There’s a new crew of characters in HBO’s hit series The White Lotus, but people are already obsessing over one in particular: Victoria Ratliff. On the show, we see the wealthy and regularly anxious Victoria, played by actor Parker Posey, show up to the resort with a huge pill container of lorazepam, a medication she name-checks and pops like candy throughout the show.
Victoria uses lorazepam to help her sleep and even takes the medication before having what should be a relaxing massage. But Victoria can also be seen mixing the prescription drug with wine at dinner, causing her to heavily slur her speech—and even fall asleep at the table—raising a lot of questions about what lorazepam is, what it’s meant for, and how to take it safely.
If you suspect that lorazepam isn’t designed to be used this way, you’re on to something, Thea Gallagher, PsyD, clinical associate professor at NYU Langone Health and cohost of the Mind in View podcast, tells SELF. “Victoria is not using this medication the way a prescriber would want you to use it,” Dr. Gallagher says. So what actually is this drug and what’s the right way to use it? We asked doctors to explain.
What is lorazepam?
Lorazepam, usually better known for its brand name, Ativan, is a prescription medication that’s used to treat anxiety disorders. It’s in a class of medications called benzodiazepines, which act as sedatives and hypnotics, according to the US Drug Enforcement Administration (DEA). Fellow medications within this group include Valium, Xanax, and Klonopin.
Lorazepam interacts with an area in the brain called the GABAA channel, which slows activity in the brain and helps people relax, Jamie Alan, PhD, an associate professor of pharmacology and toxicology at Michigan State University, tells SELF. “This activity can result in muscle relaxation, sedation, and a decrease in seizure activity,” she says. “It can also promote sleep.”
Unlike medications like selective serotonin reuptake inhibitors, which are used long-term to treat anxiety disorders and depression, lorazepam is designed to be taken on-demand and goes to work within a few minutes.
Okay, so what is lorazepam used for?
Victoria’s behavior suggests that lorazepam can be used for just about anything, but doctors say it has a specific purpose. “Lorazepam is most commonly used in very short-term situations for treatment of things like anxiety, panic attacks, and alcohol withdrawal,” Ryan Marino, MD, an assistant professor in the departments of emergency medicine and psychiatry at Case Western Reserve University School of Medicine, tells SELF. It can also be used to treat insomnia that’s related to anxiety or temporary stressors.
But short-term is the key part here, with the Food and Drug Administration (FDA) recommending that lorazepam only be prescribed for periods of two to four weeks.
“It’s not something that you should be consistently on, for life,” Dr. Gallagher says. She lists possible scenarios for using this drug, like helping someone with severe flying anxiety get on a plane, or a person with a dental phobia feel comfortable enough to go through a teeth cleaning. “It’s supposed to be used for situations when you’re feeling especially anxious and activated as a ‘bridge’ medication to help you manage that,” she says. Once that acute, anxiety-provoking situation ends, so should your use of the drug.
What are lorazepam’s side effects?
Lorazepam can be really helpful in certain scenarios, but it’s meant to be used short-term because it does come with the risk of a handful of side effects. Everyone reacts to lorazepam slightly differently according to Dr. Marino. While higher doses tend to have more of an impact, even low doses can cause a wide range of effects, from helping people feel relaxed to making them belligerent, he says.
These are the most common side effects of taking lorazepam, according to the FDA:
- Sedation
- Dizziness
- Weakness
- Unsteadiness
But the FDA notes that you may also experience a range of effects including drowsiness, amnesia, confusion, seizures, blurred vision, depression, and euphoria, to name a few, while using the medication.
Long-term usage can also lead to both psychological and physiological dependence and "life-threatening withdrawal in chronic use,” Dr. Marino says. In fact, in 2020, the FDA announced that benzodiazepines will require a new boxed warning—the most prominent FDA warning available—to alert consumers about the potential for “abuse, misuse, addiction, physical dependence, and withdrawal reactions” that can be side effects of the drugs, as SELF previously reported. Because of this, doctors also recommend that people who have been on the medication for longer periods of time gradually wean themselves off it under the guidance of a health care provider instead of quitting abruptly.
Can you drink on lorazepam?
Nope, you definitely should never drink while taking lorazepam. “Both lorazepam and alcohol are ‘downers’ and can cause sedation when taken in normal amounts or in overdose,” Kelly Johnson-Arbor, MD, a toxicologist at MedStar Health, tells SELF. Ingesting the two at the same time can make the effects worse and have life-threatening effects on your cardiovascular and respiratory systems, leading to coma and death, per the FDA. (Same goes for other benzodiazepines.)
“Mixing lorazepam with alcohol can easily result in death,” Dr. Alan says. Dr. Gallagher also warns against combining the two: “It can be incredibly dangerous.”
On that note, lorazepam can also interact with other medications that depress the central nervous system, like opioids, antipsychotics, antidepressants, anticonvulsants, certain antihistamines, and more. So it’s critical to talk with your doctor about any other drugs (prescription or not) that you take before using this one too.
Despite the way Victoria misuses lorazepam on The White Lotus, Dr. Gallagher says there is a role for the medication in people trying to navigate intense moments of anxiety—for the short-term. However, mental health providers usually work with patients to build other coping skills so they don’t need to use lorazepam anymore.
“When you take a fast-acting anxiety medication, you teach your brain that you need to have that to get through anything that makes you anxious,” Dr. Gallagher says. “We want you to learn to use other skills and tools to manage your anxiety without it.”
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