How and when to take lorazepam

Always take lorazepam exactly as a doctor or pharmacist has told you.

Dosage and strength

Lorazepam comes as 0.5mg, 1mg and 2.5mg tablets. The liquid contains 1mg of lorazepam in each 1ml.

The usual dose is:

• anxiety in adults – 1mg to 4mg each day. Your doctor will tell you how often you need to take it
• sleeping problems in adults – 1mg to 2mg before bedtime (lorazepam will start to work in around 20 to 30 minutes)
• a pre-med for adults – 2mg to 3mg the night before the procedure and then 2mg to 4mg about 1 to 2 hours before your procedure
• a pre-med for children aged 5 years to 11 years – the dose will depend on the child’s weight
• a pre-med for children aged 12 to 17 years – 1mg to 4mg either the night before the procedure or at least 1 hour before the procedure, or both

For older people or people with liver or kidney problems, a doctor may recommend a lower dose.

Changes to your dose

Lorazepam is usually prescribed for a short time, from a few days to 4 weeks. Your dose may go up or down until your doctor is sure you’re on the right dose.

Your doctor may gradually reduce your dose at the end of the course of treatment before you stop completely.

How to take it

Take lorazepam tablets with a drink of water. You can take them with or without food.

If you’re taking lorazepam as a liquid, the medicine will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

How long to take it for

How long you take lorazepam for depends on why you’re taking it.

For anxiety and sleep problems, it’s usually only recommended for up to 4 weeks. Your dose may be reduced gradually to prevent withdrawal symptoms.

Before an operation or procedure, you’ll usually only need a maximum of 2 doses.

If you’re having a seizure or fit, you’ll only be given a lorazepam injection while you’re in hospital.

If a doctor prescribes lorazepam for more than 4 weeks, they’ll tell you how long to take it for.

If you forget to take it

If you forget to take your lorazepam:

• for anxiety – if it’s less than 3 hours since your missed dose, take it as soon as you remember. If more than 3 hours have passed, skip the missed dose and take your next dose at the usual time
• for sleeping problems – leave out the missed dose if you have not taken it by bedtime, and take your usual dose the next night
• before an operation or procedure (pre-med) – read any information the hospital has given you about your procedure, which may have advice about missed doses. If it does not, call the hospital to ask what to do next

Never take 2 doses to make up for a forgotten dose.

If you often forget doses, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on other ways to remember to take your medicine.

If you take too much

If you take more than your prescribed dose of lorazepam you may get symptoms including:

• poor co-ordination or trouble speaking
• feeling sleepy
• a slow or irregular heartbeat
• uncontrolled eye movements
• muscle weakness
• feeling overexcited

The amount of lorazepam that can lead to an overdose varies from person to person.

Urgent advice: Contact 111 for advice now if:

• you take more than your prescribed dose of lorazepam

Go to 111. nhs.uk or call 111

If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the lorazepam packet or leaflet inside it, plus any remaining medicine, with you.

Page last reviewed: 14 February 2023

Next review due: 14 February 2026

Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Lorazepam and diazepam are generic drugs that work to treat anxiety disorders, among other mental health conditions. Both drugs are classified as benzodiazepines. They work by increasing the activity of GABA, or gamma-aminobutyric acid, in the brain. The neurotransmitter GABA is an inhibitory chemical that blocks certain nerve signals, boosting the mood, and promoting a sense of calm.

Both lorazepam and diazepam are Schedule IV drugs, according to the Drug Enforcement Administration (DEA). This means that these drugs, like other benzodiazepines, carry a risk of dependence and abuse. Therefore, they should only be used as short-term therapy under the supervision of a healthcare provider.

Read on to learn about other differences between lorazepam and diazepam.

What are the main differences between lorazepam vs. diazepam?

The main difference between lorazepam and diazepam is that diazepam stays in the body longer than lorazepam. Lorazepam (Lorazepam coupons | What is Lorazepam?), which is the generic name for Ativan, has a half-life of up to 18 hours. On the other hand, diazepam, which is the generic name for Valium, has a half-life of up to 48 hours. Therefore, lorazepam is considered an intermediate-acting benzodiazepine, and diazepam is considered a long-acting benzodiazepine.

Lorazepam and diazepam are also metabolized, or processed, in the body differently. Lorazepam is metabolized in the liver by a process known as glucuronidation. Diazepam (Diazepam coupons | What is Diazepam?) is metabolized in the liver by cytochrome enzymes. As a result, diazepam has more of a potential to interact with other drugs than lorazepam.

Lorazepam is available in generic oral tablets with strengths of 0.5 mg, 1 mg, and 2 mg. It also comes as an oral solution and a solution for injection. Ativan is available in generic oral tablets with strengths of 2 mg, 5 mg, and 10 mg. Ativan can also be administered as an oral solution, solution for injection, and rectal gel.

Conditions treated by lorazepam vs. diazepam

Lorazepam and diazepam act as anxiolytics to reduce anxiety symptoms, such as overwhelming stress and difficulty thinking clearly. Lorazepam and diazepam are both FDA approved to treat anxiety and anxiety disorders, such as panic disorders and panic attacks.

Like other benzodiazepines, lorazepam and diazepam can be used to treat seizure disorders, or epilepsy. They can also be used as a premedication before surgery for the purpose of sedation.

Diazepam is also FDA approved to treat alcohol withdrawal syndrome and muscle spasms. In addition to treating anxiety, lorazepam is also approved for treating insomnia caused by anxiety. Other off-label uses can be found in the table below.

Is lorazepam vs. diazepam more effective?

Compared to placebo, or no medication, both lorazepam and diazepam are effective for treating anxiety. The more effective benzodiazepine will depend on the condition being treated, other medications being taken, and any treatments that have been previously tried.

Randomized, controlled clinical trials have largely shown that lorazepam and diazepam are comparable in effectiveness for treating anxiety. One double-blind clinical trial comparing lorazepam and diazepam in 134 anxious patients over four weeks found that both drugs were more effective than placebo. However, lorazepam was found to be more effective in patients who had worse symptoms initially. Sedation was reported to be a more significant side effect in the group taking lorazepam.

In a network meta-analysis, midazolam, lorazepam, and diazepam were compared for treating status epilepticus, a severe prolonged seizure, in children. Data compiled from 16 different clinical trials found that midazolam and lorazepam were more effective than diazepam.

This comparison is for general informational purposes. Seek medical advice from a doctor or healthcare provider before using a benzodiazepine. Your healthcare provider will conduct a thorough medical evaluation to determine the severity of your condition and to rule out other possible mental health conditions.

Coverage and cost comparison of lorazepam vs. diazepam

Generic lorazepam is generally covered by most Medicare and insurance plans. Without insurance, the average cash price can be $25 for 30, 0.5 mg tablets. A SingleCare lorazepam coupon could bring the cost down to about $9.

Try the SingleCare prescription discount card

Like other generic drugs, diazepam is often covered by Medicare and insurance plans. The average cash price of generic diazepam is approximately $24 for 30, 0.5 mg tablets. Compared to lorazepam, diazepam may be slightly cheaper depending on your pharmacy. Using a SingleCare diazepam coupon could lower the cost to $7 at participating pharmacies.

Common side effects of lorazepam vs. diazepam

Lorazepam and diazepam, like other benzodiazepines, primarily cause side effects in the central nervous system (CNS). The most common side effects of lorazepam, or Ativan, are sedation, dizziness, weakness, and unsteadiness, or loss of coordination. The most common side effects of diazepam, or Valium, are drowsiness, fatigue, muscle weakness, and loss of coordination.

Other possible side effects may include memory problems. The occurrence of side effects is usually dependent on the dosage of the medication taken. More serious side effects are reported with high doses of benzodiazepines. Serious side effects, including respiratory depression, or shallow breathing, could indicate a medical emergency.

*not reported
Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.
Source: DailyMed (Lorazepam), DailyMed (Diazepam)

Drug interactions of lorazepam vs. diazepam

Lorazepam and diazepam primarily interact with other drugs that affect the central nervous system (CNS). Taking these benzodiazepines with drugs like opioids, barbiturates, antipsychotics, antidepressants, and anticonvulsants can lead to increased CNS-depressant effects, such as dizziness, confusion, and drowsiness. The antigout medication probenecid can affect the metabolism of benzodiazepines and lead to increased side effects.

The use of theophylline or aminophylline can counteract the sedative effects of benzodiazepines. Tell your doctor if you take either of these drugs before starting a benzodiazepine.

Diazepam is processed by certain P450 enzymes whereas lorazepam is not. Some drugs can block these enzymes, which affects how well diazepam is processed in the body. This may result in increased sedative side effects of diazepam. Drugs like ketoconazole, cimetidine, and omeprazole can interact with diazepam and lead to increased sedation.

Antacids like calcium carbonate and magnesium hydroxide can decrease the absorption of diazepam in the body. This effect may alter how well diazepam works.

Consult a healthcare professional for other possible drug interactions.

Warnings of lorazepam vs. diazepam

The use of opioids with benzodiazepines should be avoided. When used together, benzodiazepines and opioids can increase the risk of respiratory depression, coma, and even death. Patients should be monitored closely when these two classes of drugs are taken together.

Lorazepam and diazepam are Schedule IV drugs. Those with a past history of alcohol or substance abuse may be at a higher risk of dependence and abuse with benzodiazepines. Dependence and abuse may increase the risk of an overdose with benzodiazepines. Signs and symptoms of a benzodiazepine overdose include severe loss of coordination, dangerously low blood pressure (hypotension), respiratory depression, and coma.

Only the lowest effective dose of lorazepam or diazepam should be used. Consult a doctor or healthcare professional on other possible warnings and precautions.

Frequently asked questions about lorazepam vs. diazepam

What is lorazepam?

Lorazepam is the generic name for Ativan. It is part of a class of medications known as benzodiazepines. Lorazepam is available as an oral tablet in strengths of 0.5 mg, 1 mg, and 2 mg. It can also be administered as an oral solution or injection. Lorazepam is approved to treat anxiety and insomnia caused by anxiety. It can also be used as a treatment for seizure disorders or premedication before surgery.

What is diazepam?

Diazepam is also known by its brand name, Valium. It is a benzodiazepine that is FDA approved to treat anxiety, alcohol withdrawal syndrome, and muscle spasms. It can also be used for seizure disorders and sedative purposes before surgery. Diazepam is available in 2 mg, 5 mg, and 10 mg oral tablets. It also comes as an oral solution, injection, and rectal gel.

Are lorazepam vs. diazepam the same?

Lorazepam and diazepam are both benzodiazepines, but they are not the same. They come in different formulations and have different FDA-approved uses. They also have different age restrictions: Lorazepam is not recommended in children under 12 years old while diazepam is not recommended in infants younger than 6 months.

Is lorazepam or diazepam better?

Lorazepam and diazepam are both effective drugs. Diazepam lasts in the body longer than lorazepam. However, this doesn’t mean it’s a better drug. The effectiveness of the benzodiazepine will depend on the condition being treated, among other factors. Consult a healthcare provider to determine the best treatment for you.

Can I use lorazepam or diazepam while pregnant?

It is not recommended to take lorazepam or diazepam while pregnant. Although diazepam may be slightly safer than lorazepam during pregnancy, not enough studies have shown that benzodiazepines are completely safe while pregnant. Consult a healthcare provider before taking a benzodiazepine during pregnancy.

Can I use lorazepam or diazepam with alcohol?

Combining alcohol and benzodiazepines is not recommended. Both alcohol and benzodiazepines can cause CNS side effects such as drowsiness and dizziness. Taking these substances together can increase the risk of side effects and overdose.

Is 3 mg lorazepam too much?

The right dosage of lorazepam will depend on the condition being treated. Consult a doctor for professional medical advice and proper instructions on how to use this medication. A standard dose of lorazepam could be anywhere from 2 to 6 mg by mouth two to three times per day.

Does diazepam last longer than lorazepam?

Diazepam lasts longer than lorazepam. It is considered a long-acting benzodiazepine with a half-life of up to 48 hours. Long-acting benzodiazepines include Valium (diazepam), Librium (chlordiazepoxide), and Dalmane (flurazepam).

Is it bad to take Ativan every day?

It is not generally recommended to take Ativan (lorazepam) long term. Not enough studies have been conducted on the safety and effectiveness of Ativan past four months of use. Some people develop a dependence and tolerance to Ativan, which can affect how well it works over time. Ativan should only be used as prescribed by a healthcare provider.

Is lorazepam fast acting?

Lorazepam is an intermediate-acting benzodiazepine. The effects of lorazepam may be felt within 1 to 1.5 hours after taking it. The half-life of lorazepam is around 10 to 20 hours. Other intermediate-acting benzodiazepines include Xanax (alprazolam), Klonopin (clonazepam), and Restoril (temazepam).

Lorazepam instructions, price in pharmacies of Ukraine

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Creation date: 04/27/2021
Update date: 06/22/2023

Indications

• For calming (superficial sedation) before and during operative and diagnostic procedures, in order to reduce fear, tension, and reach the patient after the procedure I didn’t lose my mind about the procedure.
• The cob of treatment of severe neurotic symptoms in anxiety depression and pronounced phobias.
• Short-stroke adjuvant therapy of important anxiety states and states of awakening in psychosis and depression, as the primary therapy with drugs that suppress the function of the central nervous system, and/or antidepressants do not control or lack control of such symptoms.
• Celebration of status epilepticus (Status epilepticus) on a variety of different focal or generalized attacks. The use of lorazepam is recommended for: generalized (toniko-clonal) attacks, generalized prostration (ptimal) or the so-called “peak-hvilovy stupor”, focal motor or psychomotor attacks, as well as combined attacks, such as generalized attacks with focal cob . Primary therapy with the drug spray can help the current streaming activity of attacks.
• Lorazepam is not prescribed for severe epilepsy. After cupping the attacks, vicoristovuvat іnshі zabi for the advancement of the attacks. When examining status epilepticus (Status epilepticus) on aphids, actual, reverse disorders of metabolism (for example, hypoglycemia, hypocalcemia, hyponatremia toshcho), it is necessary to use the name of the disorder.

Lorazepam that kolaptoid become.

Lorazepam cannot be administered overnight with scopolamine, and the shards of the same can sometimes produce a stronger sedative effect, hallucinations and irrational behavior.

Through the addition of benzyl alcohol, the drug cannot be ingested for newborns, but it is not possible (div. section “Specifics of ingestion”).

Side effects

Benzodiazepines may cause dose-dependent impairment of CNS function.

It is necessary to remember about memnesia at the hour of amnesia (anterograde amnesia) or to lose memory.

The delay in drug therapy, after prolonged exposure to high doses, or after prolonged use of therapeutic doses, may cause withdrawal symptoms. Withdrawal symptoms can include mild dysphoria and sleep disturbances to severe sleep apnea with generalized seizures, triplets, cranial and mucosal seizures, vomiting and increased sweating. In order to eliminate withdrawal symptoms, as far as possible, conduct stepwise administration of the drug.

Even with other medical problems of the pharmacological group, with a trivial variation, the development of fallow is not safe.

Data on the development of tolerance to sedative drugs in the benzodiazepine series.

Miscellaneous symptoms: local phlebitis, pain without delay after injection and redness around the time of administration of the drug.

Sensitivity to benzyl alcohol can rarely be suspected.

Specifics of congestion

Congestion during pregnancy or breastfeeding

During pregnancy, the drug can be taken only in vinatkovyh depressions. Lorazepam cannot be congested during breastfeeding.

Children

Prevention of lorazepam treatment of children and children under 18 years of age, due to the culprit of apparent epileptic status (div. section “Method of administering that dose”). Zastosuvannya for new people is not allowed (children under the age of 1) fenced (div. division “Contraindications”).

The cost of influencing the severity of the reaction when caring for by motor transport or other mechanisms

contributes to the possibility of active participation in road Russia or to the control of mechanisms. Significant peace is associated with the action of benzyl alcohol.

Patients who have taken lorazepam are not recommended to spend the next 24–48 years in motor transport, operate unsafe mechanisms, and also engage in any kind of activity that will lead to a higher level of respect. Decrease in respect, for example, in patients of a summer age, in connection with weakened people through operations, or in a filthy camp, you can save yourself by stretching a thriving hour.

Overdose

When looking at the skin disorder of intoxication, it is necessary to take into account the fact that the patient, perhaps, having taken a sprat of drugs.

Symptoms of intoxication

Overdose of drugs of the benzodiazepine series, as a rule, manifests itself in the reduced function of the central nervous system of various degrees of severity, from stunning to coma. Symptoms of mild overdose may include, for example, stupor, confusion, drowsiness, lethargy, ataxia, dysarthria, myalgia, and decreased arterial pressure. In cases of severe intoxication, central depression of the respiratory system, blood circulation and loss of information (intense sight!) can be blamed.

In case of other medical precautions, which take into account the function of the central nervous system, there is a risk of bugatoriasis intoxication, it is necessary to take care of the fatal injury.

Therapy of intoxications

Treatment is mostly symptomatic. It is necessary to closely follow the life functions and the balance of blood in the body. It is necessary to ensure the passage of wild ways. If necessary, carry out piecework. Hypotension can be treated with plasmoamine and, if necessary, with cardiovascular drugs of the peripheral type norepinephrine. Flumazenil, a benzodiazepine antagonist, can be used to treat the CNS function with drugs of the benzodiazepine series. Hemodialysis in case of intoxication is not of great importance, however, it can be related to mixed disorders.

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Lorazepam instructions

LORAZEPAM-ZN
(UA/16804/01/01)

Release form:

1 mg tablets, 10 tablets per blister; 1, 2, 3 or 5 blisters per carton box

Stock:

1 lorazepam tablet 1 mg

Manufacturer:

Ukraine

LORAZEPAM-ZN
(UA/16804/01/01)

Release form:

tablets of 1 mg, 10 tablets in a blister; 1, 2, 3 or 5 blisters per carton box

Stock:

1 lorazepam tablet 1 mg

Manufacturer:

Ukraine

LORAZEPAM-ZN
(UA/16804/01/02)

Release form:

tablets of 2. 5 mg, 10 tablets per blister; 1, 2, 3 or 5 blisters per carton box

Stock:

1 lorazepam tablet 2.5 mg

Manufacturer:

Ukraine

LORAZEPAM-ZN
(UA/16804/01/02)

Release form:

tablets of 2. 5 mg, 10 tablets in a blister; 1, 2, 3 or 5 blisters per carton box

Stock:

1 lorazepam tablet 2.5 mg

Manufacturer:

Ukraine

LORAZEPAM-ZN
(UA/16804/02/01)

Release form:

for injections, 2 mg/ml, 1 ml in ampoules, 5 ampoules in a blister; 1, 2 blisters per carton box

Stock:

1 ml mixed with lorazepam 2 mg

Manufacturer:

Ukraine

Preparations – Lorafen

ICD-10: F41 – Panic disorder [episodic paroxysmal anxiety], F60. 3 – Emotionally unstable personality disorder, G47.0 – Disorders of falling asleep and maintaining sleep [insomnia], R11 – Nausea and vomiting, R45.0 Nervousness R45.1 Restlessness and agitation

• Manufacturer: Tarkhominsk Pharmaceutical Plant “Polfa” A.O.
• RC number: P N016057/01
• Production standard for formulation: (EU) GIF-IW-400/0196_02_08/04/159/16
• Production standard for active substance: (EU) GIF-IW-400/0196_02_08/04/159/16 9001 6
• ATX code: N05BA06 – Lorazepam
• Presentation: film-coated tablets 2.5 mg, blister packs – 1
• Dose: 1 mg, 2. 5 mg
• Packaging: 25

---

Pharmacokinetics

Reference product: MERLIT®

Study name: Ref.: CPMP/EWP/QWP/1401/98 Rev. 1/ Corr *, GUIDELINE ON THE INVESTIGATION OF BIOEQUIVALENCE, London, 20 January 2010.

Country of study: UK

Pharmacokinetic parameters									Pharmacokinetic parameters
AUC ∞ (ng x h/ml)		C max 902 06 (ng/ml)		t max (h)		t 1 /2 (pure)			Cl 90%
test	reference	test	reference	test	reference	test	reference	Bioavailability (%)	Pharmacokinetic area. curve AUC test / AUC reference; :	Max. concentration C max , test/ C max, reference :	Absorption rate (C max /AUC) test /(C 9 0205 max /AUC) reference :
Lorazepam
403.4 ± 53.5	416.0 ± 50.4 90 207	26.90 ± 1.89	27.45 ± 1.66	2.0	2.0	10.32 ± 0.44	10.42 ± 0.63	97.11%	96.97%	97.99%	95.03%
Note: Bioequivalence analysis was performed according to Lorafen tab. 2.5 mg.

---

Instruction

on the medical use of the drug

Pharmaceutical form

film-coated tablets 2. 5 mg, blister packs – 1

Composition / active ingredient

Tablets 1 mg: lorazepam 1 mg.

2.5 mg tablets: lorazepam 2.5 mg.

Excipients

1 mg tablets: 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;

Tablets 2.5 mg: potato starch 6 mg, sodium carboxymethyl starch 0.5 mg, gelatin 1.5 mg, talc 1.8 mg, crimson color [Ponceau 4R] 0.00286 mg, magnesium stearate 1.2 mg , lactose up to 80 mg.

Sheath

Tablets 1 mg: 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: 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 of dosage form

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

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

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 takes place 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.

Breeding
Lorazepam is excreted in the urine as lorazepam glucuronate.

Indications for use

• Neurotic and neurosis-like states occurring with anxiety, irritability. increased fatigue. sleep disturbance. vegetative disorders.
• Alcohol withdrawal syndrome (as part of complex therapy).
• Skeletal muscle hypertonicity of various origins.
• Premedication (preparation for lengthy diagnostic procedures and operations).

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

• Hypersensitivity to 1.4-benzodiazepine derivatives or to any substance that is part of the preparation.
• Severe respiratory failure, whatever the cause.
• Severe liver and kidney failure.
• Myasthenia.
• Glaucoma.
• Acute porphyria.
• Alcohol poisoning.
• Sleep apnea syndrome.
• Children’s age up to 12 years.

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.

Precautions

Mild to moderate hepatic and/or renal failure, 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.

Pregnancy and lactation

Before using any drug, the patient should consult a doctor. The use of lorazepam in pregnant women is allowed only if its use in the mother has an absolute indication, 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 case of 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 divided into 1-3 doses.

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

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 before 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
Care must be taken 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 (gait instability 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 sensory organs: 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), skin itching: extremely rare – 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 the smooth muscles of the 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

As a result of an overdose of lorazepam, the following symptoms may appear: drowsiness, a state of disorientation, 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. tract (provoking vomiting, taking activated charcoal, gastric lavage – subject to preserved consciousness), monitor basic vital functions (respiration, pulse, blood pressure) and, if necessary, apply appropriate symptomatic treatment.

The specific antidote is flumazenil.

Drug interactions

Pharmaceutical

Pharmaceutical incompatibilities not identified.

Pharmacodynamic

• The inhibitory effect of lorazepam on the central nervous system is enhanced by opioid analgesics, drugs for general anesthesia (anesthetics), psychotropic drugs, antidepressants, antihistamines, antihypertensive drugs of central action.
• The use of alcohol during treatment with lorazepam increases the inhibitory effect on the central nervous system and may lead to the development of paradoxical reactions such as: psychomotor agitation, aggressive behavior. In addition, alcohol may enhance the sedative effect of lorazepam. up to coma.
• Lorazepam, taken with other muscle relaxant drugs, prolongs and enhances the action of the latter.

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.
• Drugs that induce the activity of cytochrome P450 (for example, rifampicin, phenobarbital, phenytoin, carbamazepine) affect the biotransformation of 1,4-benzodiazepine derivatives and lead to a weakening of their pharmacological action.
• Theophylline and caffeine may reduce the hypnotic effect of benzodiazepines (including lorazepam). because have a stimulating effect on the central nervous system and are able to induce hepatic enzymes responsible for the metabolism of drugs. This effect caused by theophylline and caffeine may not be present in smokers.
• Oral contraceptives used together with lorazepam may increase its metabolism, the half-life of lorazepam may be reduced.

Special instructions

• Lorafen must be used under strict medical supervision.
• If after 7-14 days of use of the drug there is no relief of symptoms of the disease or a relapse occurs, then the patient should consult a doctor.
• 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.
• 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 occur even between single 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 withdrawal symptoms or rebound insomnia increases with abrupt discontinuation of the drug. A gradual decrease in the dose of the drug is recommended in order to minimize the risk of such symptoms.
• Lorazepam. like benzodiazepines and similar drugs, can cause antegrade amnesia. This condition is most often observed a few hours after taking the drug, especially in a large dose. In order to minimize the risk of developing amnesia, it is recommended to use lorazepam half an hour before bedtime and provide conditions for uninterrupted 7-8 hours of sleep.
• Lorazepam. as benzodiazepines and drugs of similar action can cause paradoxical reactions, such as psychomotor agitation, irritability, aggressiveness, nightmares, hallucinations, psychosis, somnambulism, depersonalization disorders, expressed by sleep disturbance and other behavioral side effects. These reactions are much more common in older patients.
• If such symptoms occur, treatment with Lorafen should be discontinued immediately.
• 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.
• Lorazepam should be used with caution in patients with chronic respiratory failure, as benzodiazepines have been found to have a depressant effect on the respiratory center.
• Lorazepam should be used with great caution in patients with depressive symptoms. These patients may have suicidal thoughts. Due to the possibility of intentional overdose, these patients should be treated with Lorafen at the lowest possible dose. Also, benzodiazepines and similar drugs should not be used as the sole drug for the treatment of depression or anxiety associated with depression. Monotherapy with these drugs may increase suicidal tendencies.
• Benzodiazepines and similar drugs should be used with great caution in patients with a history of alcohol, drug or drug dependence. These patients should be under strict medical supervision while taking lorazepam. are at risk of developing addiction, mental and physical dependence.
• 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 long-term therapy with Lorafen, periodic blood tests (morphological analysis with a smear) and urinalysis are indicated.
• During treatment with Lorafen and for 3 more days after its completion, you should not drink any alcoholic beverages. 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.

Pharmacy conditions

Prescription

Storage conditions

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

Shelf life

2 years. Do not use after the expiry date stated on the packaging.

Owner of RU

Tarkhominsk Pharmaceutical Plant “Polfa” A.O.

Producer

Tarkhominsk Pharmaceutical Plant “Polfa” Joint Stock Company st. A. Fleming 2. 03-176 Warsaw, Poland

Representative

Representation of the Tarkhominsk Pharmaceutical Plant “POLFA” A, O. in Russia: 105082 Moscow, st.