What is lorazepam used for. How should lorazepam be taken. What are the potential side effects of lorazepam. How to safely store and dispose of lorazepam. What precautions should be taken when using lorazepam.

Understanding Lorazepam: An Anxiolytic and Sedative Medication

Lorazepam, commonly known by its brand name Ativan, is a potent medication belonging to the benzodiazepine class. It is primarily prescribed to alleviate anxiety and treat insomnia caused by anxiety or temporary situational stress. The drug works by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that slows down brain activity, thereby promoting relaxation and reducing anxiety symptoms.

The effectiveness of lorazepam in managing anxiety disorders has made it a widely prescribed medication. However, it’s crucial to understand its proper use, potential side effects, and the precautions necessary to ensure safe and effective treatment.

How does lorazepam work in the brain?

Lorazepam acts on the central nervous system by binding to GABA receptors. This action increases the inhibitory effects of GABA, resulting in decreased neuronal excitability. Consequently, this leads to:

• Reduced anxiety
• Muscle relaxation
• Sedation
• Anticonvulsant effects

The calming effect produced by lorazepam makes it an effective treatment for various anxiety-related conditions.

Proper Usage and Dosage Guidelines for Lorazepam

Lorazepam is available in several forms, including tablets, extended-release capsules (Loreev), and a liquid concentrate. The dosage and administration method may vary depending on the specific formulation and the condition being treated.

How should lorazepam tablets and liquid concentrate be taken?

• Tablets and liquid concentrate are typically taken two to three times daily, with or without food.
• For insomnia treatment, it’s usually administered at bedtime.
• The liquid concentrate should be diluted in water, juice, or carbonated beverages immediately before consumption.
• It can also be mixed with applesauce for easier administration.

What is the proper way to take lorazepam extended-release capsules?

• Extended-release capsules (Loreev) are generally taken once daily in the morning, with or without food.
• Swallow the capsules whole without chewing or crushing.
• If swallowing is difficult, the capsule contents can be sprinkled on a tablespoon of applesauce and consumed immediately.

It’s crucial to follow the prescribed dosage and administration instructions provided by your healthcare provider. Never adjust your dosage without consulting your doctor first.

Potential Side Effects and Risks Associated with Lorazepam Use

While lorazepam can be highly effective in treating anxiety and insomnia, it’s not without potential side effects. Being aware of these effects can help patients recognize and report any adverse reactions promptly.

What are the common side effects of lorazepam?

Common side effects of lorazepam may include:

• Drowsiness and sedation
• Dizziness
• Weakness
• Unsteadiness
• Headache
• Nausea
• Changes in appetite
• Blurred vision
• Confusion

These effects are typically mild and often subside as the body adjusts to the medication. However, if they persist or worsen, it’s important to consult your healthcare provider.

Are there any serious risks associated with lorazepam use?

Yes, lorazepam can pose serious risks, especially when misused or combined with certain substances. Some of the more severe risks include:

• Respiratory depression, particularly when combined with opioids or alcohol
• Physical dependence and withdrawal symptoms
• Increased risk of falls and fractures, especially in older adults
• Cognitive impairment and memory problems
• Paradoxical reactions (increased anxiety or agitation)
• Potential for abuse and addiction

It’s crucial to be aware of these risks and to use lorazepam only as prescribed by a healthcare professional.

Important Precautions and Contraindications for Lorazepam

Given the potent nature of lorazepam, certain precautions must be taken to ensure its safe and effective use. Understanding these precautions can help prevent potentially dangerous interactions and adverse effects.

Who should exercise caution or avoid using lorazepam?

Lorazepam may not be suitable for everyone. Caution is advised for:

• Elderly patients, due to increased sensitivity to benzodiazepines
• Individuals with a history of substance abuse
• Patients with respiratory conditions, as lorazepam can depress breathing
• Those with liver or kidney disease
• Pregnant or breastfeeding women
• Individuals with a history of depression or suicidal thoughts

Always inform your healthcare provider about your complete medical history and any medications you’re currently taking before starting lorazepam treatment.

What substances should be avoided while taking lorazepam?

Certain substances can interact dangerously with lorazepam, increasing the risk of severe side effects. These include:

• Alcohol
• Opioid medications
• Other central nervous system depressants
• Certain antidepressants
• Some antihistamines

It’s crucial to avoid these substances while taking lorazepam unless specifically advised by your healthcare provider.

Managing Lorazepam Treatment: Dosage Adjustments and Discontinuation

Proper management of lorazepam treatment is essential to maximize its benefits while minimizing risks. This includes understanding how to handle missed doses, recognizing signs of dependence, and knowing how to safely discontinue the medication when necessary.

How should missed doses of lorazepam be handled?

If you miss a dose of lorazepam:

• Take it as soon as you remember, unless it’s almost time for your next scheduled dose.
• Never take a double dose to make up for a missed one.
• If you’re unsure about what to do, consult your healthcare provider or pharmacist.

Consistency in taking lorazepam as prescribed is important for maintaining its therapeutic effects.

What is the proper way to discontinue lorazepam treatment?

Discontinuing lorazepam requires careful management to avoid withdrawal symptoms. The process typically involves:

• Gradual dose reduction under medical supervision
• Monitoring for withdrawal symptoms
• Possibly implementing alternative anxiety management strategies

Never attempt to stop taking lorazepam abruptly or without consulting your healthcare provider, as this can lead to severe withdrawal symptoms.

Storage and Disposal Guidelines for Lorazepam

Proper storage and disposal of lorazepam are crucial for maintaining its effectiveness and preventing accidental ingestion or misuse.

How should lorazepam be stored?

To ensure the stability and safety of lorazepam:

• Store at room temperature, away from moisture and heat
• Keep out of reach of children and pets
• Store in its original container with the label intact
• Do not store in the bathroom, where humidity levels can be high

Proper storage helps maintain the medication’s potency and prevents accidental ingestion.

What is the correct way to dispose of unused lorazepam?

To safely dispose of unused or expired lorazepam:

• Do not flush down the toilet or pour down the drain
• Use a medication take-back program if available in your area
• If no take-back program is available, mix the medication with an undesirable substance (like used coffee grounds), seal in a plastic bag, and dispose of in household trash
• Remove or obscure any personal information on the empty medication container before disposing

Proper disposal helps prevent environmental contamination and reduces the risk of accidental ingestion or misuse.

Recognizing and Responding to Lorazepam Overdose

While lorazepam is generally safe when used as prescribed, overdose can occur, especially if the medication is misused or combined with other central nervous system depressants. Recognizing the signs of overdose and knowing how to respond can be life-saving.

What are the signs of a lorazepam overdose?

Symptoms of lorazepam overdose may include:

• Extreme drowsiness or difficulty waking up
• Confusion or disorientation
• Slurred speech
• Lack of coordination
• Slow or shallow breathing
• Weak pulse
• Coma in severe cases

If you suspect a lorazepam overdose, it’s crucial to seek immediate medical attention.

How should one respond to a suspected lorazepam overdose?

In case of a suspected overdose:

• Call emergency services immediately
• Provide information about the person’s age, weight, and the amount of lorazepam taken, if known
• Follow the instructions given by emergency responders
• If the person is unconscious but breathing, place them in the recovery position
• Do not induce vomiting unless instructed to do so by medical professionals

Prompt action in case of overdose can prevent severe complications and potentially save a life.

Understanding the proper use, potential risks, and management of lorazepam treatment is crucial for patients and caregivers alike. By following prescribed guidelines, being aware of potential side effects, and knowing how to respond in emergency situations, individuals can maximize the benefits of lorazepam while minimizing risks. Always consult with a healthcare provider for personalized advice and never hesitate to seek medical attention if concerns arise during treatment.

Lorazepam: MedlinePlus Drug Information

pronounced as (lor a’ ze pam)

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Lorazepam may increase the risk of serious or life-threatening breathing problems, sedation, or coma if used along with certain medications. Tell your doctor if you are taking or plan to take certain medications for cough or for pain that contain opiates (e. g. codeine, hydrocodone, morphine, oxycodone, tramadol). Your doctor may need to change the dosages of your medications and will monitor you carefully. If you take lorazepam with any of these medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care immediately: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own.

Lorazepam may be habit forming. Do not take a larger dose, take it more often, or for a longer time than your doctor tells you to. Tell your doctor if you have ever drunk large amounts of alcohol, if you use or have ever used street drugs, or have overused prescription medications. Do not drink alcohol or use street drugs during your treatment. Drinking alcohol or using street drugs during your treatment with lorazepam also increases the risk that you will experience these serious, life-threatening side effects. Also tell your doctor if you have or have ever had depression, another mental illness, or thoughts of harming or killing yourself or trying to do so.

Lorazepam may cause a physical dependence (a condition in which unpleasant physical symptoms occur if a medication is suddenly stopped or taken in smaller doses), especially if you take it for several days to several weeks. Do not stop taking this medication or take fewer doses without talking to your doctor. Stopping lorazepam suddenly can worsen your condition and cause withdrawal symptoms that may last for several weeks to more than 12 months. Your doctor probably will decrease your lorazepam dose gradually. Call your doctor or get emergency medical treatment if you experience any of the following symptoms: unusual movements; ringing in your ears; anxiety; memory problems; difficulty concentrating; sleep problems; seizures; shaking; muscle twitching; changes in mental health; aggression; depression; burning or prickling feeling in your hands, arms, legs or feet; seeing or hearing things that others do not see or hear; thoughts of harming or killing yourself or others; overexcitement; or losing touch with reality.

Lorazepam is used to relieve anxiety. Lorazepam is also used to treat insomnia caused by anxiety or temporary situational stress. Lorazepam is in a class of medications called benzodiazepines. It works by slowing activity in the brain to allow for relaxation.

Lorazepam comes as a tablet, an extended release capsule (Loreev), and concentrate (liquid) to take by mouth with or without food. The tablets and concentrate (liquid) are usually taken with or without food two or three times a day. If lorazepam (tablets or concentrate) is used to treat insomnia, it is usually taken at bedtime. The extended release capsules (Loreev) are usually taken with or without food once a day in the morning. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take lorazepam exactly as directed.

Swallow the extended release capsules whole; do not chew or crush them. If you are unable to swallow the extended release capsule, you may open the capsule and sprinkle the entire contents onto a tablespoon of applesauce. You may prepare the mixture in advance and store it for up to 2 hours. When you are ready to take your medication, swallow all the mixture without chewing. Then drink water to wash down the mixture and be sure that you have swallowed all of it. Do not store the medication mixture for future use.

Lorazepam concentrate (liquid) comes with a specially marked dropper for measuring the dose. Ask your pharmacist to show you how to use the dropper. Dilute the concentrate in water, juice, or carbonated beverages just before taking it. It also may be mixed with applesauce or pudding just before taking the dose. Stir the mixture gently for a few seconds. Take the entire mixture immediately; do not store it for future use.

Lorazepam is also sometimes used to treat nausea and vomiting from cancer treatment and to control agitation caused by alcohol withdrawal. Talk to your doctor about the possible risks of using this medication for your condition.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Before taking lorazepam,

• tell your doctor and pharmacist if you are allergic to lorazepam, alprazolam (Xanax), chlordiazepoxide (Librium, in Librax), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium, Valtoco), estazolam, flurazepam, oxazepam, temazepam (Restoril), triazolam (Halcion), any other medications, or any of the ingredients in lorazepam tablets, extended release capsules, or concentrate. If you are taking the extended release capsules, tell your doctor or pharmacist if you are allergic to aspirin or tartrazine (a yellow dye in some processed foods and drugs). Ask your doctor or pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have narrow angle glaucoma (a serious eye condition that may cause loss of vision). Your doctor will probably tell you not to take lorazepam.
• tell your doctor if you have or have ever had seizures, sleep apnea (condition in which a person briefly stops breathing many times during the night), lung problems or any condition that affects your breathing such as asthma or chronic obstructive pulmonary disease (COPD), or heart or liver disease.
• tell your doctor if you are pregnant or plan to become pregnant. If you take lorazepam late during your pregnancy, your baby may experience sedation and/or withdrawal symptoms after birth. Tell your baby’s doctor right away if your baby experiences any of the following symptoms: breathing problems, sluggishness, low muscle tone, jitteriness, irritability, restlessness, shaking, excessive crying, or feeding problems. If you become pregnant while taking lorazepam, call your doctor.
• tell your doctor if you are breastfeeding. You should not breastfeed while you are taking lorazepam.
• talk to your doctor about the risks and benefits of taking this medication if you are 65 years of age or older. Older adults should take lower doses of lorazepam because higher doses may not be more effective and are more likely to cause serious side effects.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking lorazepam.
• you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.

Unless your doctor tells you otherwise, continue your normal diet.

If you take several doses per day and miss a dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Lorazepam may cause side effects. Call your doctor if any of the following symptoms are severe or do not go away:

• drowsiness
• dizziness
• tiredness
• weakness
• unsteadiness
• diarrhea
• nausea
• changes in appetite
• restlessness or excitement
• constipation
• blurred vision
• changes in sex drive or ability

Some side effects can be serious.

If you experience any of these symptoms or those listed in the IMPORTANT WARNINGS section, call your doctor immediately or get emergency medical treatment:

• shuffling walk
• persistent, fine tremor or inability to sit still
• trouble talking
• rash; hives; itching; swelling of the face, eyes, or mouth; wheezing; or shortness of breath
• yellowing of skin or eyes
• irregular heartbeat

Lorazepam may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

• drowsiness
• confusion
• tiredness
• slowed breathing and heartbeat
• problems with coordination
• trouble talking
• loss of consciousness

• Ativan^®
• Lorazepam Intensol^®
• Loreev XR^®

Last Revised – 02/15/2023

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Uses, Risks & Overdose for Lorazepam

What are the side effects of Ativan?

Major side effects associated with Ativan use and/or abuse include:

• Confusion
• Lack of muscle control
• Blood in urine or stool
• Stomach pain
• Weight loss
• Tremors
• Overdose
• Addiction

• Tolerance to the impact of Ativan
• Rebound anxiety
• Restlessness
• Depression
• Memory loss
• Learning difficulties
• Emotional blunting

About 40 million American adults ” 18 percent of the US population ” suffer from some form of anxiety, according to the Anxiety and Depression Association of America.

Many of these individuals are treated with anti-anxiety medications like lorazepam, a short-acting tranquilizer sold under the trade name Ativan. Ativan acts quickly on the central nervous system by increasing the availability of gamma-aminobutyric acid (GABA) to the brain. GABA is a brain chemical that calms the central nervous system, exerting a tranquilizing effect on the mind and body.
When taken appropriately under a doctor’s supervision, Ativan can help reduce many of the common symptoms of anxiety, including panic attacks, unjustified fears, sleeplessness, agitation, and restlessness. In addition to treating anxiety, Ativan is prescribed for seizure, spasms, alcohol withdrawal, or insomnia. Ativan can causes side effects, especially when it is taken in excessively high doses or used for recreational reasons.

Ativan Effects on the Body

By slowing the activity of the brain and nerves, Ativan also affects physical functions and responses. As a tranquilizer, Ativan can make the user feel calm and physically relaxed. Ativan can also stop painful spasms in muscles, or prevent life-threatening seizures when taken correctly. For patients who take Ativan as directed for legitimate reasons, this medication is generally safe and effective. However, all users must watch out for potential adverse reactions to the drug, such as:

• Daytime sleepiness
• Low energy levels
• Confusion
• Poor muscle coordination
• Blurry vision
• Loss of balance

• Blood in stool or urine
• Stomach pain
• Weight loss
• Chills
• Pale, cool skin
• Involuntary movements (tremors, shaking)

Because it can cause clumsiness, drowsiness, and disorientation, Ativan poses an increased risk of accidental injuries. The National Highway Traffic and Safety Administration cautions that drugs in the benzodiazepine family, like Ativan, can cause symptoms resemble alcohol intoxication, such as loss of motor coordination, slurred speech, visual disturbances, and blurred vision. Driving under the influence of Ativan, or performing other activities that require hand-eye coordination and quick reflexes, can be extremely dangerous, especially if the user has also consumed alcohol or other sedatives.

Ativan Effects on the Mind

Ativan can have powerful effects on the brain and nerves. However, many users experience “rebound” side effects, or a worsening of the same symptoms that the drug is designed to treat. In particular, Ativan can cause rebound anxiety, sleep disturbances, abnormal body movements, and agitation.

• Rebound anxiety
• Restlessness
• Loss of pleasure in day-to-day experiences
• Depression
• Memory problem
• Learning difficulties

The chemical structure of lorazepam is intended to reduce the excitability of the brain and nerves, while soothing emotional responses that create anxiety and restlessness. On the negative side, Ativan can flatten users’ emotional responses and blunt their experiences of the world. Individuals who take Ativan may begin to feel a loss of interest in their everyday experiences or responsibilities. They may feel constantly sluggish and tired, and have a dazed, drowsy appearance.

Signs of an Ativan Overdose: Is It Possible?

Ativan is a safe drug when taken in the prescribed doses, at the recommended times. But taking large doses of this medication puts the user at risk of an overdose, which may end in coma or even death. The number of overdose-related deaths associated with prescription benzodiazepines like Ativan has increased fourfold since 2001, according to the National Institute on Drug Abuse. In 2013, there were nearly 7,000 fatalities attributed to benzodiazepine overdose in the US.

As a central nervous system depressant, Ativan slows down activity in the brain and nerves. When taken alone and used correctly, Ativan rarely causes unconsciousness, coma, or death. However, high doses of Ativan can have fatal consequences, especially when lorazepam is combined with other drugs that also suppress the activity of the brain and vital organs. Many overdoses, either accidental or deliberate, have been linked to the use of Ativan with alcohol, prescription pain medications, other anti-anxiety drugs, and hypnotic medications used for insomnia.

Learning to recognize the signs of a lorazepam overdose could literally save a life:

• Pale, cool, bluish skin or lips
• Shallow, slow breathing
• Over-sedation or drowsiness
• Stumbling and loss of coordination
• Slurred speech
• Memory loss
• Confusion
• Weakness
• Loss of consciousness

An Ativan overdose is an emergency that may end in death if the individual doesn’t receive immediate medical attention.

People who have overdosed on Ativan should never be left alone to recover from the effects of the drugs, especially if there are other drugs involved.

Ativan Addiction and Withdrawal

One of the most serious side effects of Ativan use is the possibility of developing an addiction to this medication. Ativan addiction is most common in users who take too much of the drug, who use it for nonmedical reasons, or who take Ativan with other tranquilizing drugs, like alcohol, prescription pain relievers, and sleep aids.

After taking Ativan for more than 2-3 weeks, the nervous system becomes accustomed to the effects of the drug.

Many patients require higher doses of the drug to relieve their symptoms, a phenomenon called tolerance. Tolerance may lead to dependence ” a physical or psychological reliance on the drug in order to feel normal. If the user continues to misuse Ativan, or the dose is not reduced, tolerance can lead to addiction. Addiction is a progressive disease that causes a compulsive need to seek and use a drug. The red flags of an Ativan addiction include:

• Restlessness, irritability, or depression when the user can’t get the drug
• An obsessive interest in getting and using more of the drug, in spite of the harmful effects on personal health or relationships
• A loss of control over how much Ativan the user takes at any given time
• Isolation from friends, family, or social events as a result of drug use
• A deterioration in the quality of one’s work on the job or at school
• A decline in physical appearance and grooming
• Physical and psychological withdrawal symptoms when the drug is discontinued or the dose is lowered

Benzodiazepine withdrawal can have dangerous side effects, including seizures, severe agitation, and hallucinations. When individuals are suddenly deprived of the drug, they may also have headaches, nausea and vomiting, sleeping problems, sweating, and episodes of restlessness. In order to minimize withdrawal symptoms, a drug taper is advised for most Ativan users. In a drug taper, a doctor gradually lowers the dose of Ativan over a certain period of time, until the drug can be safely stopped without compromising the patient’s health or wellbeing.

Along with a physician-supervised drug taper, individuals who are addicted to Ativan need therapeutic treatment for addiction, as well as psychosocial resources to rebuild their lives. In a randomized, controlled trial of benzodiazepine users published in the Canadian Journal of Psychiatry, 180 patients were followed after completing a benzodiazepine discontinuation program. Patients who went through a drug taper were able to stop using the medication for longer periods of time. Heavier benzodiazepine users and those who were also addicted to alcohol or other drugs had more difficulty staying sober. Comprehensive recovery services include individual therapy, access to support groups, behavioral modification therapies, case management, and other research-based interventions.

Seeking Help for Ativan Abuse

Many people mistakenly believe that prescription medications like Ativan are less harmful or habit-forming than illegal drugs like meth, cocaine, or marijuana. But prescription drug addiction “including the addiction to tranquilizers like Ativan” has become a major threat to public health in the US. If individuals continue to abuse Ativan in spite of harmful side effects and negative health consequences, they may be addicted to this medication. While talking to loved ones about Ativan abuse may feel awkward or uncomfortable, this expression of concern could be the first step in helping them recover physical and psychological health. If you or a loved one is concerned about their Ativan use, rehab may be an option. See if your insurance provider may be able to cover all or part of the cost of rehab.

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Lorazepam – description of the substance, pharmacology, use, contraindications, formula

Contents

• Structural formula

• Russian name

• English title

• Latin name

• chemical name

• Gross formula

• Pharmacological group of the substance Lorazepam

• Nosological classification

• CAS code

• pharmachologic effect

• Characteristic

• Pharmacology

• The use of the substance Lorazepam

• Contraindications

• Application restrictions

• Use during pregnancy and lactation

• Side effects of Lorazepam

• Interaction

• Overdose

• Dosage and administration

• Precautionary measures

• special instructions

• Trade names with the active ingredient Lorazepam

Structural formula

Russian name

Lorazepam

English name

Lorazepam

Latin name

Lorazepamum (born 90 066 Lorazepami)

Chemical name

7-Chloro-5-(2-chlorophenyl)- 1,3-dihydro-3-hydroxy-2H-1,4-benzodiazepin-2-one

Gross formula

C ₁₅ H ₁₀ Cl ₂ N ₂ O 9 0075 2

Pharmacological substance group Lorazepam

Anxiolytics

Nosological classification

ICD-10 code list

• F10. 3 Withdrawal state

• F10.5 Alcoholic psychosis

• F25 Schizoaffective disorders

• F30 Manic episode

• F32 Depressive episode

• F34. 1 Dysthymia

• F40.0 Agoraphobia

• F41.0 Panic disorder [episodic paroxysmal anxiety]

• F41.1 Generalized anxiety disorder

• F42 Obsessive-compulsive disorder

• F43. 0 Acute stress reaction

• F43.1 Post-traumatic stress disorder

• F43.2 Adjustment disorder

• F51.0 Insomnia of non-organic etiology

• F60 Specific personality disorders

• F91 Conduct disorders

• G40 Epilepsy

• G44. 2 Tension headache

• G47.0 Disorders of initiation and maintenance of sleep [insomnia]

• R45.0 Nervousness

• R45.1 Restlessness and agitation

• R45. 7 State of emotional shock and stress, unspecified

• Z100* CLASS XXII Surgical practice

CAS code

846-49-1

Pharmacological action

Pharmacological action –

anxiolytic , muscle relaxant , anticonvulsant , sedative , hypnotic , central .

Characteristics

Anxiolytic, benzodiazepine derivative.

Almost white powder, very slightly soluble in water.

Pharmacology

Interacts with specific benzodiazepine receptors of the GABA-benzodiazepine receptor complex, increases the sensitivity of GABA receptors to GABA. As a result, the frequency of opening of transmembrane channels for chloride ions increases, the postsynaptic membrane of the neuron is hyperpolarized, neuronal activity is inhibited, and interneuronal transmission to the CNS is inhibited. The effects are due to the influence on various parts of the central nervous system: the amygdala complex of the limbic system (anxiolytic), the reticular formation of the brain stem and nonspecific nuclei of the thalamus, hypothalamus (sedative and hypnotic), spinal cord (muscle relaxant), hippocampus (anticonvulsant). It reduces the excitability of subcortical formations (limbic system, thalamus, hypothalamus) responsible for the implementation of emotional reactions, and inhibits the interaction of these structures with the cerebral cortex. Stabilizes vegetative functions.

Suppresses anxiety, fear, reduces psychomotor agitation, emotional stress. It has anti-panic and amnestic (mainly for parenteral use) action. It is effective for insomnia caused by anxiety or a short-term stressful situation: it facilitates the onset of sleep (shortens the period of falling asleep), reduces the number of night awakenings, and increases the duration of sleep. It inhibits polysynaptic spinal reflexes and lowers the tone of skeletal muscles.

Lorazepam has low toxicity and a wide range of therapeutic effects.

An animal reproduction study showed that administration of lorazepam at doses of 40 mg/kg orally and 4 mg/kg or more IV to rabbits resulted in fetal resorption and an increased incidence of fetal death. Causes developmental anomalies in rabbits, regardless of dose. In an 18-month study in rats, no carcinogenic activity was found.

Good but slowly absorbed from the gastrointestinal tract when taken orally, bioavailability is 90%. max “> C _max is achieved within 2 hours and is dose dependent: at a dose of 2 mg max”> C _max is 20 ng / ml. About 85% binds to plasma proteins. The equilibrium concentration in the blood is usually reached after 2-3 days. Passes through the BBB and the placental barrier. It is rapidly metabolized in the liver by conjugation to form the main inactive metabolite, lorazepam glucuronide. 1/2 “> T _1/2 unconjugated lorazepam – about 12 hours, the main metabolite – 18 hours. Excreted mainly by the kidneys mainly in the form of glucuronide.

When administered intramuscularly, max “> C _max is achieved in 60-90 minutes. 1/2″> T _1/2 when administered parenterally is 16 hours. When used for 6 months, no cumulation phenomena are observed. The pharmacokinetic parameters of lorazepam do not change in the elderly.

Application of the substance Lorazepam

Neurosis accompanied by anxiety, agitation, incl. generalized anxiety disorder, post-traumatic stress disorder, phobias, obsessive-compulsive disorder, psychoreactive states, emotional reactive disorders, anxiety in depressive states of various origins (usually in combination with antidepressants), insomnia, psychosomatic disorders (including heart – vascular, gastrointestinal and other diseases), premedication before surgical and diagnostic manipulations (in combination with analgesics), tension headache; nausea and vomiting caused by chemotherapy, epilepsy (as part of combination therapy), alcoholic delirium and withdrawal syndrome in chronic alcoholism (as part of combination therapy).

Contraindications

Hypersensitivity, incl. to other benzodiazepines, myasthenia gravis, angle-closure glaucoma, acute intoxication with CNS depressants, respiratory depression, liver failure, pregnancy (especially the first trimester), breast-feeding, age up to 18 years.

Restrictions for use

Chronic respiratory failure, sleep apnea syndrome, open-angle glaucoma, drug and alcohol dependence, depression (see Precautions), psychosis, severe renal impairment.

Use during pregnancy and lactation

Contraindicated during pregnancy (especially in the first trimester). At the time of treatment should stop breastfeeding.

Side effects of the substance Lorazepam

From the nervous system and sensory organs: lethargy, fatigue, drowsiness, disorientation, headache, dizziness, depression, ataxia, sleep disturbance, agitation, visual impairment, amnesia episodes.

From the digestive tract: dry mouth, nausea, vomiting, diarrhea, change in appetite.

On the part of the skin: erythema, urticaria.

Others: changes in blood composition (leukopenia), increased LDH activity.

May develop addiction, drug dependence, withdrawal syndrome, rebound syndrome (see “Precautions”).

Interaction

Lorazepam enhances the effect of CNS depressants, incl. phenothiazines, narcotic analgesics, barbiturates, antidepressants, hypnotics, anticonvulsants, antihistamines with a sedative effect. Potentiates the action of general and local anesthetics, enhances the action of curare-like drugs. With simultaneous use with alcohol, in addition to increasing the inhibitory effect on the central nervous system, paradoxical reactions are possible (psychomotor agitation, aggressive behavior, a state of pathological intoxication). Nicotine inhibits the activity of lorazepam (accelerates its metabolism).

Overdose

Symptoms: drowsiness, arterial hypotension, confusion, depression of reflexes, coma.

Treatment: induction of vomiting, gastric lavage, intravenous administration of norepinephrine to increase blood pressure, symptomatic therapy, monitoring of vital functions. The introduction of a specific antidote – an antagonist of benzodiazepine receptors flumazenil (in a hospital setting).

Dosage and administration

Inside. The dosage regimen and the duration of the course of treatment are set strictly individually.

In neurological practice – 1 mg 2-3 times a day; in psychiatric practice – 4-6 mg / day; with insomnia – 1-2 mg 30 minutes before bedtime. In elderly and debilitated patients, the dose should not exceed 2 mg / day (in divided doses). In patients with liver and / or kidney disease, as well as in patients with cerebral sclerosis, hypotension, heart failure, underweight, dose adjustment is recommended.

Precautions

Use with caution in patients with depression, given the tendency to suicide. In patients with drug and alcohol dependence, use under close medical supervision.

Side effects are usually observed at the beginning of therapy. The possibility of a more frequent occurrence of side effects in elderly and debilitated patients should be taken into account.

During treatment and for 2 days after its completion, it is necessary to exclude the intake of alcoholic beverages; drivers of vehicles and people whose work requires a quick mental and physical reaction, and is also associated with increased concentration of attention, should not engage in professional activities during this period.

Long-term use may cause addiction and drug dependence (especially when taking high doses). In this regard, lorazepam should not be used for longer than 4-6 weeks. If long-term treatment is necessary, weekly breaks in taking the drug should be periodically taken. With a sharp cessation of treatment, a withdrawal syndrome may occur (tremor, convulsions, abdominal or muscle cramps, vomiting, perspiration), and symptoms similar to those of the disease (anxiety, agitation, irritability, emotional stress, insomnia, convulsions) may also occur.

With prolonged use, it is necessary to periodically monitor the picture of peripheral blood, liver and kidney function.

Special instructions

Note that anxiety or tension associated with everyday stress does not usually require treatment with anxiolytics.

Trade names with active substance Lorazepam

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Lek. form
All lek. dragee forms substance-powder tablets, coated tablets, film-coated

Dosage
All dosages 1 mg 2.5 mg No dosage

Manufacturer
All manufacturers of Cambrex Propharmaco Milan S.r.L. Moscow Endocrine Plant Federal State Unitary Enterprise Tarkhominsk Pharmaceutical Plant Polfa, JSC

The use of lorazepam in the treatment of children with cancer

Supportive care

Trademarks:

Ativan®

Other names:

Lorazepam Intensol

Often used for:

treatment of seizures, nausea and vomiting, anxiety

Lorazepam is a benzodiazepine. Drugs of this type are aimed at slowing down the activity of the central nervous system (CNS). Lorazepam helps to manage seizures, relieve symptoms of nausea and vomiting in cancer treatment, reduce anxiety levels, and help calm the patient before medical procedures.

Long-term use of this drug may cause addiction. Follow dosage instructions carefully.

Administered intravenously (by drip or injection) in liquid form

IM administration in liquid form

Oral tablets

Oral liquid form

Nasal injection (intranasal)

• Drowsiness
• Increased fatigue or general weakness
• Dizziness
• Reduced respiratory rate
• Loss of clarity of vision
• Diarrhea
• Constipation
• Headache
• Dry mouth
• Problems with urination

The listed side effects are not observed in all patients who are prescribed lorazepam. The most common side effects are highlighted in bold, but others are not excluded. Report all possible side effects to your doctor or pharmacist.

With long-term use, some patients develop drug resistance or dependence.

In young children, frequent use of the drug before medical procedures may lead to long-term brain damage.

Be sure to discuss these and other recommendations with your doctor or pharmacist.

• After prolonged use of lorazepam, it is possible to stop taking it only under medical supervision. The doctor may gradually reduce the dosage to prevent the negative consequences associated with discontinuing the drug.
• Alcoholic beverages should be avoided while taking this drug.
• Patients of reproductive age who have been prescribed lorazepam should consult with their doctor before planning pregnancy.
• Pregnant or breastfeeding patients should notify their physician.

Lorazepam home use:

• Do not exceed the recommended dose and frequency of use.
• This drug may cause dizziness or drowsiness and increase the risk of falls. Do not drive or engage in hazardous activities until a drug reaction has been identified.
• If taking lorazepam causes stomach upset, take it with meals.
• The liquid form may be mixed with a small amount of water, juice, pudding or applesauce immediately before use. Measure the dosage using the measuring device included in the kit.
• Sublingual tablets must be held under the tongue until completely dissolved. After 2 minutes, the drug can be swallowed. Let the drug dissolve completely before swallowing it.
• Tablets should be stored at room temperature.
• Lorazepam liquid should be stored in the refrigerator.
• Take your dose as soon as possible if you miss it. Do not do this only if there is little time left until the next appointment. In no case do not double the dose at the next dose!
• Long-term use of this drug may cause addiction.