Lorazepam Dosage Guide + Max Dose, Adjustments

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Medically reviewed by Drugs.com. Last updated on May 22, 2023.

Applies to the following strengths: 1 mg; 2 mg; 0.5 mg; 4 mg/mL; 2 mg/mL; 1 mg/mL-NaCl 0.9%; 1.5 mg; 3 mg; 200 mg/200 mL-D5%

Usual Adult Dose for:

• Anxiety
• Light Anesthesia
• Status Epilepticus
• Insomnia

Usual Geriatric Dose for:

• Anxiety

Usual Pediatric Dose for:

• Anxiety
• Insomnia

Additional dosage information:

• Renal Dose Adjustments
• Liver Dose Adjustments
• Dose Adjustments
• Precautions
• Dialysis
• Other Comments

Usual Adult Dose for Anxiety

ORAL:
Initial dose: 2 to 3 mg orally per day, given 2 to 3 times per day
Maintenance dose: 1 to 2 mg orally 2 to 3 times a day

Comments:

• The daily dosage may vary from 1 to 10 mg/day.
• The dosage should be increased gradually when needed to help avoid adverse effects.
• When higher dosage is indicated, the evening dose should be increased before the daytime doses.
• Use of anxiolytic agents is typically not needed to treat anxiety/tension associated with the stress of everyday life.
• Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months).

Uses:

• Management of anxiety disorders
• Short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms

Usual Adult Dose for Light Anesthesia

INJECTION:
IM: 0.05 mg/kg IM ONCE

• Maximum dose: 4 mg

IV: 2 mg total OR 0.044 mg/kg IV ONCE, whichever is smaller

Comments:

• Doses of other injectable central-nervous-system depressant drugs should be reduced.
• Narcotic analgesics should be administered at their usual preoperative time.
• IV: The recommended dose of 2 mg (OR 0.44 mg/kg, whichever is smaller) should not ordinarily be exceeded in patients over 50 years of age.
• IV: Doses up to 0.05 mg/kg (4 mg maximum) may be administered.
• IM: For optimum effect, this route should be administered at least 2 hours before the anticipated operative procedure.
• IV: For optimum effect, this route should be administered 15 to 20 minutes before the anticipated operative procedure.

Use: As a preanesthetic medication to produce sedation (sleepiness or drowsiness), relieve anxiety, and decrease the ability to recall events related to the day of surgery

Usual Adult Dose for Status Epilepticus

INJECTION: 4 mg IV given at a rate of 2 mg/min; may repeat the dose in 10 to 15 minutes

• Maximum total dose: 8 mg

Comments:

• Vital signs should be monitored, an unobstructed airway should be maintained, and artificial ventilation equipment should be available.
• When an intravenous port is not available, the IM route may prove useful.

Use: Treatment of status epilepticus

Usual Adult Dose for Insomnia

ORAL: 2 to 4 mg orally once a day at bedtime

Comments:

• The dosage should be increased gradually when needed to help avoid adverse effects.
• Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months).

Use: Management of insomnia due to anxiety of transient situational stress

Usual Geriatric Dose for Anxiety

ORAL:
Older or debilitated patients:

• Initial dose: 1 to 2 mg orally per day, given in divided doses

Comments:

• The dosage should be increased gradually when needed to help avoid adverse effects.
• The daily dosage may vary from 1 to 10 mg/day.
• When higher dosage is indicated, the evening dose should be increased before the daytime doses.
• Use of anxiolytic agents is typically not needed to treat anxiety/tension associated with the stress of everyday life.
• Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months).

Uses:

• Management of anxiety disorders
• Short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms

Usual Pediatric Dose for Anxiety

ORAL:
12 years or older:

• Initial dose: 2 to 3 mg orally per day, given 2 to 3 times per day
• Maintenance dose: 1 to 2 mg orally 2 to 3 times a day

• The daily dosage may vary from 1 to 10 mg/day.
• The dosage should be increased gradually when needed to help avoid adverse effects.
• When higher dosage is indicated, the evening dose should be increased before the daytime doses.
• Use of anxiolytic agents is typically not needed to treat anxiety/tension associated with the stress of everyday life.
• Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months).

Uses:

• Management of anxiety disorders
• Short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms

Usual Pediatric Dose for Insomnia

ORAL:
12 years or older: 2 to 4 mg orally once a day at bedtime

Comments:

• For debilitated patients, an initial dosage of 1 to 2 mg/day in divided doses is recommended.
• The dosage should be increased gradually when needed to help avoid adverse effects.
• Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months).

Use: Management of insomnia

Renal Dose Adjustments

INJECTION:

• Frequent doses given over a relatively short period of time: Use with caution.
• Infrequent doses and/or doses given over a long period of time: No adjustment recommended.

ORAL: Use with caution.

Liver Dose Adjustments

INJECTION: No adjustment recommended.

ORAL:

• Mild to moderate liver dysfunction: Use with caution.
• Severe liver dysfunction: Dose adjustment(s) may be required; however, no specific guidelines have been suggested. Caution recommended.

Dose Adjustments

Doses should be reduced by 50% when coadministered with probenecid or valproate.

INJECTION: It may be necessary to increase the dose in female patients who are concomitantly taking oral contraceptives.

Precautions

US BOXED WARNINGS:
RISKS FROM CONCOMITANT USE WITH OPIOIDS:

• Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death.

Recommendations:

• Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate.
• Limit dosages and durations to the minimum required.
• If a decision is made to use this drug concomitantly with opioids, monitor patients closely for respiratory depression and sedation.

ABUSE, MISUSE, AND ADDICTION:

• The use of benzodiazepines, including this drug, exposes users to risks of abuse, miscues, and addiction, which can lead to overdose or death.
• Abuse and misuse of benzodiazepines commonly the involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes.

Recommendation:

• Before prescribing this drug and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction.

DEPENDENCE AND WITHDRAWAL REACTIONS:

• The continued use of benzodiazepines for several days to weeks may lead to clinically significant physical dependence.
• Although this drug is indicated only for intermittent use, if used more frequently than recommended, abrupt discontinuation or rapid dosage reduction of this drug may precipitate acute withdrawal reactions, which can be life-threatening.

Recommendation:

• Patients using this drug more frequently than recommended should gradually taper this drug to reduce the risk of withdrawal reactions.

INJECTION CONTRAINDICATIONS:

• Hypersensitivity to the active component, benzodiazepines, or to any of the ingredients (e.g., Benzyl alcohol, polyethylene glycol, propylene glycol)
• Intra-arterial use
• Patients with acute narrow-angle glaucoma
• Patients with sleep apnea syndrome
• Severe respiratory dysfunction EXCEPT those requiring relief of anxiety and/or reduced recall of events while being mechanically ventilated
• Use in premature infants

ORAL CONTRAINDICATIONS:

• Hypersensitivity to the active component, benzodiazepines, or to any of the ingredients
• Patients with acute narrow-angle glaucoma

Safety and efficacy of oral formulations have not been established in patients younger than 12 years.

Safety and efficacy of injection formulations have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule IV

Dialysis

Data not available

Other Comments

Administration advice:

• Oral concentrates: Solutions may be mixed with liquid or semi-solid foods.

Storage requirements:

• Injection: Protect from light; store in a refrigerator at 2 to 8 C
• Oral Concentrate: Store in a refrigerator at 2 to 8 C; discard after 90 days of opening
• Oral Solution: Store in a refrigerator at 2 to 8 C; protect from light
• Tablets: Store in a cool, dry place; protect from light

Reconstitution/preparation techniques:

• The manufacturer product information should be consulted.

IV compatibility:

• The manufacturer product information should be consulted.

General:

• This drug has not been shown to treat cardiovascular and/or gastrointestinal components of anxiety.

Monitoring:

• HEMATOLOGIC: Periodic blood counts, especially in patients on long-term therapy
• HEPATIC: Periodic liver function tests, especially in patients on long-term therapy
• NERVOUS SYSTEM: Sedation, especially within 1 hour of administration AND when given a parenteral formulation
• RENAL: Renal function, especially in older patients with decreased renal function
• RESPIRATORY: Respiratory function, especially in status epilepticus

Patient advice:

• This medicine may increase the risk of suicidal thoughts and behavior. Patients should be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Patients should report any behavior of concern to their healthcare provider as soon as possible.
• This drug may cause drowsiness, dizziness, and reduced alertness. Patients should not drive a car or operate dangerous machinery until they know how this drug affects them.
• Patients should avoid drinking alcohol or taking other drugs that may cause sleepiness or dizziness while taking this drug until they talk to their healthcare provider.
• Patients should be told to contact their healthcare provider before increasing/decreasing the dose or discontinuing treatment.
• Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.

Frequently asked questions

• Lorazepam vs Xanax: What is the difference?
• Ativan vs Xanax – What is the difference?

More about lorazepam

• Check interactions
• Compare alternatives
• Pricing & coupons
• Reviews (1,019)
• Drug images
• Latest FDA alerts (5)
• Side effects
• Patient tips
• During pregnancy
• Support group
• Drug class: benzodiazepine anticonvulsants
• Breastfeeding

Patient resources

• Drug Information
• Lorazepam injection
• Lorazepam (Injection) (Advanced Reading)
• Lorazepam (Oral) (Advanced Reading)
• Lorazepam Tablets

Other brands

Ativan, Lorazepam Intensol, Loreev XR

Professional resources

• Prescribing Information

Related treatment guides

• Borderline Personality Disorder
• Cervical Dystonia
• Anxiety
• Dysautonomia

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Forms, strengths, for sleep, and more

Ativan (lorazepam) is a prescription brand-name medication. The Food and Drug Administration (FDA) has approved it to:

• treat sleep problems caused by anxiety or stress
• treat certain seizures
• treat anxiety
• make you fall asleep before surgery

Ativan contains the active drug lorazepam and belongs to a drug class called benzodiazepines. Lorazepam is also the name of the generic form of Ativan.

Ativan comes as oral tablets and injections.

For information about the dosage of Ativan, including its forms, strengths, and how to take the medication, keep reading. For a comprehensive look at Ativan, see this article.

This article describes typical dosages for Ativan provided by the drug’s manufacturer. When taking Ativan, always follow the dosage prescribed by your doctor.

If your doctor prescribes Ativan, you may have questions about the drug’s dosage, such as:

• What’s Ativan’s dosage range?
• What are the usual dosage amounts of Ativan?
• What’s considered a safe dose of Ativan?

Below is a basic dosage chart for Ativan (“mg” refers to milligrams).

Ativan forms and strengths

Ativan comes as oral tablets and a vial that contains a liquid solution. The solution is given as an intravenous (IV) injection or intramuscular (IM) injection.

Here are the strengths for each form of Ativan:

• Oral tablets: 0.5 mg, 1 mg, 2 mg
• Liquid solution for injection: 2 mg per 1 milliliter (mL) of liquid solution (2 mg/mL), 4 mg/mL

Typical dosages

Depending on what you’re taking Ativan to treat and the dosage form your doctor prescribes, they may start you on a low dosage. Then they may adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly taken or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Dosage for sleep problems caused by anxiety or stress

To treat sleep problems caused by anxiety or stress, your doctor will prescribe Ativan tablets. The dosage range for this use is 2 mg to 4 mg once per day, taken at bedtime.

Dosage for certain seizures

To treat certain seizures, a healthcare professional will typically give you Ativan as an IV injection. In some cases, they may give you an IM injection.

The usual dosage is 4 mg given slowly (about 2 minutes). If the seizures continue after 10 to 15 minutes, you may be given another 4-mg dose.

Dosage for anxiety

To treat anxiety, your doctor will prescribe Ativan tablets. The dosage range for this use is 1 mg to 10 mg, which is usually split into two or three doses per day.

The typical dose is 2 mg to 6 mg, divided into two or three doses per day. For example, if your daily dosage is 4 mg, you would take 2 mg once in the morning and once in the evening.

Dosage for surgery

To make you sleep before surgery, a healthcare professional will typically give you an IM injection of Ativan.

For this use, Ativan is dosed based on body weight. You’ll likely receive an IM injection of 0.05 mg per kilogram (kg) of body weight, up to a maximum dose of 4 mg. (One kilogram equals about 2.2 pounds.)

Ativan may also be given by IV injection to make you sleep before surgery. The recommended dose for this use is either 2 mg or 0.02 mg per pound (0.044 mg/kg) of body weight, whichever is smaller.

The healthcare professional will determine what dose is right for you.

Long-term use

Using Ativan for more than 4 months in a row hasn’t been studied. Ativan is not meant to be taken as a long-term treatment. Your doctor will typically check from time to time whether you still need to take Ativan.

Children’s dosage

Ativan is not approved for children to take. The drug has not proven to be safe and effective to treat conditions in this group.

The maximum dose of Ativan in 24 hours is 10 milligrams (mg). This dose is typically taken for conditions that are treated with Ativan tablets, such as anxiety.

The 10-mg maximum dose is usually divided into two or three doses. For example, you may take 2 mg in the morning, 2 mg in the afternoon, and 6 mg before bed.

For making you sleep before surgery, the maximum dose of Ativan is 4 mg.

For more information about Ativan dosages, including what’s a safe dose of Ativan, see the “Ativan dosage” section just above.

Below are answers to some frequently asked questions about Ativan dosages.

What’s considered a ‘normal’ dosage of Ativan?

The “normal” (usual) dosage of Ativan is 2 milligrams (mg) to 6 mg total, divided into two or three doses. For example, to treat anxiety, you may take Ativan tablets at a dosage of 2 mg twice per day, for a total daily dosage of 4 mg.

For more information about Ativan dosages, including what’s a safe dose of Ativan, see the “Ativan dosage” section above. You can also speak with your doctor or pharmacist.

What’s the Ativan dosage for panic and anxiety attacks?

Ativan is not approved to treat panic or anxiety attacks. But the drug may be prescribed off-label for this use. Off-label use is when a drug is prescribed to treat a condition it isn’t approved to treat.

To learn more about using Ativan for panic or anxiety attacks and what the dosage would be, talk with your doctor or pharmacist.

Is Ativan used for dogs? If so, what’s the dosage for dogs?

Ativan is not approved for use in dogs, but your veterinarian might recommend Ativan for your dog in some situations. Ativan may be used in dogs to help reduce anxiety or stress, to sedate your dog during a surgery, or to treat seizures.

Do not give your dog Ativan unless your veterinarian recommends this. Your veterinarian can recommend whether this drug is safe for your dog and what dosage your dog might need. If you think your pet has eaten your Ativan medication, contact your veterinarian right away.

The Ativan dosage your doctor prescribes will depend on several factors. These include:

• the type and severity of the condition you’re using Ativan to treat
• the form of Ativan you take
• your age
• your body weight, depending on the form of the drug and what it’s treating

Other medical conditions you have can also affect your Ativan dosage.

Dosage adjustments

If you’re an older adult, you may need a lower dose of Ativan than usual. This is because Ativan affects your body differently as you age.

You may also need a dosage adjustment if you have kidney or liver problems. Your doctor will typically decrease your dose based on the severity of your liver or kidney condition.

Your doctor or pharmacist can tell you more about Ativan dosage adjustments.

How you take Ativan depends on the form of the drug you’re prescribed.

One form is oral tablets that you swallow. You can take them with or without food.

Ativan’s other form is a liquid solution that’s given as an intravenous (IV) injection or intramuscular injection. A healthcare professional will give you Ativan injections.

Be sure to take Ativan exactly as your doctor prescribes. You should not take more or less Ativan than prescribed without first speaking with them.

If you miss a dose of Ativan, take it as soon as you remember. But if it’s almost time for your next dose, skip the missed dose. Then take your next dose at your regular scheduled time.

You should not take more than one dose to try and make up for the missed dose. This can increase your risk for side effects from Ativan. (For more about Ativan’s side effects, see this article.)

To help make sure that you do not miss a dose, try using a medication reminder. This can include setting an alarm or timer on your phone or downloading a reminder app. A kitchen timer can work, too.

Ativan has a boxed warning regarding misuse and addiction. A boxed warning is the most serious warning given to a medication by the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

Taking Ativan can lead to misuse and addiction, even when you take an approved dosage. Misusing Ativan can cause serious side effects such as trouble breathing or coma. This risk increases if you take Ativan with certain other drugs or substances, including alcohol. Although rare, misusing Ativan can be fatal.

Misusing Ativan can also increase your risk for overdose. (To learn more, see the “Ativan and overdose” section below.

Because of the risk for misuse, Ativan is a controlled substance. This means its use is regulated by the government to prevent possible misuse. You should not share your Ativan prescription with anyone else. Be sure to take Ativan exactly as your doctor prescribes.

Also, it’s recommended that you store Ativan in a safe place, away from children.

If you take more Ativan than your doctor prescribes, you may develop serious side effects.

It’s important that you do not take more Ativan than your doctor advises.

Symptoms of an overdose

Overdose symptoms of Ativan can include:

• confusion
• drowsiness
• low blood pressure
• problems with coordination or balance
• slowed reflexes
• coma
• in rare cases, death

If you take more than the recommended amount of Ativan

Call your doctor right away if you believe you’ve taken too much Ativan. Another option is to call the American Association of Poison Control Centers at 800-222-1222 or use its online tool. If you have severe symptoms, immediately call 911 or your local emergency number, or go to the nearest emergency room.

Ativan has a boxed warning regarding physical dependence and withdrawal. A boxed warning is the most serious warning given to a medication by the Food and Drug Administration. It alerts doctors and patients about drug effects that may be dangerous.

Using Ativan can lead to physical dependence. This could lead to withdrawal if you suddenly stop taking the drug, even if you take an approved dosage.

You should not suddenly stop taking Ativan. Doing so could cause serious or, rarely, life-threatening side effects that can include:

• seizures
• unusual movements, expressions, or responses
• depression
• hallucinations (seeing or hearing things that aren’t there)
• losing touch with reality

In some people, withdrawal symptoms from benzodiazepines such as Ativan can cause symptoms that last for up to 12 months, such as:

• anxiety
• trouble remembering or concentrating
• depression
• trouble sleeping
• feeling like insects are crawling under your skin
• muscle weakness or twitching
• tinnitus (ringing in your ears)

Instead of suddenly stopping Ativan treatment, your doctor will help you with a drug taper. This involves gradually lowering the dosage of the medication over time. A drug taper can help decrease your risk for withdrawal symptoms or make them less severe.

If you’re interested in stopping treatment with Ativan, be sure to talk with your doctor first. You should not suddenly stop taking the drug on your own.

The dosages in this article are typical dosages provided by the drug manufacturer. If your doctor recommends Ativan for you, they will prescribe the dosage that’s right for you. Always follow the dosage that your doctor prescribes for you.

As with any drug, never change your dosage of Ativan without your doctor’s recommendation. If you have questions about the dosage of Ativan that’s right for you, talk with your doctor.

Besides learning about dosage, you may want other information about Ativan. These additional articles might be helpful:

• More about Ativan. For information about other aspects of Ativan, refer to this article.
• Drug comparison. To find out how Ativan compares with Xanax, read this article.
• Side effects. To learn about side effects of Ativan, see this article. You can also look at the prescribing information for Ativan tablets and solution.
• Interactions. For details about what Ativan interacts with, see this article.
• Details about your condition. For details about sleep problems, refer to our sleep hub and list of sleep articles. For more information about mental health and anxiety, see our mental health hub and list of anxiety articles. To learn more about the other conditions Ativan is prescribed for, talk with your doctor.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

official instructions for use, analogues, price, availability in pharmacies

INSTRUCTIONS for the medical use of the drug

Registration number:

P N016057/01 10/16/2009

Trade name of the drug: 9000 5

Lorafen.

International non-proprietary name:

lorazepam (lorazepam).

Dosage form:

Coated tablets

Composition:

Tablets 1 mg
active ingredient: lorazepam 1 mg
excipients:
tablet core: potato starch 6 mg, sodium carboxymethyl starch 0. 1 mg, gelatin 1.5 mg, talc 1.8 mg, magnesium stearate 1.2 mg, lactose up to 80 mg;
tablet shell: polyvinyl alcohol 0.125 mg, talc 7 mg, maltodextrin 0.23 mg, sucrose 22.5 mg, titanium dioxide 0.18 mg.

Tablets 2.5 mg
active ingredient: lorazepam 2.5 mg
excipients:
tablet core: potato starch 6 mg, sodium carboxymethyl starch 0.5 mg, gelatin 1.5 mg, talc 1.8 mg, crimson dye [Ponceau 4R] 0.00286 mg, magnesium stearate 1.2 mg , lactose up to 80 mg;
tablet shell: polyvinyl alcohol 0.125 mg, talc 7 mg, maltodextrin 0.23 mg, sucrose 22.5 mg, crimson dye [Ponceau 4R] aluminum lacquer 0.01 mg, titanium dioxide 0.17 mg.

Description

Tablets 1 mg – round, biconvex film-coated tablets, white or almost white.

Tablets 2.5 mg – round, biconvex film-coated tablets, pink.

Pharmacotherapeutic group:

Anxiolytic agent.

ATX code:

N 05 VA 06

Pharmacological properties

Pharmacodynamics
The drug belongs to the list of psychotropic substances (list III).

Lorazepam belongs to the group of 1,4-bepzodiazepine derivatives. The drug acts on many structures of the central nervous system – primarily on the limbic system and the hypothalamus, i.e. on the structures associated with the regulation of emotional activity. Like all benzodiazepines, it enhances the inhibitory effect of GABAergic neurons in the cerebral cortex, hypocampus, cerebellum, thalamus, and hypothalamus. The existence of binding sites specific for benzodiazspins, which are protein structures of the cell membrane, which are associated with a complex consisting of a GABA-A receptor and a chloride channel, has been established. The action of lorazepam is to modulate the “sensitivity” of the GABAergic receptor, which leads to an increase in the affinity of this receptor for gamma-aminobutyric acid (GABA), which is an endogenous inhibitory neurotransmitter. The consequence of activation of the benzodiazepine receptor or GABA-A is an increase in the flow of chloride ions into the neuron through the chloride channel. This leads to hyperpolarization of the cell membrane, resulting in inhibition of neuron activity. Clinically, lorazepam has an anxiolytic and hypnotic effect. It also has an anticonvulsant and central muscle relaxant effect.

During treatment with Lorafen and within 3 days after its completion, you can not drive vehicles and engage in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Pharmacokinetics

Absorption
Lorazepam is well absorbed from the digestive tract. The maximum concentration in the blood reaches approximately 2 hours. After ingestion of 2 mg lorazepam. the maximum concentration in the blood is 20 ng / ml.

Distribution
Lorazepam is 85% bound to blood proteins. Passes through the blood-brain and placental barriers. Penetrates into mother’s milk.

Metabolism
The process of biotransformation of lorazepam occurs in the liver. As a result of conjugation with glucuronic acid, an inactive metabolite, lorazepam glucuronate, is formed. The biological half-life of lorazepam is about 12 hours.

Elimination
Lorazepam is excreted in the urine as lorazepam glucuronate.

Indications for use:

The drug should be used strictly according to the doctor’s prescription in order to avoid complications. Attention! States of mental stress and anxiety associated with everyday problems are not an indication for the use of the drug.

Contraindications:

Severe liver and kidney failure.

Lorafen is not recommended for use in patients with psychoses.

Due to the lactose content, Lorafen should not be used in patients with hereditary lactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption.

Due to the sucrose content, Lorafen should not be used in patients with hereditary disorders associated with fructose intolerance, glucose-galactose malabsorption syndrome or sucrase-isomaltase deficiency.

Caution:

Hepatic and (or) renal insufficiency of mild and moderate severity, chronic respiratory failure, porphyria. depression, history of suicidal thoughts and attempts, history of drug, drug or alcohol addiction, cerebral and spinal ataxia, hyperkinesis. organic diseases of the brain, hypoproteinemia. elderly age.

Lorafen is not recommended for use in patients with psychosis.

Do not drink any alcoholic beverages during treatment with Lorafen and for 3 days after its completion.

Use in pregnancy and lactation

Before using each drug, the patient should consult a doctor.

The use of lorazepam in pregnant women is allowed only if its use in the mother is absolutely indicated, and the use of a safer, alternative agent is not possible.

Lorazepam passes into breast milk. Therefore, if the use of the drug in a nursing mother is indicated, it is necessary to stop breastfeeding.

Dosage and Administration

The drug should be taken orally with a small amount of water. Dosage and duration of treatment should be strictly according to the doctor’s instructions.

Adults and children over 12 years old

In neurotic and neurosis-like conditions, it is usually first prescribed from 2 mg to 3 mg of lorazepam per day, divided into 1-3 doses, and then, if necessary, increase the daily dose of the drug to a maintenance dose, which most often ranges from 2 mg to 6 mg per day. day, divided into 1-3 doses.

For the relief of anxiety symptoms, it is recommended to use the lowest possible effective dose.

The dose of lorazepam should be increased gradually, starting with an increase in the dose taken in the evening. A maximum of 10 mg per day can be prescribed.

For sleep disturbances caused by anxiety, 2 mg to 5 mg lorazeiam is usually given once a day at bedtime.

For premedication, 2 mg to 5 mg on the night before the scheduled procedure or surgery, and on the day of the procedure, from 2 mg to 5 mg 1-2 hours before the procedure or surgery.

Children under 12

The use of lorazepam in children is not recommended due to the lack of data on the safety and efficacy of lorazepam in children under 12 years of age.

Patients with mild to moderate hepatic and/or renal insufficiency

Caution should be exercised when prescribing lorazepam to patients with mild to moderate hepatic and/or renal impairment. The dose is selected individually for each patient, depending on the degree of insufficiency of the diseased organ.

Elderly patients
Elderly patients are more sensitive to drugs acting on the central nervous system. When using lorazepam in these patients, it is recommended to prescribe the lowest possible effective dose. It is usually sufficient to use half the dose prescribed for adults.

In the symptomatic treatment of anxiety disorders, the duration of treatment should be limited to a minimum – usually from a few days to 2 weeks. In individual cases, treatment may be extended. The maximum duration of treatment, including a period of gradual withdrawal, should not exceed 4 weeks. The gradual withdrawal of the drug must be set individually for each patient. In individual cases, after assessing the patient’s condition, the doctor may decide to extend the maximum treatment time.

If a dose of Lorafen is missed:
the drug should be taken as soon as possible or continue to take the drug regularly.

Do not take a double dose to make up for a missed dose!

Side effects

From the nervous system (especially in elderly patients): drowsiness, fatigue, dizziness, decreased ability to concentrate, ataxia (unstability of gait and poor coordination of movements leading to loss of balance), disorientation, lethargy , muscle atony, dullness of emotions, slowing down of mental and motor reactions: less often – headache, euphoria, depression, tremor, depressed mood, catalepsy, amnesia, confusion, dystonic extrapyramidal reactions (uncontrolled body movements, including the eyes), myasthenia gravis during the day . dysarthria; extremely rarely, paradoxical reactions (aggressive outbursts, fear, suicidal tendencies, muscle spasm, confusion, hallucinations, acute agitation, irritability, anxiety, insomnia).

From the senses: visual impairment (diplopia).

On the part of the hematopoietic organs: leukopenia, neutropenia, agranulocytosis (chills, hyperthermia, sore throat, excessive fatigue or weakness), anemia, thrombocytopenia.

From the digestive system: dry mouth or salivation, heartburn, nausea, vomiting, loss of appetite, constipation or diarrhea; abnormal liver function, increased activity of “liver” transaminases, lactate dehydrogenase and alkaline phosphatase, jaundice.

From the genitourinary system: urinary incontinence, urinary retention, impaired renal function, increased or decreased libido, dysmenorrhea.

Allergic reactions: skin rash (including erythematosus, urticaria), itching of the skin: extremely rarely – anaphylactic reactions.

Effect on the fetus: teratogenicity, respiratory failure and suppression of the sucking reflex in newborns whose mothers used the drug.

Others: addiction, drug dependence, lowering blood pressure: rarely – depression of the respiratory center, bulimia, weight loss, tachycardia.

With a sharp decrease in the dose or discontinuation of the intake – “withdrawal” syndrome (irritability, headache, anxiety, excitement, agitation, fear, nervousness, sleep disturbances. dysphoria, spasm of smooth muscles of internal organs and skeletal muscles, myalgia. depersonalization, perspiration , increased sweating, depression, nausea, vomiting, tremor, perception disorders, including hyperacusis, paresthesia, photophobia, tachycardia, convulsions, hallucinations, rarely acute psychosis).

Overdose

An overdose of lorazepam may result in the following symptoms: drowsiness, confusion, slurred speech, and in severe cases, loss of consciousness, coma. Life-threatening poisoning can be caused by the simultaneous use of lorazepam and alcohol or lorazepam and other drugs that have a depressant effect on the central nervous system.

In case of poisoning with lorazepam, it is necessary to take measures aimed at the fastest possible elimination of the still unabsorbed drug from the body or a decrease in its absorption from the digestive tract (provoking vomiting, taking activated charcoal, gastric lavage – subject to preserved consciousness), monitoring basic vital functions (respiration, pulse, blood pressure) and, if necessary, apply appropriate symptomatic treatment.

The specific antidote is flumazenil.

Interaction with other medicinal products

Pharmaceutical
Pharmaceutical types of incompatibility have not been determined.

Pharmacodynamic

Pharmacokinetic

Disulfiram. cimetidine, erythromycin, ketoconazole, being inhibitors of cytochrome P450 isoenzymes, inhibit the processes of biotransformation of 1,4-benzodiazepine derivatives and enhance their inhibitory effect on the central nervous system.

Special instructions

Regular use of benzodiazepines or similar drugs, including lorazepam for several weeks, may lead to a decrease in their effectiveness due to the development of tolerance.

The use of benzodiazepines or drugs of similar action can lead to the development of mental and physical drug dependence. The risk of developing drug dependence increases with the dose and duration of treatment and increases in patients with alcohol dependence, with drug dependence, as well as in patients with dependence on other drugs.
In the event of drug dependence, abrupt discontinuation of the drug may lead to withdrawal symptoms.
The characteristic manifestations of the withdrawal syndrome are: headache, irritability, muscle pain, psychomotor agitation and emotional stress, motor restlessness, confusion and disorientation, sleep disturbance. In severe cases, there may be: loss of a sense of the reality of the environment (derealization), personality disorders (depersonalization), increased sensitivity to touch (tactile hyperesthesia), increased sensitivity to auditory and visual stimuli (acoustic and light hyperesthesia). a feeling of “crawling” and numbness of the limbs, hallucinations or seizures. Especially dangerous can be an abrupt cessation of treatment carried out for a long time, during which lorazepam was used in doses higher than average. The manifestations of the withdrawal syndrome are then more pronounced.
There is evidence that in the case of short-acting benzodiazepines and benzodiazepine-like drugs, withdrawal symptoms can be observed even in the intervals between taking individual doses. especially if the drug is used in large doses.

After the end of treatment, there may be a temporary recurrence of symptoms more pronounced than those that caused the initial treatment (so-called “rebound” insomnia). These symptoms are often accompanied by mood changes, fear, anxiety, increased motor activity. The patient should be informed about the possibility of rebound insomnia, this will reduce his anxiety in case such symptoms appear after stopping treatment with the drug.
The likelihood of developing an abstinence syndrome or the appearance of rebound insomnia increases with a sharp cessation of the drug. A gradual decrease in the dose of the drug is recommended in order to minimize the risk of such symptoms.

Lorafen should be used with great caution in elderly patients (over 65 years of age), due to the increase in adverse events in this age group, mainly impaired orientation and coordination of movements, which can lead to loss of balance.

Lorafen should be used with caution in patients with non-acute porphyria. The use of the drug can lead to an increase in the symptoms of this disease.

During treatment with Reladorm and within 3 days after its completion, you can not drive vehicles and engage in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Presentation:

Coated tablets, 1 mg; 2.5 mg.
25 tablets in a blister of aluminum foil and orange PVC film. One blister with instructions for use of the drug in a cardboard box, equipped with stickers for the control of the first opening.

Storage conditions

The drug belongs to the list of psychotropic substances (list III).
Store in a dry, dark place at temperatures not exceeding 25°C.
Keep out of the reach of children.

Shelf life

2 years.
Do not use after the expiry date which is stated on the package.

Terms of dispensing from pharmacies:

On prescription.

Manufactured in Poland

Name and address of manufacturer A. Fleming 2. 03-176 Warsaw, Poland

Representation of the Tarkhominsk Pharmaceutical Plant “POLFA” A, O. in Russia:

105082 Moscow, st. Bolshaya Pochtovaya, 26 V, bldg. 2, office 15.

Liki Control – Assistance to patients free of charge to receive medical, effective and medical services

Call, mi yuchi at the station stress .

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