1. Introduction
Lorazepam is a benzodiazepine used for its anxiolytic, sedative, anticonvulsant, and muscle relaxant properties. It works by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity, producing a calming effect.
2. Indications
- Approved Indications:
- Anxiety disorders.
- Insomnia associated with anxiety or transient stress.
- Preoperative sedation.
- Status epilepticus (IV use).
- Off-Label Uses:
- Alcohol withdrawal syndrome.
- Acute agitation or aggression in psychiatric conditions.
3. Dosage
- Anxiety:
- Adults: 1–3 mg/day in divided doses, typically 2–6 mg/day for severe anxiety.
- Elderly: 1–2 mg/day in divided doses (start at the lower end).
- Insomnia:
- Adults: 1–2 mg at bedtime.
- Preoperative Sedation:
- Adults: 1–4 mg IM or IV, 30–90 minutes before surgery.
- Status Epilepticus (IV use):
- Adults: 4 mg IV at a rate of 2 mg/min. May repeat after 10–15 minutes if seizures persist.
- Paediatrics (Status Epilepticus):
- 0.05–0.1 mg/kg IV every 10–15 minutes, maximum total dose of 4 mg.
4. Administration
- Oral: Take tablets with or without food, usually at the same time daily.
- IV/IM: Administered under medical supervision, ensuring proper dosing and monitoring.
5. Forms Available
- Tablets: 0.5 mg, 1 mg, 2 mg.
- Oral solution: 2 mg/mL.
- Injection: 2 mg/mL, 4 mg/mL.
6. Side Effects
6.1. Common Side Effects
- Drowsiness.
- Dizziness.
- Fatigue.
- Weakness.
6.2. Less Common Side Effects
- Confusion.
- Blurred vision.
- Nausea.
6.3. Rare but Serious Side Effects
- Respiratory depression (especially with IV use or in high doses).
- Dependence or withdrawal symptoms with long-term use.
- Paradoxical reactions (e.g., agitation, irritability).
7. Warnings
- Dependence and Withdrawal: Prolonged use can lead to physical and psychological dependence. Withdrawal symptoms may include anxiety, tremors, seizures, and insomnia.
- Respiratory Depression: Risk increases when combined with alcohol or other CNS depressants.
- Elderly Patients: Increased risk of sedation, falls, and cognitive impairment.
8. Precautions
- Avoid abrupt discontinuation to prevent withdrawal symptoms. Gradually taper the dose under medical supervision.
- Use cautiously in patients with:
- Respiratory conditions (e.g., COPD, sleep apnoea).
- Severe liver or kidney impairment.
- History of substance abuse.
9. Interactions
- Drug-Drug Interactions:
- Alcohol and CNS depressants (e.g., opioids): Increased risk of respiratory depression and sedation.
- Valproate: Increases lorazepam levels, requiring dose adjustments.
- CYP3A4 inhibitors (e.g., ketoconazole): May increase lorazepam levels.
- Drug-Food Interactions:
- Avoid alcohol, as it enhances sedative effects.
10. Monitoring Parameters
- Symptom relief (e.g., reduced anxiety or seizure control).
- Signs of sedation or respiratory depression.
- Dependence or misuse in long-term users.
11. Use in Children
- Approved for short-term use in conditions like status epilepticus. Use cautiously and adjust doses based on weight.
12. Use in Pregnancy
- Category D: May cause foetal harm (e.g., congenital malformations, neonatal withdrawal). Avoid use during pregnancy unless necessary.
13. Use in Elderly
- Use cautiously at the lowest effective dose to reduce the risk of sedation, falls, and cognitive impairment.
14. Use in Kidney Disease
- No specific dose adjustments are needed in mild to moderate renal impairment. Use cautiously in severe kidney disease.
15. Use in Liver Disease
- Use cautiously in patients with hepatic impairment, as lorazepam is metabolised in the liver. Dose adjustments may be necessary.
16. Patient Counselling Points
- Take lorazepam exactly as prescribed. Do not increase the dose or use it more frequently than recommended.
- Avoid alcohol while using lorazepam, as it may increase sedation and respiratory depression.
- Inform your doctor if you experience worsening symptoms, unusual mood changes, or excessive drowsiness.
- Do not stop lorazepam suddenly if you have been taking it for a long time; consult your doctor for a tapering schedule.
- Store lorazepam in a safe place to prevent misuse, especially by others in the household.
17. Table of Brand Names, Manufacturers, and Prices
Brand Name | Manufacturer | Price (USD) |
---|---|---|
Ativan | Pfizer | $20–40 (30 tablets, 1 mg) |
Generic Lorazepam | Various manufacturers | $10–30 (30 tablets, 1 mg) |
18. FAQs (15 Questions)
- What is lorazepam used for?
It is used to manage anxiety, insomnia, seizures, and for preoperative sedation. - How does lorazepam work?
It enhances the effects of GABA, a neurotransmitter that calms brain activity. - How long does lorazepam take to work?
Effects begin within 20–30 minutes when taken orally. - How long does lorazepam last?
Its effects last 6–8 hours, but it may remain in the body longer. - Can lorazepam cause dependence?
Yes, prolonged use can lead to physical and psychological dependence. - Is lorazepam safe for children?
It can be used in specific conditions (e.g., seizures) but requires close monitoring. - Can lorazepam be used during pregnancy?
It is generally avoided due to potential harm to the foetus. - Can lorazepam be taken with alcohol?
No, alcohol increases the risk of sedation and respiratory depression. - What are common side effects of lorazepam?
Common side effects include drowsiness, dizziness, and fatigue. - How should I store lorazepam?
Store at room temperature, away from moisture and heat, and out of reach of children. - Can lorazepam be stopped suddenly?
No, sudden discontinuation may cause withdrawal symptoms; taper off gradually. - How should lorazepam be taken for insomnia?
Take 1–2 mg at bedtime or as prescribed. - What should I do if I miss a dose of lorazepam?
Take it as soon as you remember unless it’s close to the next dose. Do not double up. - Can lorazepam cause memory problems?
Yes, it may cause short-term memory issues, especially with high doses. - Is lorazepam safe for elderly patients?
Yes, but it should be used cautiously at the lowest effective dose to minimise side effects.