatment?
The prescribing information states that the effectiveness of oral lorazepam beyond four months has not been systematically evaluated in clinical studies.
This is not the same as saying that every patient must stop at exactly four months. If treatment continues, the prescribing clinician should periodically reassess whether the medicine remains useful and whether its benefits continue to outweigh its risks.
Can Ativan Cause Heart Palpitations?
The answer requires some context.
Palpitations are especially recognized in connection with benzodiazepine withdrawal or rapid dose reduction. Withdrawal can increase autonomic and sympathetic activity, and a person may experience tachycardia, anxiety, tremor, sweating or a pounding heartbeat.
However, it would be inaccurate to say that anyone experiencing palpitations while taking Ativan must be having a medication side effect.
Withdrawal or rapid dose reduction
A reduction in benzodiazepine exposure after physical dependence has developed can produce withdrawal symptoms. Tachycardia is among the recognized acute withdrawal manifestations.
Missed or delayed doses
In a person who has developed physical dependence, missed or substantially delayed doses may sometimes allow withdrawal symptoms to emerge. The response varies considerably between individuals.
Anxiety or panic
Anxiety itself is a common cause of heartbeat awareness, racing or pounding. If anxiety returns while the medication is being reduced, distinguishing recurrence of anxiety from medication withdrawal may be difficult.
Learn more about anxiety and heart palpitations.
Another cause entirely
Caffeine, nicotine, thyroid disease, anemia, dehydration, premature beats, atrial fibrillation and many other conditions can produce palpitations independently of lorazepam.
If anxiety is causing a strong awareness of an otherwise normal heartbeat, treating anxiety may make the sensation less noticeable. That does not mean lorazepam treats PVCs, atrial fibrillation, SVT or another arrhythmia. Recurrent unexplained palpitations may still require ECG or ambulatory rhythm monitoring.
See our broader guide to causes and triggers of heart palpitations.
Why Can Lorazepam Withdrawal Cause a Fast Heartbeat?
Lorazepam enhances inhibitory GABA activity in the central nervous system. With repeated exposure, the nervous system adapts to the presence of the medicine.
When the dose is substantially reduced or the medication is suddenly stopped, that inhibitory effect may fall faster than the nervous system can comfortably adapt. This can produce a state of increased nervous-system activity.
Possible acute withdrawal symptoms include:
- anxiety or panic symptoms;
- restlessness or irritability;
- insomnia;
- tremor;
- sweating;
- dizziness;
- nausea or other gastrointestinal symptoms;
- increased blood pressure;
- tachycardia or a noticeably fast heartbeat; and
- increased sensitivity to light, sound or other sensations.
The combination of tachycardia and anxiety can easily be perceived as heart palpitations.
Severe Withdrawal Can Be Dangerous
Serious benzodiazepine withdrawal reactions can include seizures, delirium, hallucinations, psychosis, severe mental-status changes and other potentially life-threatening complications.
Someone with severe withdrawal symptoms needs prompt medical assessment rather than attempting to manage the reaction by repeatedly changing lorazepam doses at home.
Physical Dependence Is Not the Same as Addiction
This distinction is important.
Physical dependence means the body has adapted to the medicine and withdrawal symptoms may occur if exposure is abruptly reduced. This can happen during appropriate prescribed treatment.
Addiction or benzodiazepine use disorder involves a different pattern that may include impaired control over use, compulsive use or continued use despite harm.
A patient who needs a slow taper because of physical dependence should not automatically be described as “addicted.”
The risk of physical dependence and withdrawal generally increases with higher doses, more frequent use and longer treatment duration.
Can Lorazepam Cause Problems While You Are Still Taking It?
Lorazepam commonly causes central nervous system effects such as sedation, dizziness, weakness and unsteadiness. It can also occasionally cause paradoxical reactions such as increased anxiety, excitation, agitation or insomnia.
Such reactions could make heartbeat awareness more prominent in an individual patient, but recurrent palpitations should not simply be attributed to lorazepam without considering other causes.
Lorazepam can also produce respiratory depression, particularly when combined with other central nervous system depressants.
Lorazepam and Opioids or Alcohol
Combining benzodiazepines with opioids can cause profound sedation, dangerous respiratory depression, coma and death.
Alcohol and other sedating substances can also increase central nervous system depression. Do not use alcohol or non-prescribed sedatives as a way to manage lorazepam withdrawal symptoms.
How Should Lorazepam Be Reduced or Stopped?
There is no single lorazepam taper that is appropriate for everyone.
Current prescribing information calls for a gradual, patient-specific taper when dose reduction is necessary in someone at risk for withdrawal.
Current multidisciplinary benzodiazepine guidance also emphasizes beginning cautiously and adjusting the pace according to the patient’s response. Some people tolerate dose reductions relatively easily; others require substantially slower changes or pauses.
Factors that can influence a taper include:
- the current daily dose;
- how frequently the medication is taken;
- how long it has been used;
- previous withdrawal symptoms;
- the condition being treated;
- other medicines and substances;
- history of seizures;
- age and other medical conditions; and
- how the patient responds to each dose reduction.
Do Not Use the Old Fixed Taper Formula
This page previously advised reducing lorazepam by one-eighth or one-quarter of the daily dose every two weeks.
That instruction has been removed. Modern guidance favors an individualized taper that can be slowed, paused or otherwise adjusted according to symptoms and clinical circumstances. A fixed internet schedule should not replace a prescribing clinician’s plan.
What About Melatonin, Paroxetine or Anticonvulsants?
There is no universal add-on medicine that reliably prevents benzodiazepine withdrawal symptoms in every patient.
The previous version of this article specifically recommended melatonin, paroxetine and anticonvulsant medicines. These should not be presented as routine self-treatment for lorazepam withdrawal.
A clinician may sometimes treat the underlying anxiety, depression, insomnia or another condition with appropriate therapies, but the choice depends on the individual patient.
Current benzodiazepine-tapering guidance places particular emphasis on adjusting the taper itself and using evidence-based treatment for the condition for which the benzodiazepine was originally prescribed.
Severe withdrawal, including withdrawal seizures, is a medical problem requiring clinician-directed management rather than a reason to start anticonvulsant medication independently.
What Should You Do If You Develop Palpitations?
If palpitations appear after a missed dose, dose reduction or medication change, contact the healthcare professional managing your lorazepam.
Useful information to provide includes:
- your prescribed dose and dosing schedule;
- how long you have been taking lorazepam;
- whether any doses were recently missed;
- whether the dose was reduced and when;
- how long the palpitations last;
- whether the heartbeat feels regular or irregular;
- your pulse or heart-rate reading if available;
- other medicines or supplements;
- caffeine, nicotine, alcohol or stimulant exposure; and
- associated chest pain, dizziness, fainting or shortness of breath.
A palpitation does not tell you whether the cause is withdrawal, anxiety or an arrhythmia. Taking extra medication without medical guidance may cause oversedation and can complicate the taper or diagnosis.
Persistent or recurrent symptoms may warrant an ECG or longer rhythm monitor. Read more about heart palpitation symptoms and medicines and heart palpitations.
Dr. Albana’s Note
When a patient develops palpitations while taking or reducing lorazepam, I first want to know whether there has been a missed dose or recent dose change and how long the medicine has been used. I also ask whether the heartbeat is simply faster or actually feels irregular, and whether chest pain, fainting or significant shortness of breath accompanies it. Withdrawal is one possibility, but it should not become an automatic diagnosis because anxiety and genuine rhythm disorders can produce very similar sensations.
When Should You Seek Urgent Medical Care?
Seek urgent or emergency assessment if palpitations occur with:
- chest pain, significant pressure or tightness;
- fainting or loss of consciousness;
- severe shortness of breath;
- severe dizziness or near-fainting;
- a sustained very rapid or markedly irregular heartbeat;
- collapse;
- a seizure;
- severe confusion or delirium;
- hallucinations or severe behavioral changes;
- suicidal thoughts or behavior; or
- rapidly worsening withdrawal symptoms.
Severe benzodiazepine withdrawal can be medically dangerous. Do not attempt to manage seizures, delirium or severe withdrawal solely by changing doses yourself at home.
Most Asked Questions
Can Ativan cause heart palpitations?
Lorazepam is particularly associated with a fast heartbeat in the context of benzodiazepine withdrawal or rapid dose reduction. Palpitations occurring while taking Ativan may also have other causes, including anxiety, stimulants or an independent heart rhythm problem.
Can stopping Ativan cause a racing heart?
Yes. Tachycardia is a recognized acute benzodiazepine-withdrawal symptom. The likelihood of withdrawal generally increases with longer treatment duration and higher or more frequent doses. Do not abruptly stop regular lorazepam therapy without medical guidance.
Can missing one Ativan dose cause palpitations?
It may in some physically dependent patients, but the response varies. A missed dose does not automatically explain every episode of palpitations. Contact your prescriber if symptoms repeatedly occur after missed or delayed doses.
Does taking Ativan mean I am addicted?
No. Physical dependence and addiction are different. Physical dependence can develop during regular prescribed benzodiazepine treatment and means withdrawal symptoms may occur when the dose is substantially reduced. Addiction involves a different pattern of impaired control and harmful use.
How quickly should lorazepam be tapered?
There is no universal schedule. Current guidance recommends an individualized gradual taper that is adjusted according to dose, duration of treatment, withdrawal risk and the patient’s response. Your prescribing clinician should determine the specific plan.
Can I take extra Ativan if withdrawal causes palpitations?
Do not independently increase the dose. Contact the clinician managing the taper. Palpitations may have several causes, and taking additional lorazepam without guidance can increase sedation and interfere with safe management.
Can Ativan help anxiety-related palpitations?
Treating anxiety can sometimes reduce heartbeat awareness when anxiety is the underlying trigger. However, lorazepam is not an antiarrhythmic medicine and should not be used to treat unexplained palpitations without determining whether another medical cause is present.
Can lorazepam withdrawal cause seizures?
Yes. Abrupt discontinuation or rapid dose reduction after continued benzodiazepine use can cause severe withdrawal reactions including seizures. This is one of the main reasons regular benzodiazepine treatment should not be stopped abruptly without appropriate medical supervision.
Related Heart Palpitation Guides
Medical References
- U.S. National Library of Medicine, DailyMed. Lorazepam Tablets — Full Prescribing Information and Medication Guide. Updated June 2026.
- U.S. Food and Drug Administration. Ativan (lorazepam) Prescribing Information — Boxed Warning for Opioid Use, Abuse, Misuse, Addiction, Physical Dependence and Withdrawal.
- American Society of Addiction Medicine and participating medical societies. Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits. 2025.
- Brunner E, Chen CY, Ogbonna C, Wright T, et al. Multisociety Guidance on Patient-Centered Benzodiazepine Tapering. American Society of Addiction Medicine. 2025.
About the Medical Team
Dr. Albana Greca, MBBS, MMedSc
Family Physician / General Practitioner
Dr. Albana Greca has more than 20 years of experience in primary care, general medicine, chronic disease management, prevention, patient education and digital health.
Dr. Benard Shehu, MBBS, MS
Cardiologist
Dr. Benard Shehu has more than 19 years of cardiovascular experience, including clinical experience relevant to arrhythmias and cardiovascular disease.