Lorazepam (Ativan) | NAMI: National Alliance on Mental Illness

Brand names:

• Ativan®
  • Tablet: 0.5 mg, 1 mg, 2 mg
  • Injection: 2 mg/mL, 4 mg/mL

• Lorazepam Intensol®
  • Liquid concentrate: 2 mg/mL solution

Generic name: lorazepam (lor A ze pam)

All FDA black box warnings are at the end of this fact sheet. Please review before taking this medication.

What Is Lorazepam And What Does It Treat?

Lorazepam is a benzodiazepine. It is approved for the treatment of anxiety, insomnia, or sleep difficulty due to anxiety or stress, status epilepticus (continuous seizures), and as a medication given right before anesthesia. However, benzodiazepines can also be used to treat alcohol withdrawal.

Generalized Anxiety Disorder (GAD) occurs when a person experiences excessive anxiety or worry for at least six months. Other symptoms include:

• Restlessness
• Fatigue (low energy, feeling tired all the time)
• Difficulty concentrating
• Irritability
• Muscle tension
• Sleep disturbance (difficulty falling asleep or waking up in the middle of the night)

What Is The Most Important Information I Should Know About Lorazepam?

Do not drive a car or operate machinery until you know how this medication affects you because you may notice that you feel tired or dizzy.

When starting lorazepam, anxiety or insomnia may improve rapidly or over a period of days.

Benzodiazepines, such as lorazepam, are often used for short periods of time only. They may produce emotional and/or physical dependence (addiction) even when used as recommended. With input from you, your health care provider will assess how long you will need to take the medicine.

Do not stop taking lorazepam without talking to your healthcare provider first. Stopping lorazepam abruptly may result in one or more of the following withdrawal symptoms: irritability, nausea, tremor, dizziness, blood pressure changes, rapid heart rate, and seizures.

The use of lorazepam with drugs like opioid medications has led to serious side effects including slowed and difficulty breathing and death. Opioid drugs are medications used to treat pain and include medications such as: codeine, oxycodone, morphine, and illegal drugs like heroin. Some opioid medications are also in cough syrup.

If you are taking lorazepam with an opioid medication, get medical assistance immediately if you feel dizziness or sleepiness, if you have slow or troubled breathing, or if you pass out. Caregivers must get medical help right away if a patient does not respond and does not wake up.

Avoid alcohol while taking this medication.

Are There Specific Concerns About Lorazepam And Pregnancy?

If you are planning on becoming pregnant, notify your healthcare provider to best manage your medications. People living with anxiety disorders who wish to become pregnant face important decisions. It is important to discuss this with your doctor and caregivers.

Regarding breastfeeding, caution is advised since lorazepam does pass into breast milk.

What Should I Discuss With My Healthcare Provider Before Taking Lorazepam?

• Symptoms of your condition that bother you the most
• If you have thoughts of suicide or harming yourself
• Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
• If you experience side effects from your medications, discuss them with your healthcare provider. Some side effects may pass with time, but others may require changes in the medication.
• Any other psychiatric or medical problems you have including obstructive sleep apnea
• All other medications you are currently taking (including over the counter products and herbal and nutritional supplements) and any medication allergies you have
• Other non-medication treatment you are receiving such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
• If you are elderly or prone to falls
• If you are pregnant, plan to become pregnant, or are breastfeeding
• If you drink alcohol or use drugs

How Should I Take Lorazepam?

Lorazepam may be taken with or without food. Take with food if you experience an upset stomach.

Lorazepam may be taken every day at regular times or on an as needed (“PRN”) basis. Typically, your healthcare provider will limit the number of doses you should take in one day.

Your healthcare provider will determine the dose and method of taking the medication that is right for you based upon your response.

Lorazepam liquid: Measure with a dosing spoon or oral syringe which you can get from your pharmacy.

If you take the medication every day (instead of ‘as needed’), use a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take it. You may also ask a family member or a friend to remind you or check in with you to be sure you are taking your medication.

What Happens If I Miss A Dose Of Lorazepam?

If you miss a dose of lorazepam, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your healthcare provider. Do not double your next dose or take more than what is prescribed.

What Should I Avoid While Taking Lorazepam?

Avoid drinking alcohol and using illegal drugs while you are taking lorazepam. They may decrease the benefits (e.g., worsen your condition) and increase the adverse effects (e.g., sedation) of the medication. Alcohol increases the risk of accidental overdose with medications like lorazepam.

What Happens If I Overdose With Lorazepam?

If an overdose occurs call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.

Symptoms of overdose include confusion, impaired coordination, slow reflexes, coma, and death.

A specific treatment to reverse the effects of lorazepam does exist. This medicine, called flumazenil, can reverse the effects of lorazepam but must be given through an IV at a hospital. Only a doctor can decide if you need this medication.

What Are Possible Side Effects Of Lorazepam?

Common side effects

• Feeling dizzy, drowsy, fatigued, or lightheaded
• Impaired coordination, decreased ability to concentrate

If you experience these side effects after starting lorazepam they will often improve over the first week or two as you continue to take the medication.

Rare/serious side effects

• Shortness of breath, trouble speaking, feeling very tired, dizziness, or passing out.
• Increased heart rate, headache, memory impairment, irritability, restlessness
• Some people taking benzodiazepines develop a severe allergic reaction and swelling of the face. This can occur as early as with the first dose.
• Some people taking benzodiazepines for sleep have experienced various behaviors while they were asleep/not fully awake, such as sleep driving, making phone calls, and preparing or eating food. The individuals have no memory of the events when they awaken.
• Signs of feeling depressed or low mood, thoughts of harming or killing yourself, or lack of interest in life.

Are There Any Risks For Taking Lorazepam For Long Periods Of Time?

Lorazepam is a safe and effective medication when used as directed. Benzodiazepines may produce emotional and/or physical dependence (addiction) even when used as recommended. Physical dependence may develop after 2 or more weeks of daily use.

What Other Medications May Interact With Lorazepam?

Lorazepam should not be taken with other benzodiazepine medications.

Lorazepam causes drowsiness, so caution should be used when combining it with other medications that cause drowsiness. These could include:

• Antihistamines such as diphenhydramine (Benadryl®)
• Narcotic pain medication such as morphine, oxycodone (OxyContin®), and hydrocodone (Vicodin® and Lortab®)
• Opioid cough medications such as codeine cough syrup
• Sleeping medications such as zolpidem (Ambien®)
• Other anti-anxiety medications, antipsychotic medications, certain anticonvulsant medications, and tricyclic antidepressant medications (such as amitriptyline)

How Long Does It Take For Lorazepam To Work?

When starting lorazepam, anxiety or insomnia may improve rapidly or over a period of days or within hours of the first dose of medication.

Summary of FDA Black Box Warnings

The FDA has found that benzodiazepine drugs, such as lorazepam, when used in combination with opioid medications or other sedating medications can result in serious adverse reactions including slowed or difficult breathing and death. Patients taking opioids with benzodiazepines, other sedating medications, or alcohol, and caregivers of these patients, should seek immediate medical attention if that start to experience unusual dizziness or lightheadedness, extreme sleepiness, slow or difficulty breathing, or unresponsiveness.

Provided by

(January 2019)

©2019 The College of Psychiatric and Neurologic Pharmacists (CPNP) and the National Alliance on Mental Illness (NAMI). CPNP and NAMI make this document available under the Creative Commons Attribution-No Derivatives 4.0 International License. Last Updated: January 2016.

This information is being provided as a community outreach effort of the College of Psychiatric and Neurologic Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The College of Psychiatric and Neurologic Pharmacists disclaims any and all liability alleged as a result of the information provided herein.

Side effects, dosage, uses, and more

Ativan (lorazepam) is a prescription tranquilizing medication. You might also hear it called a sedative-hypnotic or anxiolytic medication. Ativan belongs to a class of medications called benzodiazepines.

Ativan is used to treat anxiety symptoms, insomnia (trouble sleeping), and status epilepticus (a type of severe seizure). It’s also given before surgery to make you sleep.

Ativan comes in two forms:

• Ativan tablets
• Ativan solution for intravenous (IV) injection

Ativan is available in a generic form called lorazepam.

Generic drugs are often less expensive than the brand-name version. In some cases, the brand-name drug and the generic version may be available in different forms and strengths.

Ativan can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking Ativan. This list doesn’t include all possible side effects.

For more information on the possible side effects of Ativan, or tips on how to deal with a troubling side effect, talk with your doctor or pharmacist.

More common side effects

The more common side effects of Ativan include:

• drowsiness
• dizziness
• weakness

Some people may also experience less frequent side effects such as:

• confusion
• lack of coordination
• depression
• fatigue
• headache
• restlessness

In people who receive the Ativan injection, redness and pain at the injection site can commonly occur.

Some of these side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Serious side effects from Ativan aren’t common, but they can occur. Call your doctor right away if you have any serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include the following:

• Breathing effects. Symptoms can include:
• slowed breathing
• respiratory failure (rare)
• Psychological and physical dependence (more likely with people who take higher doses of Ativan or use it long term, or who misuse or abuse alcohol or drugs). Symptoms of physical dependence can include:
• anxiety
• depression
• muscle weakness
• nightmares
• body aches
• sweating
• nausea
• vomiting
• Serious allergic reactions. Symptoms can include:
• severe rash or hives
• trouble breathing or swallowing
• swelling of your lips, tongue, or face
• rapid heartbeat
• Suicidal thoughts. (Ativan should be avoided by people with depression that’s not treated.)

Side effects in children

Ativan tablets aren’t approved by the Food and Drug Administration (FDA) for use in children under 12 years. They’re sometimes used off-label in children under 12 years, but this use hasn’t been confirmed to be safe.

Children may be more likely than adults to experience side effects from Ativan.

Side effects in seniors

In older adults, Ativan should be used cautiously or avoided altogether. Many seniors are more likely to experience side effects such as drowsiness or dizziness. This can increase their risk of falls, which can lead to bone fractures. Lower dosages are often needed for seniors.

Long-term side effects

Ativan is FDA-approved for short-term use, up to four months. Long-term use of Ativan should be avoided because it can cause serious side effects. These include:

• Dependence. Ativan is a habit-forming drug. This means that long-term use can cause physical and psychological dependence. It can also cause serious withdrawal symptoms when the medication is stopped.
• Rebound effects. In addition, long-term use of Ativan for sleep or anxiety can cause “rebound insomnia” or “rebound anxiety.” This means that Ativan can make symptoms of these conditions worse over time, which makes it even harder to stop taking the drug.

If you’ve been taking Ativan regularly for a long time, talk with your doctor about other medication options, and how you might be able to stop taking Ativan.

Driving warning

Ativan can impair your ability to drive. If you feel lightheaded or sleepy after taking it, don’t drive. Also, don’t use dangerous equipment.

Nausea

It’s not common, but some people who take Ativan can feel nauseated. This side effect may go away with continued use of the drug. If nausea doesn’t go away or is bothersome, talk with your doctor.

Headache

Some people who take Ativan report having headaches afterward. This side effect may go away with continued use of the drug. If headaches don’t get better or are bothersome, talk with your doctor.

Slowed breathing

Ativan can cause your breathing to slow down. In rare cases, this can lead to respiratory failure.

Slowed breathing is more likely to occur in people who are:

• seniors
• receiving high doses of Ativan
• taking other medications that affect breathing, such as opioids
• severely ill or have a breathing disorder such as sleep apnea or chronic obstructive pulmonary disorder (COPD)

Weight gain/weight loss

Weight gain or loss aren’t typical side effects of Ativan, and studies have not confirmed these as side effects of this drug. However, weight changes may still occur.

Some people who take Ativan say they have a bigger appetite. This might cause them to eat more and gain weight. And other people who take it have a reduced appetite. This might cause them to eat less and lose weight.

Memory loss

Some people who take Ativan can have temporary memory loss. If this happens, you may have trouble remembering things that occurred while you were taking the medication.

Memory loss should stop after you stop taking Ativan.

Constipation

It’s not common, but some people who take Ativan report constipation. This side effect may go away with continued use of the drug. If it doesn’t get better or is bothersome, talk with your doctor.

Vertigo

It’s not common, but some people who take Ativan can experience vertigo. Vertigo is a feeling that things around you are moving when they’re not. People with vertigo often feel dizzy.

It’s not clear if Ativan is the actual cause of symptoms of vertigo. Also, Ativan is sometimes used off-label to treat people who have symptoms of vertigo caused by other conditions such as Meniere’s disease.

Hallucinations

It’s rare, but some people who take Ativan have hallucinations. If you have this side effect, talk with your doctor about alternatives to Ativan.

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
• your age
• the form of Ativan you take
• other medical conditions you may have

Typically, your doctor will start you on a low dosage and adjust it over time to reach the dosage that’s right for you. They’ll ultimately prescribe the smallest dosage that provides the desired effect.

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

Drug forms and strengths

• Tablet: 0.5 mg, 1 mg, 2 mg
• Solution for injection (IV): 2 mg per mL, 4 mg per mL

General dosage information

The usual oral dosage for Ativan tablets is 2 to 6 mg daily. This dosage amount is usually divided and taken two or three times daily.

Dosage for anxiety

Typical dosage: 1 to 3 mg taken two or three times daily.

Dosage for insomnia due to anxiety or stress

Typical dosage: 2 to 4 mg at bedtime.

Dosage for IV Ativan

Intravenous (IV) Ativan will be given by your doctor or nurse. Your doctor will determine the best dosage for your condition.

Special dosage considerations

Older adults and people with certain physical conditions may need to start with a lower dosage. This might be 1 to 2 mg, taken two or three times daily for anxiety or once at bedtime for insomnia.

What if I miss a dose?

If you miss a dose, take it as soon as you can. However, if it’s just a few hours until your next dose, skip the missed dose and take the next one on schedule.

Never try to catch up by taking two doses at a time. This can cause dangerous side effects.

The Food and Drug Administration (FDA) approves drugs to treat certain conditions. Ativan is approved to treat several conditions. In addition, it’s sometimes used off-label for purposes that aren’t approved by the FDA.

Approved uses for Ativan

Ativan is FDA-approved for treating several different conditions.

Ativan for anxiety

Ativan is FDA-approved for the short-term treatment of anxiety symptoms. It’s also commonly used off-label for treating generalized anxiety disorder and panic attacks.

Ativan for sleep/insomnia

Ativan is FDA-approved for short-term treatment of insomnia (trouble sleeping) that’s caused by anxiety or stress.

Ativan is also used off-label for other types of insomnia. However, according to the American Academy of Sleep Medicine, it’s not a first-choice medication for this use.

Ativan for seizures

The IV form of Ativan is FDA-approved for treating a severe type of seizure called status epilepticus. With this condition, seizures don’t stop, or one seizure comes after another without allowing the person time to recover.

Ativan for sedation during surgery

The IV form of Ativan is FDA-approved to cause sleep before surgery.

Non-FDA-approved uses

Ativan is also sometimes prescribed off-label. Off-label use is when a drug is approved for one use but is prescribed for a different use.

Ativan for nausea from vertigo

Ativan is sometimes used off-label for the short-term treatment of symptoms of vertigo. These symptoms include nausea and vomiting. In some cases, Ativan may be used along with other medications for this purpose.

Ativan for depression

Ativan and other similar medications aren’t prescribed to treat depression itself. However, some people with depression also have symptoms of anxiety or insomnia. In these cases, your doctor may prescribe Ativan to reduce those symptoms.

If you have depression only, your doctor will likely prescribe a different medication.

Ativan for pain

Ativan isn’t typically used to treat pain itself. However, people who have severe, long-lasting pain are often prescribed Ativan or similar medications. This may be because they have anxiety or trouble sleeping due to their pain.

People with severe pain are often treated with opioid pain medications. Ativan and other benzodiazepine medications shouldn’t be used with opioids. This is due to the risk of life-threatening side effects such as serious sedation, decreased breathing, coma, and death.

If you’re taking an opioid pain medication with Ativan, talk to your doctor about safer options.

Other off-label uses for Ativan

Ativan may also be used off-label to treat other conditions such as:

• agitation
• alcohol withdrawal
• nausea and vomiting related to chemotherapy
• anxiety when flying

If you’re taking Ativan, you shouldn’t drink alcohol. Consuming alcohol with Ativan can increase the risk of serious side effects such as:

• breathing problems
• respiratory failure
• memory problems
• excessive sleepiness or sedation
• coma

Ativan can interact with several other medications. It can also interact with certain supplements and foods.

Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Ativan and other medications

Below is a list of medications that can interact with Ativan. This list doesn’t contain all drugs that may interact with Ativan.

Before taking Ativan, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Opioids

Taking opioids with Ativan can cause dangerous side effects. These include excessive drowsiness, breathing problems, respiratory failure, and coma.

Examples of these drugs include:

• morphine (Astramorph PF, Kadian, MS Contin, and others)
• oxycodone (Percocet, Roxicet, Oxycontin, and others)
• hydrocodone (Zohydro ER, Hysingla ER)
• methadone (Dolophine, Methadose)
• fentanyl (Abstral, Duragesic, and others)

Opioids should only be used with Ativan when there are no other treatment alternatives.

Sedative drugs

Taking sedative drugs with Ativan can cause excessive drowsiness and breathing problems. Examples of sedative drugs include:

• anticonvulsant medications such as carbamazepine (Carbatrol, Epitol, Equetro, Tegretol), phenytoin (Dilantin, Phenytek), and topiramate (Qudexy XR, Topamax, Trokendi XR)
• antihistamines such as diphenhydramine (Benadryl), cetirizine (Zyrtec), chlorpheniramine (Chlor-Trimeton and others), and doxylamine (Unisom and others) — also found in over-the-counter and combination products
• antipsychotic drugs such as clozapine (Clozaril, Fazaclo ODT), haloperidol (Haldol), quetiapine (Seroquel), and risperidone (Risperdal)
• anxiety drugs such as buspirone (Buspar)
• barbiturates such as phenobarbital
• other benzodiazepines such as alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), and midazolam

Probenecid

Taking Ativan with probenecid, a drug that can be used to treat gout, can increase the levels of Ativan in your body. This can increase your risk of Ativan side effects. For people who take probenecid and Ativan together, the Ativan dosage needs to be reduced by half.

Valproic acid

Taking Ativan with valproic acid (Depakene, Depakote), a drug used to treat seizures and other conditions, can increase the levels of Ativan in your body. This can increase your risk of Ativan side effects.

For people who take valproic acid and Ativan together, the Ativan dosage needs to be reduced by half.

Ativan and Zoloft

Zoloft (sertraline) can make some people feel tired or drowsy. Ativan can also cause drowsiness. Taking these medications together may cause you to feel even more tired or drowsy.

Ativan and Ambien

Ativan and Ambien (zolpidem) shouldn’t be taken together. Both medications are used to help promote sleep. If taken together, they can cause excessive sleepiness and sedation.

Taking this combination of medications can also increase the risk of odd behaviors such as sleep-driving (trying to drive while asleep).

Ativan and Tylenol

There are no known interactions between Ativan and Tylenol (acetaminophen).

Ativan and herbs and supplements

Taking Ativan with herbs or supplements that have sedative effects can cause excessive drowsiness and breathing problems. Examples of sedative herbs and supplements that can cause these effects include:

• chamomile
• kava
• lavender
• melatonin
• valerian

Ativan and marijuana

Marijuana shouldn’t be used with Ativan. Using marijuana with Ativan can cause excessive drowsiness or sedation.

Some people can have bothersome withdrawal symptoms after stopping Ativan. These can occur after taking Ativan for as little as one week. If Ativan is taken longer, withdrawal symptoms are more likely to occur. They’re also likely to be more severe.

Withdrawal symptoms can include:

• headache
• anxiety
• trouble sleeping
• irritability
• tremor
• panic attacks
• depression

Talk with your doctor before stopping Ativan. Your doctor may recommend that you slowly reduce your dosage before stopping the drug completely.

Taking too much Ativan can increase your risk of harmful or serious side effects.

Overdose symptoms

Symptoms of overdose can include:

• drowsiness
• confusion
• lethargy
• low blood pressure
• trouble breathing
• coma

What to do in case of overdose

If you think you or your child has taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

There are other medications that are often used to treat the same conditions as Ativan. Some may be better suited for you than others.

The best choice may depend on your age, the type and severity of your condition, and previous treatments you’ve used.

To learn more about other medications that may work well for you, talk to your doctor.

Note: Some of the drugs listed here are used off-label for treating conditions also treated by Ativan.

Medication alternatives

Examples of medications that could be used as alternatives to Ativan include:

• Antidepressants such as:
  • duloxetine (Cymbalta)
  • doxepin (Zonalon, Silenor)
  • escitalopram (Lexapro)
  • paroxetine (Paxil, Paxil CR, Pexeva, Brisdelle)
  • venlafaxine (Effexor XR)
• Buspirone, an anxiolytic drug
• Benzodiazepines such as:
  • alprazolam (Xanax)
  • diazepam (Valium)
  • midazolam
  • oxazepam

Herb and supplement alternatives

Some people use certain herbs and dietary supplements to help manage their anxiety. Examples include:

• kava
• lavender
• lemon balm
• passion flower
• rhodiola
• St. John’s wort
• valerian

Be sure to talk to your doctor before using herbs or supplements to treat your anxiety.

You may wonder how Ativan compares to other medications that are prescribed for similar uses. Below are comparisons between Ativan and several medications.

Ativan vs. Xanax

Ativan and Xanax both belong to the class of drugs called benzodiazepines. They work in the same way and are very similar medications.

The generic name of Xanax is alprazolam.

Uses

Ativan and Xanax are used for similar and different purposes.

Drug forms

Ativan is available as an oral tablet and as an intravenous (IV) solution. The oral tablet is usually taken one to three times a day. The IV solution is given by your healthcare provider.

Xanax is available as an oral tablet, which is usually taken three times daily. It’s also available as an extended-release tablet, which is taken just once daily.

Side effects and risks

Ativan and Xanax have some similar side effects, and some that differ. Below are examples of these side effects.

More common side effects

More common side effects that Ativan and Xanax share include:

• drowsiness
• dizziness
• weakness
• lack of coordination
• confusion
• depression
• fatigue
• headache
• increase or decrease in libido (sex drive)
• memory problems
• constipation

In addition to these, other side effects that Xanax can cause include:

• weight gain or loss
• irregular menstruation

Serious side effects

Possible serious side effects that Ativan and Xanax share include:

• psychological and physical dependence
• life-threatening side effects when used with opioid medications (boxed warning)

Effectiveness

Ativan and Xanax are both used to treat anxiety symptoms. Xanax is also FDA-approved to treat generalized anxiety disorder and panic attacks. Ativan is used off-label to treat those conditions, too. They work about equally well to treat all three conditions.

It’s important to note, however, that these drugs are usually considered second-choice options for these conditions and should only be used for short-term treatment. This is due to the risk of side effects and dependence.

Both Ativan and Xanax work quickly, but Ativan may last slightly longer than Xanax.

• When it starts working: Both drugs start to work 15 to 30 minutes after you take them.
• How long it lasts: Both drugs have a peak effect within 1.5 hours of when you take them. However, Ativan may last slightly longer than Xanax.

Costs

Ativan and Xanax are both brand-name medications. They’re also both available in generic form. The generic version of a drug usually costs less than the brand-name version. The generic name of Xanax is called alprazolam.

Brand-name Ativan usually costs much more than brand-name Xanax. The generic versions of Ativan and Xanax cost about the same. Whichever drug or version you use, the amount you pay will depend on your insurance.

Ativan vs. Klonopin

Ativan and Klonopin work in the same way and are very similar medications. They both belong to the class of drugs called benzodiazepines.

The generic name of Klonopin is clonazepam.

Uses

Although Ativan and Klonopin are similar medications, they’re FDA-approved for different uses.

Ativan is approved for:

• short-term treatment of symptoms of anxiety
• treating insomnia (trouble sleeping) due to anxiety or stress
• treating a severe type of seizure called status epilepticus
• providing sedation before surgery

Klonopin is approved for treating:

• different types of seizures such as Lennox-Gastaut syndrome and myoclonic seizure
• panic attacks

Klonopin is used off-label for treating anxiety symptoms, insomnia, and status epilepticus.

Drug forms

Ativan is available as an oral tablet and as an intravenous (IV) solution. The oral tablet is usually taken one to three times a day. The IV solution is given by your healthcare provider.

Klonopin is available as an oral tablet that’s usually taken one to three times a day.

Side effects and risks

Ativan and Klonopin have similar side effects. Both drugs can cause these more common side effects:

• drowsiness
• dizziness
• weakness
• lack of coordination
• confusion
• depression
• fatigue
• headache

Both can also cause these serious side effects:

• psychological and physical dependence
• life-threatening side effects when used with opioid medications (boxed warning)

Effectiveness

While Ativan and Klonopin have different FDA-approved uses, they’re both used to treat the following conditions:

• For anxiety and panic attacks: Ativan and Klonopin usually work about equally well for treating anxiety and panic attacks. However, they’re typically considered second-choice options for these conditions and should only be used for short-term treatment. This is due to the risk of side effects and dependence.
• Insomnia: There have been no studies comparing the two drugs, but both can be effective for trouble sleeping. However, they’re usually considered second-choice options and should only be used for short-term treatment. This is due to the risk of side effects and dependence.
• Status epilepticus: Both drugs are effective for treating status epilepticus, but only Ativan is considered a first-choice treatment. This condition is treated in the hospital, so the drug used would be chosen by the hospital doctor.

Both Ativan and Klonopin work quickly, but Klonopin may last longer than Ativan:

• When it starts working: Both Ativan and Klonopin start to work within 15 to 30 minutes of when you take them.
• How long it lasts: Ativan has a peak effect within 1.5 hours of when you take it. Klonopin has a peak effect within 4 hours of when you take it.

Costs

Ativan and Klonopin are both brand-name medications. They’re also both available in generic form. The generic version of a drug usually costs less than the brand-name version. The generic name of Klonopin is called clonazepam.

Brand-name Ativan usually costs much more than brand-name Klonopin. The generic versions of Ativan and Klonopin cost about the same. Whichever drug or version you use, the amount you pay will depend on your insurance.

Ativan vs. Valium

Ativan and Valium both belong to the class of drugs called benzodiazepines. They work in the same way and are very similar medications.

The generic name of Valium is diazepam.

Uses

Ativan and Valium are used for similar and different purposes.

Drug forms

Ativan is available as an oral tablet and as an intravenous (IV) solution. The oral tablet is usually taken one to three times a day. The IV solution is given by your healthcare provider.

Valium is also available as an oral tablet, which is typically taken one to four times daily.

Side effects and risks

Ativan and Valium have some similar side effects, and some that differ. Below are examples of these side effects.

More common side effects

More common side effects that Ativan and Valium share include:

• drowsiness
• dizziness
• weakness
• lack of coordination
• confusion
• depression
• fatigue
• headache
• increase or decrease in libido (sex drive)
• memory problems

In addition to these, other side effects that Valium can cause include:

• weight gain or loss
• urinary problems such as incontinence
• irregular menstruation

Serious side effects

Possible serious side effects that Ativan and Valium share include:

• psychological and physical dependence
• life-threatening side effects when used with opioid medications (boxed warning)

Effectiveness

Ativan and Valium have different FDA-approved uses, but they are both used to treat the following conditions:

• Anxiety: These drugs usually work about equally well for treating anxiety. However, they’re typically considered second-choice options and should only be used for short-term treatment. This is due to the risk of side effects and dependence.
• Insomnia: No studies have directly compared these two drugs for treating insomnia. However, both drugs can be effective for this condition. It’s important to note that they’re both typically considered second-choice options for treating this condition and should only be used for short-term treatment. This is due to the risk of side effects and dependence.
• Status epilepticus: Ativan is considered a first-choice treatment for status epilepticus. Valium works as well as Ativan and is also a first-choice treatment, but may cause more side effects, such as sleepiness. Valium is also effective for treating other kinds of seizures. However, it may not be a first-choice medication for those conditions, or may only be used in combination with other medications.

Both Ativan and Valium work quickly. Valium may work longer than Ativan for some uses, but not as long for other uses:

• When it starts working: Ativan starts working within 15 to 30 minutes. Valium starts working within about 15 minutes.
• How long it lasts: Ativan has a peak effect within about 1.5 hours. It lasts in the body for about 10 to 20 hours. However, its effects wear off more quickly — usually within a few hours. Valium has a peak effect within an hour. It remains in the body for about 32 to 48 hours, but its effects don’t usually last that long. Some effects may wear off within a few hours.

Costs

Ativan and Valium are both brand-name medications. Both are also available in generic form. The generic version of a drug usually costs less than the brand-name version. The generic name of Valium is diazepam.

Brand-name Ativan usually costs much more than brand-name Valium. The generic versions of Ativan and Valium cost about the same. Whichever drug or version you use, the amount you pay will depend on your insurance.

Ativan vs. Ambien

Ativan and Ambien have some similar effects in the body. Both are considered to work as sedative-hypnotic drugs. This means they both cause sleepiness and sedation (relaxation). However, these medications belong to different drug classes. Ativan is a benzodiazepine, while Ambien belongs to a class of drugs called non-benzodiazepine hypnotics.

The generic name of Ambien is zolpidem.

Uses

Ativan is FDA-approved for many uses, including:

• short-term treatment of symptoms of anxiety
• treating insomnia (trouble sleeping) due to anxiety or stress
• treating a severe type of seizure called status epilepticus
• providing sedation before surgery

Ambien is only FDA-approved for short-term treatment of insomnia.

Drug forms

Ativan is available as an oral tablet and as an intravenous (IV) solution. The oral tablet is usually taken one to three times a day. The IV solution is given by your healthcare provider.

Ambien is available as an oral tablet and as an extended-release tablet called Ambien CR. Both forms are taken once daily just before bedtime.

Side effects and risks

Ativan and Ambien have some similar side effects, and some that differ. Below are examples of these side effects.

* These can include sleepwalking, and eating, driving, making phone calls, or having sex while asleep.

Effectiveness

The only condition that both Ativan and Ambien are approved to treat is insomnia. Both are effective for treating this condition, although they haven’t been compared in clinical studies for this purpose.

It’s important to note that Ambien is typically a first-choice option for treating insomnia because it usually causes fewer side effects than other drugs.

Ativan is usually considered a second-choice option for treating insomnia. It’s typically used in people for whom first-choice options such as Ambien don’t work well.

Costs

Ativan and Ambien are both brand-name medications. Both are also available in generic form. The generic version of a drug usually costs less than the brand-name version. The generic name of Ambien is zolpidem.

Brand-name Ativan usually costs more than brand-name Ambien. The generic versions of Ativan and Ambien cost about the same. Whichever drug or version you use, the amount you pay will depend on your insurance.

Ativan tablets should be taken in the way your doctor prescribed them. Don’t take more or less Ativan than prescribed without first talking with your doctor.

Timing

Ativan is usually taken two or three times daily. These doses are usually spread out at equal intervals. However, when Ativan is used for insomnia, it’s usually taken just once at bedtime.

Taking Ativan with food

You can take Ativan with or without food. If it upsets your stomach, try taking it with food to help decrease this side effect.

Can Ativan be crushed?

Yes, Ativan can be crushed. Some Ativan tablets may also be split. If you’d like to split your tablets, ask your pharmacist if it’s safe to do so.

Ativan is classified as a benzodiazepine. These drugs are typically used to treat anxiety and insomnia, but can also be used to treat other conditions.

Benzodiazepines are often categorized by how fast they work (onset of action) and how long they last in the body (duration). This chart includes examples of these classifications.

Ativan belongs to a class of medications called benzodiazepines. These medications work by boosting the activity of gamma-aminobutyric acid (GABA) within your body.

GABA is a neurotransmitter that transmits messages between cells in different parts of your body. Increasing GABA in the body results in a tranquilizing effect that reduces feelings of stress and anxiety.

How long does it take to work?

Benzodiazepines such as Ativan are categorized based on how fast they work. Ativan is classified as having a rapid to intermediate onset (start) of action. It begins to work right away after it’s taken, but its peak effect occurs within 1 to 1.5 hours.

Ativan is sometimes prescribed by veterinarians to sedate an animal during surgery or to treat seizures. It’s also used to help reduce stress or fears, especially related to loud noises.

If you think your dog or cat is in distress, see your veterinarian for an evaluation and treatment. Don’t give your pet any Ativan that your doctor has prescribed for you.

If you think your pet has eaten your Ativan, call your veterinarian immediately.

Ativan can harm a fetus when taken by a pregnant woman. Avoid using Ativan during pregnancy.

If you’re pregnant or planning to become pregnant, talk to your doctor. If you’re taking Ativan, you may need to stop.

You shouldn’t breastfeed while taking Ativan. This medication can pass through breast milk and cause side effects in a child who is breastfed.

Tell your doctor if you’re breastfeeding. You may need to decide whether to stop breastfeeding or stop taking this medication.

Before taking Ativan, talk with your doctor about any medical conditions you have. Ativan may not be appropriate for you if you have certain medical conditions.

• For people with depression. Ativan and other benzodiazepine medications can worsen symptoms of depression. Ativan shouldn’t be used by people with depression who aren’t receiving adequate treatment for this condition.
• For people with breathing disorders. Ativan can slow breathing. People with sleep apnea, chronic obstructive pulmonary disease (COPD), or other breathing disorders should use Ativan cautiously or avoid it.
• For people with acute narrow-angle glaucoma. Ativan may increase the pressure inside the eye, worsening glaucoma.

Yes, Ativan is a controlled substance. It’s classified as a Schedule four (IV) prescription drug. This means that it has an accepted medical use but may also cause physical or psychological dependence and be may be abused.

The government has created special rules for how Schedule IV drugs can be prescribed by a doctor and dispensed by a pharmacist. Your doctor or pharmacist can tell you more.

Some people who take Ativan can become physically and psychologically dependent on the drug. The risk of dependence increases if Ativan is used in doses that are higher than prescribed, or for long periods of time.

In some cases, Ativan dependence can lead to misuse or abuse of the drug. The risk is higher with people who have previously abused alcohol or drugs.

Symptoms of Ativan abuse can include:

• confusion
• loss of coordination
• memory problems
• sleep problems
• irritability
• unsteadiness when walking
• impaired judgment

Taking Ativan may cause a positive result for benzodiazepines on urine drug screenings. If you’re taking Ativan, consider disclosing this information before completing a drug screening.

The length of time Ativan stays in your system varies from person to person, but it’s usually three to five days.

Here are answers to some frequently asked questions about Ativan.

How long does Ativan last?

Most of the effects of Ativan last about six to eight hours. However, this can vary from person to person.

How fast does Ativan work?

Ativan begins to work within minutes, but its maximum effect usually happens about 1 to 1.5 hours after you take it.

When stopping Ativan, should you taper your dosage?

If you’ve been taking Ativan regularly, yes, you’ll likely need to slowly taper your dosage of the medication. If you don’t taper your dosage, you may experience withdrawal symptoms.

In some cases, the taper may last several weeks. How slowly you taper the medication will depend on how much you’ve been taking and how long you’ve been using Ativan. Talk with your doctor before stopping Ativan to find out the best way to taper the medication.

What are the withdrawal effects of stopping Ativan?

Ativan can cause withdrawal effects in some people when they stop taking the medication. These effects are more likely to happen if you’ve taken higher doses or taken Ativan for a long period of time.

Symptoms of withdrawal can include:

• headache
• anxiety
• trouble sleeping
• irritability
• sweating
• dizziness

For people with severe Ativan dependence who abruptly stop taking it, more severe withdrawal symptoms can occur. These can include:

• hallucinations
• seizures
• tremor
• panic attacks

Is Ativan addicting?

Ativan is habit-forming and can lead to physical and psychological dependence and addiction.

What are the effects of long-term use of Ativan?

Long-term use of Ativan can increase your risk of certain side effects, especially physical and psychological dependence. This can lead to withdrawal symptoms (see above) when the medication is stopped.

Ativan is typically prescribed for short-term use of two to four weeks. If you’re concerned that you might need to use this medication for longer periods, talk with your doctor.

When Ativan is dispensed from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically one year from the date the medication was dispensed.

The purpose of such expiration dates is to guarantee the effectiveness of the medication during this time.

The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. However, an FDA study showed that many medications may still be good beyond the expiration date listed on the bottle.

How long a medication remains good can depend on many factors, including how and where the medication is stored. Ativan should be stored at room temperature in its original container.

If you have unused medication that has gone past the expiration date, talk to your pharmacist to find out whether you might still be able to use it.

The following information is provided for clinicians and other healthcare professionals.

Mechanism of action

Ativan has a tranquilizing effect in the central nervous system. Ativan binds to benzodiazepine receptors, which increases the effects of gamma-aminobutyric acid. This results in sedation, skeletal muscle relaxation, anticonvulsant effects, and coma.

Pharmacokinetics and metabolism

Ativan has a bioavailability of 90 percent. Peak plasma levels occur about two hours after oral administration.

Ativan is conjugated to glucuronide and excreted in the urine.

The mean half-life of Ativan is about 12 hours; however, it can range from 10 to 20 hours.

Nursing implications

The following should be assessed or monitored in patients receiving Ativan:

• Monitor blood pressure, heart rate, and respiratory function.
• Monitor sedation level in critical care patients, older adults, or debilitated patients.
• Determine history of addiction. Long-term use can lead to dependence and addiction, which is more likely with patients who have a history of addiction.
• Assess fall risk. To prevent falls, ambulation may need to be supervised in older adults taking Ativan.
• Assess need for ongoing or long-term treatment.
• Conduct periodic lab monitoring of liver function, blood count, and renal function with long-term use of Ativan.
• Evaluate for mood disorders such as depression and for improvement in symptoms of anxiety.

Contraindications

Ativan is contraindicated in people with hypersensitivity to benzodiazepines or any component of Ativan. It’s also contraindicated in people with acute narrow-angle glaucoma.

Abuse and dependence

The use of Ativan can cause psychological and physical dependence. The risk of dependence increases when higher doses are used or when it’s used for long periods of time. The risk of dependence is also higher in people with a history of drug or alcohol abuse.

The risk of dependence and abuse can be reduced by using appropriate doses for the shortest time possible.

Storage

Ativan should be stored in a tight container at room temperature of 77°F (25°C). Temperature excursions to 59°F to 86°F (15°C to 30°C) are permissible.

Disclaimer: MedicalNewsToday 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 other 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.

LORAZEPAM 1 MG TABLET (Generic Ativan)

Precautions and Contraindications

Drugs that affect the CNS (e.g., phenothiazines, barbiturates, antidepressants, alcohol, scopolamine, monoamine oxidase inhibitors) may have additive CNS effects when used concomitantly with, or during the period of recovery from, lorazepam. Such combinations, or IV lorazepam used alone in higher than recommended doses, can produce excessive sedation which may result in partial airway obstruction. The manufacturer warns that scopolamine does not provide additional benefit when used concomitantly with lorazepam, but may increase sedation, hallucinations, and irrational behavior.

Concomitant use of benzodiazepines, including lorazepam, and opiate agonists or opiate partial agonists may result in profound sedation, respiratory depression, coma, and death. Patients receiving lorazepam and/or their caregivers should be apprised of the risks associated with concomitant therapeutic or illicit use of benzodiazepines and opiates.

When lorazepam is administered IV prior to regional or local anesthesia, especially at doses greater than 0.05 mg/kg or when opiate agonists or partial agonists are used concomitantly with recommended lorazepam doses, excessive sedation or drowsiness may occur; these effects may possibly interfere with patient cooperation in determining levels of anesthesia.

Lorazepam should be administered IV only in settings in which continuous monitoring of respiratory and cardiac function (i.e., pulse oximetry) is possible. Safety and efficacy of lorazepam may vary according to the dose administered and clinical status of the patient. Since lorazepam is capable of producing several levels of CNS depression–from mild to deep sedation, facilities, age- and size-appropriate equipment for bag/mask/valve ventilation and intubation, drugs, and skilled personnel necessary for ventilation and intubation, administration of oxygen, assisted or controlled respiration, airway management, and cardiovascular support should be immediately available whenever this drug is administered. Monitoring of vital signs also should continue during the recovery period. Lorazepam injection should be administered with extreme caution to geriatric or debilitated patients, and to patients with compromised pulmonary function (decreased reserve), since underventilation and/or hypoxic cardiac arrest may occur. For deeply sedated pediatric patients, a dedicated individual other than the clinician performing the procedure should monitor the patient throughout the procedure.

Lorazepam should only be used for the treatment of status epilepticus by clinicians experienced in the comprehensive management of the disease. Since these patients may be at increased risk of respiratory depression associated with administration of IV lorazepam, they require careful monitoring of respiratory rate and maintenance of an adequate, patent airway. Ventilatory support also may be needed in some patients. Because of the prolonged duration of action of lorazepam, it should be considered that the sedative effects of the drug (especially after multiple doses) may increase the impairment of consciousness observed in the postictal state.

The manufacturer warns that there is no evidence to date to support the use of lorazepam injection in patients with coma, shock, or acute alcohol intoxication. The manufacturer warns that there are insufficient data to support the use of lorazepam injection for outpatient endoscopic procedures; when these procedures are conducted in inpatients, adequate recovery room observations are necessary and pharyngeal reflex activity should be minimized prior to the procedure by administering adequate topical or regional anesthesia.

Adverse effects associated with propylene glycol (e.g., lactic acidosis, hyperosmolality, hypotension) or polyethylene glycol (e.g., acute tubular necrosis) may occur in patients receiving lorazepam injection at higher than recommended dosages. Manifestations of toxicity are more likely to occur in patients with renal impairment.

Lorazepam injection is not recommended for use in patients with hepatic and/or renal failure, since the drug is most likely conjugated in the liver and since conjugated lorazepam is excreted via the kidneys. However, this does not preclude use of the drug in patients with mild to moderately severe hepatic or renal disease; in these patients, the lowest possible effective dose of lorazepam injection should be administered since the effects of the drug may be prolonged. The manufacturer states that administration of oral lorazepam may exacerbate hepatic encephalopathy and, therefore, the drug should be used with caution in patients with severe hepatic insufficiency and/or encephalopathy. Dosage of lorazepam should be adjusted carefully in patients with severe hepatic insufficiency; lower than recommended dosages may be sufficient in these.

Patients should be informed of the pharmacologic effects of lorazepam (e.g., sedation, relief of anxiety, lack of recall) and the duration of these effects (8 hours or longer) so that they may adequately perceive the risks and benefits of use of lorazepam injection. Patients should be warned that lorazepam injection may impair their ability to perform activities requiring mental alertness or physical coordination (e.g., operating machinery, driving a motor vehicle) for 24-48 hours following administration of the drug. Impaired performance may persist for longer periods in geriatric patients, in patients using other drugs concomitantly, and as a result of the stress of surgery or general condition of the patient. Patients also should be warned that premature ambulation (within 8 hours of receiving lorazepam injection) may result in injury from falling. Patients also should be warned that concomitant use of lorazepam injection with sedatives, opiate analgesics (opiate agonists or partial agonists), or tranquilizers may increase the extent and duration of impaired performance, may cause excessive sedation, and, rarely, may interfere with recall and recognition of events on the day of surgery and the following day. Patients should be advised to abstain from consumption of alcoholic beverages for 24-48 hours following administration of lorazepam injection.

Lorazepam injection is contraindicated in patients with known hypersensitivity to benzodiazepines or any ingredients in the formulation (i.e., polyethylene glycol, propylene glycol, or benzyl alcohol) and in patients with acute angle-closure glaucoma or sleep apnea syndrome. The injection also is contraindicated in patients with severe respiratory insufficiency, except in those requiring relief of anxiety and/or diminished recall of events while being mechanically ventilated.

Teva-Lorazepam – Uses, Side Effects, Interactions

How does this medication work? What will it do for me?

Lorazepam belongs to the class of medications called benzodiazepines. Lorazepam is used for the short-term relief of the symptoms of excessive anxiety. It works by slowing down the communication between the nerves in the brain (i.e., the central nervous system).

Some people experience some improvement in anxiety about half an hour after taking lorazepam. Injectable lorazepam can be used as an initial treatment for the control of prolonged seizures (status epilepticus).

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

0.5 mg
Each small, round, white, flat with bevelled-edged, compressed tablet, engraved “N” on one side, and “0.5” on the other, contains 0.5 mg of lorazepam.  Nonmedicinal ingredients: colloidal silicon dioxide, magnesium stearate, microcrystalline cellulose, sodium lauryl sulfate, and starch.

1 mg
Each small, white, capsule-shaped, flat with bevelled-edged, compressed tablet, engraved “N”, vertical scoreline, “1” on one side, and plain on the other, contains 1 mg of lorazepam. Nonmedicinal ingredients: colloidal silicon dioxide, magnesium stearate, microcrystalline cellulose, sodium lauryl sulfate, and starch.

2 mg
Each white, oval-shaped, flat with bevelled-edged, compressed tablet, engraved “N”, vertical scoreline, “2” on one side, and plain on the other, contains 2 mg of lorazepam. Nonmedicinal ingredients: colloidal silicon dioxide, magnesium stearate, microcrystalline cellulose, sodium lauryl sulfate, and starch.

How should I use this medication?

Anxiety: The recommended starting dose of lorazepam for adults is 2 mg per day, given in divided doses. The dose is individualized according to your specific needs and response to the medication. This dose can be increased by your doctor to as high as a total of 6 mg per day in 2 to 4 divided doses.

If you are taking the sublingual tablets, place the tablet under the tongue. The medication will dissolve in about 20 seconds. You should not swallow for at least 2 minutes to allow the medication to be absorbed into the body.

Seizures: The dose of injectable lorazepam for seizures is based on body weight and given by a trained health care provider in a hospital.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you have been taking this medication regularly, do not stop taking the medication without speaking with your doctor. A gradual reduction in dose is recommended when stopping this medication to avoid withdrawal effects.

If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store lorazepam tablets at room temperature, protect from light and moisture, and keep them out of the reach of children. The lorazepam injection is stored in the fridge.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take lorazepam if you:

• are allergic to lorazepam, other benzodiazepines, or any ingredients of the medication
• have acute narrow-angle glaucoma
• have myasthenia gravis










What side effects are possible with this medication?




Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• clumsiness or unsteadiness
• dizziness or lightheadedness
• drowsiness
• nightmares
• sleep disturbance
• slurred speech
• symptoms of low blood pressure (e.g., fainting, dizziness, lightheadedness, blurred vision, increased thirst, nausea)
• weakness

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• abnormal thinking (disorientation, delusions, or loss of sense of reality)
• anxiety
• behavioural changes (e.g., aggressiveness, angry outburst)
• blurred vision or other changes in vision
• confusion
• false sense of well-being
• fast, irregular heartbeat
• hallucinations (seeing or hearing things that are not there)
• inappropriate behavior
• memory problems
• muscle weakness
• signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• unusual bleeding or bruising
• unusual excitement, nervousness, or irritability
• unusual tiredness or weakness

Stop taking the medication and seek immediate medical attention if any of the following occur:

• breathing difficulties
• chest pain
• convulsions (seizures)
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• symptoms of myasthenia gravis (e.g., muscle weakness, drooping eyelid, vision changes, difficulty chewing and swallowing, trouble breathing)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.









Are there any other precautions or warnings for this medication?




Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

HEALTH CANADA ADVISORY

October 30, 2020

Health Canada has issued new restrictions concerning the use of benzodiazepines and benzodiazepine-like prescription drugs. To read the full Health Canada Advisory, visit Health Canada’s web site at www.hc-sc.gc.ca.

Alcohol and other medications that cause drowsiness: People taking this medication should not combine it with alcohol and avoid combining it with other medications, such as narcotic pain relievers, that cause drowsiness. Doing so can cause additive drowsiness and reduced breathing, as well as other side effects, which can be dangerous.

Allergic reaction: Some people may develop a serious allergic reaction to this medication. Signs of an allergic reaction include a severe rash, hives, swollen face or throat, or difficulty breathing. If these occur, seek immediate medical attention.

Dependence and withdrawal: Physical dependence (a need to take regular doses to prevent physical symptoms) has been associated with benzodiazepines such as lorazepam. Severe withdrawal symptoms may be experienced if the dose is significantly reduced or suddenly discontinued. Withdrawal symptoms can include:

• abdominal cramps
• agitation
• confusion
• diarrhea
• extreme anxiety
• headache
• irritability
• memory impairment
• muscle pain
• nervousness
• restlessness
• sleep problems
• tension
• tremors
• vomiting

Reducing the dose gradually under medical supervision can help prevent or decrease these withdrawal symptoms. If you have a history of addiction or substance use problems, discuss the risks and benefits of the medication with your doctor.

Depression: People who have preexisting depression may experience emerging or worsening symptoms of depression while taking this medication. If you experience this, contact your doctor as soon as possible. People with depression should be treated with appropriate antidepressant therapy.

If you experience symptoms of depression such as poor concentration, changes in weight, changes in sleep, decreased interest in activities, or notice them in a family member who is taking this medication contact your doctor as soon as possible.

Drowsiness/reduced alertness: People taking lorazepam should not drive a car or perform hazardous tasks until they determine that this medication does not impair their ability to perform these tasks safely. Avoid drinking alcohol, as it can increase the drowsiness effects of this medication.

Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Lung disease: If you have underlying lung disease (e.g., chronic obstructive pulmonary disease, sleep apnea), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: Taking lorazepam during the first trimester of pregnancy may result in an increased risk of certain birth defects. This medication should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking lorazepam, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children and adolescents: The safety and effectiveness of using this medication have not been established for those under 18 years of age.

Seniors: Seniors may be more likely to experience side effects of lorazepam, such as sedation (drowsiness) and impaired coordination. Seniors should discuss with their doctor the risks and benefits of taking this medication.







What other drugs could interact with this medication?




There may be an interaction between lorazepam and any of the following:

• alcohol
• antihistamines (e.g., cetirizine, chlorpheniramine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• azelastine
• barbiturates (e.g., butalbital, phenobarbital, secobarbital)
• benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
• brimonidine
• buprenorphine
• buspirone
• cannabis
• chloral hydrate
• efavirenz
• general anesthetics (medications used to put people to sleep before surgery)
• kava kava
• melatonin
• methadone
• mirtazapine
• muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine)
• nabilone
• narcotics (e.g., codeine, fentanyl, morphine, oxycodone)
• olopatadine
• pramipexole
• ropinirole
• rotigotine
• rufinamide
• scopolamine
• seizure medications (e.g., carbamazepine, clobazam,  levetiracetam, phenobarbital, phenytoin, primidone, topiramate, valproic acid, zonisamide)
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
• tapentadol
• thalidomide
• theophyllines (e.g., aminophylline, oxtriphylline, theophylline)
• tramadol
• tricyclic antidepressants (e.g., amitriptyline, clopimpramine, desipramine, imipramine, nortriptyline)
• valerian
• yohimbine
• zolpidem
• zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications; you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Teva-Lorazepam

Lorazepam

Side effects

Please do not be worried by the side effects listed on this page. Many people take lorazepam without any side effects or only a few mild side effects. If you think you might be getting a side effect from lorazepam, then you should discuss this with your doctor, nurse, or pharmacist.

Very common side effects of lorazepam (affecting more than one in ten people) include:

• daytime drowsiness and tiredness

Common side effects of lorazepam (affecting up to one in ten people) include:

• dizziness, feeling less alert
• poor muscle control, muscle weakness

Go and see your doctor but do not stop taking the tablets if you notice any of the following:

• feeling that you are becoming reliant on lorazepam and finding it difficult to stop
• a feeling of wellbeing for no reason
• memory loss or forgetfulness

Body

Lorazepam has not been shown to affect weight in most people.

It can affect the appetite, but this is rare (happens in up to one in 10,000 people).

Talk to your doctor about this if it worries you.

Sleep

Lorazepam is used to help people who cannot sleep, so you would expect it to make you feel sleepy.

Lorazepam can, however, make people feel sleepy during the day which can become a problem.

If lorazepam makes it more difficult for you to get to sleep, or gives you strange nightmares, you should go back to your doctor as soon as possible.

Sex and fertility

Sex

Lorazepam can have side effects that affect your sex life. These are rare but might include:

• losing interest in sex, or sometimes feeling more like having sex
• feeling ‘numb’ to your normal emotions
• feeling less inhibited about sex
• finding it difficult to reach orgasm (come)
• finding it difficult to get an erection (get hard)

These effects should pass after the first couple of weeks on the medication. If they don’t and this is a problem for you, go back to your doctor.

The good effects of lorazepam may have a positive impact on your sex life as your symptoms settle, you sleep better, and you can concentrate on your relationships.

Fertility

There is no evidence that lorazepam affects fertility.

Pregnancy, post-natal and breastfeeding

Pregnancy

Lorazepam can affect the developing baby, and cause symptoms in a newborn baby. For this reason, it is usually recommended to avoid taking lorazepam during pregnancy.

However, the risks to the developing baby from taking lorazepam will need to be weighed up against the risks of not taking lorazepam to your mental health.

Some studies suggest a low risk of possible mouth defects, but other studies didn’t find this.

If you and your doctor decide that you need to take lorazepam during the pregnancy, then this will be at the lowest dose that works for you and for the shortest period that is necessary. This is to minimise the amount of lorazepam that the developing baby is exposed to.

If you are taking lorazepam in the last few weeks of pregnancy, you should tell your midwife and doctor so that they can look out for symptoms in the newborn baby.

Post-natal

Your baby may be less active than other babies, have a low body temperature, be floppy, or have breathing or feeding difficulties for a while.

Your baby’s response to the cold might be affected for a while.

Your baby may develop withdrawal symptoms after birth.

Breastfeeding

Lorazepam is passed to the baby in breast milk in small amounts. It is not usually seen as a problem unless your baby was born early or has other health problems.

Breastfeeding can reduce any withdrawal symptoms the baby may have from lorazepam.

If your baby becomes restless, very sleepy or develops feeding problems, stop breastfeeding and quickly seek medical advice.

It is important that you remain well while you are bonding with your newborn baby. For this reason, you may need to keep taking some medicines on your doctor’s advice.

Driving and transport

Do not drive a car or ride a bike just after you start taking lorazepam.

Taking lorazepam may make you feel dizzy, sleepy or forgetful, and you may find it difficult to concentrate.

It may also cause blurred vision and muscle weakness.

This could affect you if you drive a car, ride a bike, or do anything else that needs a lot of focus.

If you are not sleeping well, this could also make driving dangerous for yourself and other people.

It might be best to stop doing these things for the first few days, until you know how it affects you.

Under new ‘drug driving’ laws introduced in 2015, you could be arrested if driving dangerously while taking lorazepam. However, the limit for the medication is higher than what a doctor would normally prescribe.

It is important to stick to the dose on the prescription, and to check that you can drive safely while taking it.

School and exams

Try not to take lorazepam for the first time just before your exams.

You may feel forgetful, very sleepy, and find it difficult to concentrate when you start taking lorazepam.

You should talk to your doctor about any future exams if you are starting lorazepam. You might decide together to delay starting it until you have done them.

If they are more than a few days away, however, you might find that it is better to start lorazepam to improve your sleep and your ability to study.

Try not to drink caffeine drinks to stay awake for exam revision – they stop the lorazepam working.

Lorazepam might make you forgetful and make it difficult to concentrate.

After the first few days you will know how it affects you.

Friends and family

You may want to let your family and friends know you are taking lorazepam so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

Sport

Lorazepam is not a banned substance in sport.

However, lorazepam has many side effects that might make you less able to take part in sports that need a lot of focus.

These side effects include feeling sleepy, blurred eyesight, being forgetful, muscle weakness and finding it difficult to concentrate.

The good effects of lorazepam may have a positive impact on your sporting performance as your symptoms settle, and you start to feel the benefits of the medication.

Alcohol and street drugs

Alcohol

You can drink a small amount of alcohol while taking lorazepam, but having the two together is likely to make you very sleepy. This will be most noticeable during the early part of your treatment

Taking large amounts of alcohol and lorazepam together could affect your breathing especially if you have an existing lung problem.

If you need to drive a car, ride a bike, or use machines at work, taking alcohol and lorazepam together could be dangerous to yourself and other people.

Street drugs

It is very easy, and serious, to overdose with any combination of lorazepam and drugs.

Using cannabis with lorazepam will make sedative effects worse. You could go into a very deep sleep where you do not breathe properly and have difficulty waking up.

Cannabis and other drugs may have their own side effects on your mental health, like anxiety or psychosis. For more information, have a look at our drugs and alcohol page.

Using heroin or methadone with lorazepam will increase their combined sedative effects. You could go into a very deep sleep where you do not breathe properly and have difficulty waking up.

Using cocaine or other stimulants (like ecstasy, amfetamines, MDA, 6-APB) with lorazepam can lead to uncertain and dangerous effects.

Prescription medicines

Lorazepam does not mix well with some other medicines and drugs and may affect the way in which they work. Tell your doctor if you are taking any other medications including over-the-counter medicines for common illnesses and things you put on your skin.

Other interactions

Caffeine interferes with the way lorazepam works on your body, as it has the opposite effect to the medicine.

Try not to drink caffeine drinks (like coffee, cola or energy drinks) while you are taking lorazepam.

Caffeine can cause anxiety and sleep loss – stopping these drinks might help to improve your symptoms.

References and further reading

For more helpful links and information, have a look at our references and further reading page.

What to Know About the Side Effects

Ativan (lorazepam) is a benzodiazepine, which is a class of medications also known as central nervous system depressants. Other benzodiazepines include Librium (chlordiazepoxide), Klonopin (clonazepam), Valium (diazepam), and Xanax (alprazolam).

Ativan is used to treat anxiety, insomnia (during a short term period), and seizure. Off-label uses of Ativan include treatment for alcohol withdrawal, chemotherapy associated nausea and vomiting, catatonia, agitation, and much more.

In the United States, benzodiazepines are considered “controlled substances” that are federally regulated because of their potential for misuse. If you are taking Ativan, it’s important to be aware of the potential side effects in case you begin to experience any. If you do, be sure to consult your doctor right away.

Common Side Effects

It is important to use Ativan under the guidance of a healthcare provider, and to avoid driving or operating heavy machinery until you know how you are affected by the medication.

Since Ativan works by depressing the nervous system, common side effects include drowsiness, sedation, low blood pressure, dizziness, and unsteadiness.

Severe Side Effects

In severe cases, Ativan can cause profound sedation, respiratory depression, coma, and, most severely, death because it dampens the signal from your brain that tells your body to breathe. These severe side effects can occur when:

• Ativan is taken in high doses
• Ativan is taken with other substances that also depress the central nervous system, such as other benzodiazepines, alcohol, opioid pain medication, barbiturates, and more
• Ativan is taken when you have other illnesses that affect your breathing, such as chronic obstructive pulmonary disease (COPD), sleep apnea, and more

Children and the Elderly

In some populations, such as the children and the elderly, Ativan can cause a “paradoxical effect.” Instead of having a calming effect, it may cause agitation and confusion. Elderly patients taking Ativan are also at a higher risk of falls.

Pregnancy, Breastfeeding, and Infants

Ativan can affect people who are pregnant and breastfeeding and their babies. Ativan can, in fact, cross the placenta and move into the breastmilk. In these cases, it is important to speak with your healthcare provider to weigh the risks and benefits of using this medication.

Physical Dependence and Tolerance

Long term use of benzodiazepines such as Ativan can lead to physical dependence. This means that your body develops a tolerance for the medication. Over time, you might need higher doses of the medication to have the same effect.

In other words, if you use the same dose of medication over a long period of time, there is a decreased effect of that dose when compared to your previous, smaller dose.

People who use benzodiazepines for a long time might have physical dependence, but it does not necessarily mean that they are addicted to or abusing these medications.

Withdrawal 

Some people who suddenly stop taking Ativan can experience withdrawal symptoms.

Common withdrawal symptoms include anxiety, depressed mood, insomnia, and tremor. In severe cases, withdrawal symptoms can include confusion, hallucinations, seizures, and death.

This is why it is so important to talk to a healthcare provider before stopping a benzodiazepine. A healthcare provider can help you slowly taper, or reduce, the Ativan dose over time in order to prevent withdrawal.

Drug Abuse and Addiction

Benzodiazepines like Ativan have the potential for abuse and addiction. If you have a personal history of addiction or a family history of addiction, you should be especially careful when using these medications and be closely monitored by your healthcare provider. According to the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5), a substance use disorder is a “problematic pattern of substance use leading to clinically significant impairment or distress,” including two or more of the following criteria over a 12-month period:

1. The substance is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
4. Craving, or a strong desire or urge to use the substance.
5. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
7. Important social, occupational, or recreational activities are given up or reduced because of substance use.
8. Recurrent substance use in situations in which it is physically hazardous.
9. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. Tolerance, as defined by either a need for markedly increased amounts of the substance to achieve intoxication or desired effect, or markedly diminished effect with continued use of the same amount of the substance.
11. Withdrawal, as manifested by either characteristic withdrawal symptoms for the substance, or the substance is taken to relieve or avoid withdrawal symptoms. 

If you experience any of these while taking Ativan, it is best to consult with your doctor to prevent and heavy dependence or addiction.

A Word From Verywell

Medications such as Ativan may be intimidating to some because of their potential for heavy side effects. If your doctor recommends you take Ativan or if you are already taking it, it may be helpful to discuss with your doctor at length the signs and symptoms of dependence on Ativan, as well as any negative or potentially harmful symptoms that may occur. Remember, working closely with your healthcare provider should enable you to spot any warning signs in advance.

Drug – Ativan (1mg) – 10 Tablet   (Lorazepam) Price List or Cost of Medication

Drug information on Ativan (1mg) (Lorazepam) from Wyeth Limited

Drug Name : Lorazepam

Lorazepam(Ativan) generic Ativan (1mg) is a benzodiazepine, prescribed for anxiety. It slows activity in the brain to allow for mind relaxation.

More Info about Lorazepam

Other Trade Names for Lorazepam

India : 

More…

International : 

Ativan, Lorazepam Intensol

Medindia currently has information on 3080 generic drugs and 110,061 brands that have their prices listed. New drugs with their prices are listed as and when they get approved by the drug controller. Please do write to us ([email protected]) if a drug is missing from our comprehensive drug price list.

Medical Condition(s) for which Ativan (1mg) may be prescribed

•   Most Common :

Dizziness, weakness and unsteadiness.

•   Central Nervous System :


Drowsiness, memory loss, confusion, disorientation, depression, emotional state, suicidal thought/attempt, incoordination, weakness, convulsions/seizures, tremor, fainting, visual disturbances, slurred speech, change in libido, impotence, headache and coma.

•   Respiratory :


Respiratory depression and worsening of obstructive pulmonary disease.

•   Gastrointestinal :


Nausea, change in appetite, constipation and jaundice.

•   Hypersensitivity reactions :


Shock.

•   Skin :


Hair loss.

PO- The recommended dose is 2-3 mg/day given in two or three divided doses.

It comes as a tablet to take by mouth, with or without food.

Contraindicated in patients with narrow-angle glaucoma and hypersensitivity.

• Caution should be exercised in patients with history of increased eye pressure, seizures, lung, heart or liver disease, any allergy, who are taking other medications, elderly, during pregnancy and breastfeeding.

•

It may cause drowsiness or dizziness, do not drive a car or operate machinery while taking this medication.

•


Avoid alcohol consumption.

•


Monitor liver function and complete blood counts regularly while taking this medication.

Avoid excess dosage.

Store it at room temperature and in an airtight container. Keep away from children.

Schedule : H  Prescription drugs – Drugs to be sold only under the prescription of a Registered Medical Practitioner.

Arpimed

Tell your doctor if you are using, have recently taken or might be taking any other medicines. The following drugs are especially important:

If necessary, your doctor will reduce the dose of these drugs before using lorazepam.

Avoid drinking alcohol while taking lorazepam as it may increase the sedative properties of the medication.

Tell your doctor or pharmacist if you are taking Lorazepam before using any other drugs or in hospital treatment.

Some elderly patients may experience dizziness and fainting after taking Lorazepam.

When taking Lorazepam, there is a risk of habituation, which can lead to a gradual decrease in effectiveness after several weeks of taking Lorazepam.

Lorazepam has the potential to develop dependence, particularly in patients with a history of alcohol and / or recreational drug abuse.

With the usual regimen of lorazepam, the development of dependence is unlikely, but the risk increases with increasing doses and increasing the duration of treatment, as well as in patients with a history of alcohol and / or recreational drug abuse or in patients with a personality disorder.Therefore, lorazepam should be avoided in patients with a history of alcohol and / or recreational drug abuse.

Addiction can lead to the development of a withdrawal syndrome, especially if treatment is suddenly stopped. Therefore, it is necessary to carry out the withdrawal of the drug gradually.

When taking lorazepam for more than 4 weeks, your doctor should conduct a peripheral blood test, as well as a biochemical blood test for liver markers, as drugs in this group can lead to liver dysfunction.

Long-term use of Lorazepam can lead to the development of drug dependence. Therefore, Lorazepam is usually prescribed in short courses lasting from several days to 4 weeks, including a period of dose reduction and drug withdrawal. This reduces the risk of drug dependence or adverse side effects observed when the drug is discontinued. (See Section “Cancellation of Lorazepam”).

The dose of Lorazepam should be increased gradually to avoid the development of side effects.

The evening dose should be higher than the daily dose of the drug.

How to take Lorazepam

Lorazepam should be taken exactly as directed by your doctor. If you have any doubts, then you should consult with your doctor.

When using Lorazepam for the treatment of anxiety and insomnia, treatment usually lasts from several days to 4 weeks, including a period of dose reduction and drug withdrawal.

The doctor should prescribe the lowest effective dose, calculated for the shortest possible period of taking the drug.

Lorazepam tablets must be swallowed with water.

Adults and children over 13 years old

In case of anxiety, the daily dose of Lorazepam is 1-4 mg, taken in divided doses. Your health care provider will determine how often you take Lorazepam. Lorazepam is not recommended for children under 12 years of age with anxiety.

For disorders of the patient, 1-2 mg of Lorazepam are prescribed at bedtime. Before taking the drug, you must be sure that you can get 7-8 hours of sleep.

2-3 mg Lorazepam is prescribed at night before surgery and 2-4 mg 1-2 hours before surgery.

Children from 5 to 13 years old

For surgery, the dose is usually 0.5-2.5 mg (depending on your child’s weight) taken one hour before the procedure.

It is not recommended to use Lorazepam in children from 5 to 13 years old for the treatment of anxiety and sleep disorders, as well as in children under the age of 5 years.

Old age

The physician should prescribe Lorazepam to elderly or malnourished patients at low doses.

The drug may be effective when taken at half or even less of the recommended dose in elderly patients, however, if necessary, the dose should be adjusted.

Patients with renal and hepatic impairment

In case of impaired renal function or mild to moderate hepatic impairment, it is allowed to take Lorazepam only in low doses.

Lorazepam is contraindicated in patients with severe hepatic impairment.

If you forget to take Lorazepam

If you forget to take Lorazepam to treat anxiety and if less than 3 hours have passed since the scheduled time, you should take it as soon as you remember. If more than 3 hours have passed since the appointed time, do not worry, take the next dose at the appointed time. Do not take a double dose to make up for the missed dose.

If you forget to take Lorazepam to treat your sleep disorder, take it if you are sure you can sleep 7-8 hours after taking the drug.

If you have used more Lorazepam than recommended

If you have taken more Lorazepam than prescribed by your doctor, seek immediate medical attention, call your doctor, or go to the nearest hospital. Take the package of the medicine with you, even if there are no pills left.

Cancellation of Lorazepam

After completing the prescribed course of treatment, your doctor will decide on the extension of further treatment.

The dose and frequency of Lorazepam should be reduced gradually until the drug is discontinued. This allows your body to adjust to the absence of Lorazepam, and reduce the risk of adverse effects if the drug is discontinued. Your doctor will tell you how to do this.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

Withdrawal Syndrome

If Lorazepam is suddenly stopped, withdrawal symptoms may occur, such as headaches, muscle aches, anxiety, tension, depression, anxiety, dizziness, nausea, diarrhea, loss of appetite, confusion, irritability, agitation, tremors, abdominal pain, heart rhythm disturbances , short-term memory loss, fever and sweating.A relapse of insomnia is possible. If you have any of these symptoms, see your doctor.

Do not stop taking Lorazepam suddenly. This can lead to more serious withdrawal symptoms, such as loss of a sense of reality, feeling unreality of what is happening or disconnected from everyday life, loss of the ability to feel emotions.

Some patients experience numbness or tingling of the hands or feet, vomiting, ringing in the ears, muscle twitching, hallucinations, convulsions, and increased sensitivity to light, sound and touch.If you have any of these symptoms, see your doctor immediately.

instructions for use, analogs, articles »Drug Handbook

From the nervous system: at the beginning of treatment (especially in elderly patients) – drowsiness, increased fatigue, dizziness, decreased ability to concentrate, ataxia (gait instability and poor coordination of movements) , disorientation, lethargy, dulling of emotions, slowing down of mental and motor reactions; rarely – headache, euphoria, depression, tremor, depression of mood, catalepsy, anterograde 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). From the side of hematopoietic organs: leukopenia, neutropenia, agranulocytosis (chills, hyperthermia, sore throat, excessive fatigue or weakness), anemia, thrombocytopenia.
From the digestive system: dry mouth or drooling, heartburn, nausea, vomiting, decreased appetite, constipation or diarrhea; liver dysfunction, increased activity of “hepatic” transaminases, LDH 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.
Influence 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 – oppression 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, tremors, perceptual disorders, incl.hyperacusis, paresthesia, photophobia, tachycardia, convulsions, hallucinations, rarely acute psychosis).
Overdose. Symptoms: drowsiness, confusion, paradoxical agitation, decreased reflexes, stunnedness, decreased response to painful irritations, deep sleep, dysarthria, ataxia, visual impairment (nystagmus), tremor, bradycardia, shortness of breath or shortness of breath, severe weakness, decreased blood pressure, collapse , depression of cardiac and respiratory activity, coma.
Treatment: gastric lavage, forced diuresis, intake of activated carbon.Symptomatic therapy (maintaining breathing and blood pressure). Flumazenil is used as a specific antagonist (in a hospital setting). Hemodialysis is ineffective.

Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

Ativan; LORazepam Intensol

Trade names: Canada

APO-LORazepam; Ativan; DOM-LORazepam [DSC]; PMS-LORazepam; PRO-LORazepam; TEVA-LORazepam

Warning

• This drug is a benzodiazepine.Concomitant use of benzodiazepines with opioids has resulted in very severe side effects. Side effects observed included slowing or difficult breathing and death. Opioids include drugs such as codeine, oxycodone, and morphine. Opioids are used to treat pain and some are used to treat coughs. Consult your doctor.
• If you are taking this drug with an opioid, get medical help right away if you feel very sleepy or dizzy, if you have slow, shallow, or difficult breathing, or if you pass out.Guardians or others should seek immediate medical attention if the patient does not respond, does not respond, or does not respond normally, or if he is asleep and does not wake up.
• There may be a risk of dependence, abuse or misuse when using benzodiazepines. Misuse or abuse of this drug can lead to overdose or death, especially when used in conjunction with certain other drugs, alcohol, or drugs.Addiction can occur even if you use this drug as directed by your doctor. Get immediate medical attention if you have changes in mood or behavior, suicidal thoughts or actions, seizures, or trouble breathing.
• You will be closely monitored to avoid misuse, abuse or dependence on this drug.
• Benzodiazepines may be addictive.Reducing the dose or stopping suddenly from this drug may cause withdrawal. This can be life threatening. The risk of addiction and withdrawal increases with long-term or high-dose use of this drug. Talk to your doctor before lowering the dose or stopping this drug. Follow your doctor’s instructions. Get immediate medical attention if you experience problems controlling body movements, seizures, behavior or mood changes, such as depression or suicidal thoughts, thoughts of harming someone, hallucinations (vision or auditory perception), appear or become more severe non-existent things), loss of contact with reality, stupid movements or conversations, or any other side effects.
• Sometimes withdrawal symptoms can last from several weeks to more than 12 months. Tell your doctor if you have anxiety; problems with memory, learning, or concentration; sleep problems; burning, numbness, or tingling; weakness; tremor; muscle twitching; ringing in the ears or any other side effects.

What is this drug used for?

• Used to treat anxiety.
• Used to treat seizures.
• Used to reduce anxiety before surgery.
• This medicinal product may be used for other indications. Consult your doctor.

What do I need to tell my doctor BEFORE taking this drug?

• If you are allergic to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergy and how it manifested itself.
• If you have any of the following health problems: glaucoma, depressed mood (depression), or any type of mental disorder.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all the medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems. You need to make sure that this drug is safe for your medical condition and in combination with other drugs you are already taking.Do not start or stop taking any drug or change the dosage without your doctor’s approval.

What do I need to know or do while I am taking this drug?

All forms of issue:

• Tell all healthcare providers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
• Consult your doctor before using marijuana, other forms of cannabis, prescription or over-the-counter drugs that may slow you down.
• With long-term use of the drug, a blood test should be performed. Talk to a medical professional.
• Do not use this drug for longer than your doctor prescribed.
• If this drug is taken for a long time or in high doses, its effectiveness may be reduced and a higher dose may be needed to obtain the same effect. The so-called drug tolerance develops. Talk to your doctor if this drug stops working.Do not take the drug in higher doses than your doctor prescribed.
• If you are 65 years of age or older, use this drug with caution. You may have more side effects.
• If the patient is a child, use this medication with caution. In children, the risk of some side effects may be higher.
• If used during pregnancy, the drug may have a harmful effect on the fetus. If you are pregnant or become pregnant while taking this drug, call your doctor right away.
• If you are breast-feeding or planning to breast-feed, tell your doctor. This drug passes into breast milk and may harm your baby.

All oral preparations:

• Avoid driving or other activities that require increased attention until you see how this drug affects you.
• Avoid drinking alcohol while taking this drug.

Injection:

• Avoid driving or other activities or activities that require special attention for 1 to 2 days after using this drug and until its effects disappear.
• Do not try to get out of bed on your own for at least 8 hours after using the drug. You may fall and be injured.
• Avoid drinking alcohol for 1 to 2 days after using this drug.
• Some preparations contain benzyl alcohol. These drugs should not be given to newborns or infants. If you want to know if this drug contains benzyl alcohol, talk to your doctor.

For procedure:

• Studies in young animals and children have shown that frequent or prolonged use of anesthetics or sleeping pills in children under 3 years of age can lead to chronic brain damage.The unborn baby can also get these problems if the mother uses the drug during the third trimester of pregnancy. Consult your doctor.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can have serious and sometimes deadly side effects. Call your doctor right away or get medical help if you have any of the following signs or symptoms, which may be associated with serious side effects:

• Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
• Occurrence or aggravation of behavioral or emotional disorders such as depression or suicidal thoughts.
• Hallucinations (a person sees or hears something that is not in reality).
• Balance change.
• Confusion of consciousness.
• Violation or loss of memory.
• Severe dizziness or fainting.
• Change in vision.
• Muscle weakness.
• Dark urine or yellowed skin or eyes.
• This drug may cause very bad and sometimes deadly breathing problems. Call a doctor right away if breathing is slow, shallow, or difficult.

What are some other side effects of this drug?

Any medicine can have side effects. However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

All forms of issue:

• Feeling dizzy, sleepy, tired, or weak.
• Headache.

Injection:

• Injection site irritation.

This list of possible side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088.You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

All oral preparations:

• Take with or without food. Take with food if the medicine causes nausea.

Liquid (solution):

• Use the pipette supplied to deliver the desired dose of the drug.
• Mix liquid with water, fruit juice, apple juice or pudding before use.
• Swallow the mixture immediately. Do not store for future use.

Sublingual tablets (sublingual tablets):

• Place the tablet under the tongue and let it dissolve.
• Do not swallow for at least 2 minutes after taking this drug.

Injection:

• For intramuscular or intravenous injection.

What to do if a dose of a drug is missed?

All oral preparations:

• If you are taking this medicine regularly, take the missed dose as soon as you can.
• If it is time for your next dose, do not take the missed dose and then return to your normal dose schedule.
• Do not take 2 doses at the same time or an additional dose.
• In most cases, this drug is used as needed.Do not take this medicine more often than prescribed by your doctor.

Injection:

• Call your doctor for further instructions.

How do I store and / or discard this drug?

Pills:

• Store at room temperature in a dry place. Do not store in the bathroom.

Sublingual tablets (sublingual tablets):

• Store at room temperature, protected from light.Store in a dry place. Do not store in the bathroom.

Liquid (solution):

• Store in refrigerator. Do not freeze.
• Throw away all unused portions after 3 months.
• Protect from light.

Injection:

• If you need to store this drug at home, ask your doctor, nurse, or pharmacist for information about how to store it.

All forms of issue:

• Store this drug in a protected place, out of the reach of children, and out of the reach of other people.A box or room, which is locked with a key, can act as a protected storage location for the drug. Keep all medicines out of the reach of pets.
• Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicines

• If your health does not improve or even worsens, see your doctor.
• You should not give your medicine to anyone and take other people’s medicines.
• Some medicines may have different patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• A separate patient instruction sheet is attached to the product. Please read this information carefully. Reread it every time you replenish your supply. If you have questions about this drug, talk with your doctor, pharmacist, or other healthcare professional.
• If you think an overdose has occurred, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Consumer Use and Limitation of Liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are suitable for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient.Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a treatment guide and does not replace information provided to you by your healthcare professional. For complete information on the possible risks and benefits of taking this drug, consult your doctor.

Copyright

© UpToDate, Inc. and its affiliates and / or licensors, 2021. All rights reserved.

90,000 Lorazepam (film-coated tablets) at a low cost. Instructions for use, description, composition, dosage, side effects

Lorazepam should be used strictly according to the doctor’s prescription in order to avoid complications. Mental stress and anxiety associated with everyday problems are not indications for the use of lorazepam.

Lorazepam must be used under strict medical supervision.

Lorazepam is not recommended for patients with psychosis. Use with extreme caution if you suspect angle-closure glaucoma, severe chronic obstructive pulmonary disease, coma, shock, epilepsy, renal dysfunction, hyperkinesis, hypoproteinemia, severe depression, organic brain diseases, porphyria, psychosis, suspected sleep apnea. With impaired liver function, a minimal increase in T _1/2 lorazepam is observed.

If, after 7-14 days of using lorazepam, there is no relief of symptoms of the disease or a relapse occurs, then the patient should consult a doctor.

The development of adverse reactions is more likely at the beginning of treatment and in cases of exceeding the recommended doses.

With prolonged use of lorazepam, addiction and drug dependence may develop. If drug dependence develops, abrupt discontinuation of lorazepam may lead to withdrawal symptoms.

Typical manifestations of withdrawal symptoms are: headache, increased irritability, muscle pain, psychomotor agitation and emotional stress, motor restlessness, confusion and disorientation, sleep disturbance. In severe cases, the following may appear: 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 “creeping” and numbness limbs, hallucinations, or seizures.It can be especially dangerous to abruptly stop long-term treatment, during which lorazepam is used in doses above average. In this case, the manifestations of withdrawal symptoms are more pronounced.

There is evidence that with the use 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 relapse 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, and increased physical activity. The likelihood of developing withdrawal symptoms or the appearance of insomnia such as “rebound” increases with abrupt discontinuation of lorazepam.

Lorazepam, like benzodiazepines and drugs of similar action, can cause paradoxical reactions such as psychomotor agitation, increased irritability, aggressiveness, nightmares, hallucinations, psychosis, somnambulism, depersonalization disorders expressed by sleep disturbance and other behavioral side effects.These reactions are much more common in elderly patients.

In the event of such symptoms, treatment with lorazepam should be discontinued immediately.

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

A gradual dose reduction of lorazepam is recommended in order to minimize the risk of these symptoms.

Lorazepam should be used with caution in patients with chronic respiratory failure, since benzodiazepines have been found to have a depressing effect on the respiratory center.

Lorazepam should be used with caution in patients with symptoms of depression. These patients may develop suicidal thoughts. Due to the possibility of deliberate overdose, these patients should be prescribed lorazepam in doses as small as possible. Also, benzodiazepines and drugs of a similar nature should not be used as the only drug for the treatment of depression or anxiety associated with depression.Monotherapy with these drugs can exacerbate suicidal tendencies. Benzodiazepines and drugs of a similar effect 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.

Lorazepam should be used with caution in patients with mild porphyria.Lorazepam may worsen the symptoms of this disease.

During prolonged therapy with lorazepam, periodic blood tests (morphological analysis with smear) and urinalysis are indicated.

During treatment with lorazepam and for 3 days after its completion, no alcohol should be consumed.

In the case of the use of lorazepam for premedication, it may be necessary to reduce the dose of fentanyl derivatives used for induction of anesthesia, while it is possible to reduce the time before turning off consciousness with the help of induction doses.

Influence on the ability to drive vehicles and mechanisms

Patients taking lorazepam should refrain from engaging in potentially hazardous activities that require increased attention and speed of psychomotor reactions.

instructions for use, analogs, composition, indications

The drug Lorafen should not be used in patients:

with hypersensitivity to benzodiazepines or to any component of the drug,

with severe respiratory failure,

with severe hepatic and renal impairment,

with myasthenia gravis,

with glaucoma,

with acute porphyria,

with alcohol poisoning,

with sleep apnea syndrome.

When to take extra care when using Lorafen

If after 7-14 days of treatment the patient does not observe improvement or a relapse of insomnia occurs, the doctor should be informed about this.

Precautions for use

General information regarding the observed effects in the treatment of benzodiazepines and other drugs that have a similar effect, which should be taken into account when using the drug Lorafen.

Tolerance

Regular use of benzodiazepines or drugs of a similar effect, including the drug Lorafen, for several weeks, may lead to a decrease in their effectiveness.

Drug dependence

The use of the drug Lorafen, as well as other benzodiazepines or drugs of a similar effect, 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, drug or drug dependence.

In the event of drug dependence, abrupt discontinuation of the drug may lead to withdrawal symptoms. Typical manifestations are: headache, muscle pain, agitation and emotional tension, restlessness, states of confusion and disorientation, irritability, insomnia.In severe cases, derealization, personality disorders, tactile, acoustic and light hyperesthesia, a feeling of “creeping” and numbness of the limbs, hallucinations or seizures may appear.

Anterograde amnesia

Lorafene, as well as other benzodiazepines and similar drugs, can cause anterograde amnesia. This condition most often occurs several hours after taking the drug, especially at a high dose.If the doctor has prescribed a daily dose, to reduce the risk of developing anterograde amnesia, patients should take the drug half an hour before bedtime and be provided with conditions for a complete, uninterrupted 7-8 hour sleep.

Insomnia as “ricochet”

After the end of treatment, there may be a transient relapse of symptoms with their greater severity than initially (the so-called “rebound” insomnia). These symptoms are often accompanied by mood changes, anxiety, anxiety, and increased physical activity.

The likelihood of a withdrawal syndrome or a rebound insomnia increases with an abrupt discontinuation of the drug. In order to reduce the risk, a gradual dose reduction is recommended.

Paradoxical reactions

Lorafene, like other benzodiazepines and similar drugs, can cause paradoxical reactions (opposite to those expected), such as motor restlessness, agitation, irritability, aggression, hostility, nightmares, hallucinations, psychosis, somnambulism, personality disorders, severe insomnia.These reactions are much more common in elderly patients or patients with alcohol dependence.

If you experience these symptoms, you should consult a doctor.

Special patient groups

Elderly patients should take smaller doses of the drug Lorafen (see section “Method of administration and dosage”), c. due to increased side effects, mainly disorientation and coordination of movements (falls, injuries).

Patients with hepatic, renal or chronic respiratory failure, before using the drug Lorafen, should inform the doctor about these diseases.

Application for depression

Before using the drug Lorafen, the patient must inform the doctor about all mental illness. For patients with symptoms of endogenous depression or anxiety associated with depression, the doctor should prescribe several drugs at the same time.The use of the drug Lorafen alone in patients with depression may lead to an increase in the symptoms of depression, including suicidal thoughts.

Patients with alcohol dependence, as well as with addiction to drugs or medications, before using the drug Lorafen should inform the doctor about these bad habits. In this group of patients, the likelihood of addiction and the development of mental and physical dependence is high. Therefore, such patients should take the drug Lorafen only under the strict supervision of a physician.

Lorafene in patients with porphyria may increase the symptoms of this disease. Patients with porphyria should inform their doctor about the condition before being treated with Lorafen.

Patients with glaucoma, especially those with a closed-angle form, should consult an ophthalmologist before treatment with Lorafen.

With long-term use of the drug Lorafen, the doctor should prescribe periodic blood tests (morphology with a smear) and urinalysis.

Consult a physician even if the above warnings refer to past situations.

Special warnings

Pregnancy

Consult your doctor or pharmacist before using any medicinal product.

The medicinal product should not be used in pregnant women.

Breastfeeding

Before using any medicinal product, you should consult your doctor or pharmacist m.

Lorazepam passes into the milk of matter. Therefore, if it becomes necessary to take a drug, breastfeeding should be discontinued.

Impact on the ability to drive vehicles and service mechanical devices

When using the drug Lorafen and for several days after its completion, you should not drive vehicles and service moving mechanical devices.

Lorafen, like all drugs from the benzodiazepine group, can affect the reaction rate depending on the dose, route of administration and individual sensitivity of the patient.Amnesia (impaired memory), decreased concentration, and impaired muscle activity can negatively affect the ability to drive vehicles and maintain mechanical devices.

Important information about some of the ingredients of Lorafen

Lorafen 1 mg and 2.5 mg contains lactose monohydrate and sucrose. If the patient has previously been diagnosed with intolerance to any sugars, then before taking the drug, the patient must inform the doctor about it.

Lorafen with a dosage of 2.5 mg additionally contains cochineal red E-124, which can cause allergic reactions.

During treatment with Lorafen and for another 3 days after its completion, you should not drink any alcoholic beverages.

Interaction with other medicinal products and other forms of interaction

Inform your doctor about all your recent medications, even over-the-counter medications.

Pharmacokinetic interactions

The metabolism of lorazepam occurs with the participation of cytochrome P-450 enzymes, mainly with the participation of CYP3A. Medicines that affect the activity of these enzymes can modify the action of lorazepam.

Inhibitors of cytochrome P-450 enzymes (for example, cimetidine, disulfiram, fluvoxamine, fluoxetine, omeprazole, erythromycin, ketoconazole) slow down the biotransformation of lorazepam and other benzodiazepines and may enhance their effect.

Inducers of cytochrome P-450 enzymes (for example, rifampicin, phenytoin, carbamazepine) accelerate the biotransformation of lorazepam and other benzodiazepines and can weaken their effect.

Pharmacodynamic interactions

An increase in the sedative effect, effect on the respiratory system and hemodynamic parameters is observed with the simultaneous use of benzodiazepines with drugs that have a depressing effect on the central nervous system, such as antipsychotics, antipsychotics, anxiolytics / sedatives, antidepressants, hypnotics, antiepileptic drugs, narcotic analgesics, anesthetics, drugs used for general anesthesia, sedative antihistamines, muscle relaxants.

Narcotic painkillers used concomitantly with lorazepam can potentiate euphoria, which can lead to more rapid development of mental dependence.

Alcohol enhances the inhibitory effect of lorazepam on the central nervous system. Lorazepam patients should not consume alcohol.

Oral contraceptives may weaken the effect of lorazepam.

Method of application and dosage

Lorafen should always be used as directed by your doctor.

If in doubt, consult a doctor.

Adults and children over 12 years old

For anxiety disorders, initially, lorazepam is usually prescribed from 2 mg to 3 mg per day, divided into 2 or 3 doses, and then, if necessary, the dose of the drug is increased to a maintenance dose, which is most often from 2 mg to 6 mg per day, divided for 2 or 3 receptions.

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

For anxiety-induced sleep disturbances, lorazepam 2 mg to 4 mg is usually given once daily at bedtime.

Children under 12 years old

Lorazepam is not recommended for use in children under 12 years of age.

Elderly patients

Elderly patients are more sensitive to drugs acting on the central nervous system. When using the drug Lorafen in these patients, it is recommended to prescribe the lowest possible effective dose.Half the dose recommended for younger patients is usually sufficient.

Patient with hepatic and / or renal failure

The doctor selects the dosage individually, depending on the degree of insufficiency of the diseased organ.

If during treatment the patient feels that the effect of the drug is too strong or weak, he should consult a doctor.

Duration of treatment

The use of the drug Lorafen should be as short as possible (from 7 to 14 days).

In individual cases, after assessing the patient’s condition, the doctor may decide to extend the treatment time.

Method of application

Tablets should be taken orally, before meals, with a little water.

The doctor will begin treatment with the lowest possible effective doses to relieve insomnia, and, if necessary, will increase them gradually.

The drug should be discontinued gradually. This is especially true for patients taking Lorafen for a long time.Abrupt discontinuation of the drug can cause sleep, mood and concentration disorders. The doctor will select the method of drug withdrawal individually for each patient.

In case of taking Lorafen in a dose greater than prescribed

Symptoms

As a result of an overdose of benzodiazepines, drowsiness, locomotor ataxia, dysarthria and nystagmus can usually appear.

An overdose of lorazepam is rarely life-threatening if only this drug has been used, but can cause weakened reflexes, apnea, decreased pressure, depression of blood circulation and respiration, and coma.

The depressing effect on the respiratory system is more pronounced in patients with diseases of the respiratory system.

Action taken

The vital signs of the patient should be monitored, and aids should be included in the treatment, which are required by his clinical condition. If necessary, when symptoms of respiratory failure or circulatory failure appear, symptomatic treatment should be applied.

Further absorption of the drug can be prevented by application within 1-2 hours after taking the drug of activated charcoal.Sleeping patients who have taken charcoal need to have an airway.

In the case of severe depression of the central nervous system, administration of a benzodiazepine antagonist, flumazenil, should be considered, but only under strictly controlled conditions. Flumazenil has a short half-life (approximately 1 hour), so patients who have taken it need to be monitored after the drug ends. Flumazenil should be used with great caution while taking medications that lower the seizure threshold (for example, tricyclic antidepressants).For the following recommendations for the correct use of flumazenil, you should read the materials related to this drug.

If convulsions occur, barbiturates should not be used.

When treating an overdose of any drug, it should be remembered that the patient could have taken many different drugs.

If you take the drug in a dose greater than recommended , you should immediately contact your doctor or pharmacist.

In case of missed dose of the drug Lorafen

If you skip taking a drug, you need to take it as soon as possible, if there is still a lot of time before taking the next dose, or continue to take the drug regularly.

Do not take a double dose to make up for the missed dose.

Side effects

Side effects, if they occur, then, as a rule, at the beginning of treatment and disappear with further treatment, or after a dose reduction.

The most commonly reported side effects associated with benzodiazepines are daytime sleepiness, dizziness, muscle weakness, and ataxia.

The number and severity of side effects depends on the individual sensitivity of the patient and the dose.

The frequency of side effects that appear after the use of a medicinal product is determined as follows:

very often (> 1/10), often (≥ 1/100 and sometimes (≥ 1/1000 and rarely (≥ 1/10 000 and very rarely (1/10 000), frequency unknown) (cannot be determined from the available data).

Disorders of the blood and lymphatic system

Very rare: violations of the morphological composition of the blood.

Hypersensitivity reactions

Immune system disorders

Very rare: anaphylactic reactions, anaphylactoid reactions.

Skin and subcutaneous tissue disorders

Rarely: allergic skin reactions (rash, itching, urticaria).

Metabolic and nutritional disorders

Frequency unknown: Lack of appetite.

Mental disorders

Rarely: disorientation, emotional disorders, lack of self-control, impulsivity, euphoria, sleep disorders, manifestation of previously undiagnosed depression.

Frequency unknown: paradoxical reactions – psychomotor agitation, insomnia, increased excitability and aggressiveness, muscle tremor, convulsions.Paradoxical reactions are most often observed after drinking alcohol, in elderly patients and with mental illness.

Frequency unknown: suicidal thoughts and attempts (can occur in patients with depression or anxiety associated with depression, treated with only one drug), mental and physical dependence (can develop during treatment with lorazepam in therapeutic doses). Sudden discontinuation of treatment can cause withdrawal symptoms.

Patients who abuse alcohol or drugs are more prone to developing addiction.

Disorders from the nervous system

Very often: drowsiness, delayed reaction.

Rarely: headache and dizziness, states of confusion and disorientation, ataxia. These effects are most often observed at the beginning of treatment, in elderly patients and, as a rule, disappear with further treatment. If these reactions intensify, a corresponding dose reduction usually decreases their severity and frequency.

Sometimes, as in the case of other benzodiazepines, especially when taking large doses, dysarthria with slurred speech and incorrect pronunciation, memory impairment may appear.

Very rare: tremor, extrapyramidal reactions, coma.

Violations of the organ of vision

Rare: visual impairment (blurred, double vision).

Cardiac disorders

Frequency unknown: bradycardia, chest pain.

Vascular disorders

Rarely: a slight decrease in blood pressure.

Disorders from the gastrointestinal tract

Rarely: nausea, dyspeptic disorders, dry mouth.

Disorders from the liver and biliary tract

Rarely: a slight increase in the activity of aminotransferases, liver dysfunction, accompanied by jaundice.

Musculoskeletal and connective tissue disorders

Often: Muscle weakness.

Kidney and urinary tract disorders

Frequency unknown: urinary retention, urinary incontinence.

Genital and breast disorders

Frequency unknown: menstrual irregularities, impaired libido.

General disorders and disorders at the injection site

Frequency unknown: general weakness, fainting.

In some patients, other side effects may occur during the use of the drug Lorafen.

In the event of any of the above or other undesirable effects not listed in this instruction, you must inform your doctor or pharmacist.

(PDF) Lorazepam: application review // Lorazepam’s clinical utility: a literature review

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17

Lorazepam: an overview of the application – Psychiatry and psychopharmacotherapy them. P.B. Gannushkin No. 04 2016

Lorazepam is a highly potent benzodiazepine anxiolytic with a number of pharmacokinetic features, in particular low lipophilicity, low tendency to cumulation, a relatively short half-life and elimination by glucuronidation in the kidneys, and not by oxidative metabolism in the liver. This ensures greater safety of lorazepam in such clinical situations as the elderly, physically impaired, drug addicts, patients with severe liver damage.In addition to a wide range of psychotropic effects, including hypnotic-sedative, anxiolytic, amnestic, anti-aggressive and anti-manic, lorazepam is also able to potentiate the action of antipsychotics and antidepressants, while reducing their side effects. It also has a number of somatotropic effects: muscle relaxant, antiemetic, vestibulolytic, vegeto-stabilizing, anti-inflammatory, anti-allergic, antipruritic and immunosuppressive, which makes it advisable to use it in general somatic practice.

Keywords: lorazepam, benzodiazepine, anxiolytic, antidepressant, antipsychotic, anxiety, agitation, insomnia, depression, manic states, psychosis.

[email protected]

For citation: Becker R.A., Bykov Yu.V. Lorazepam: an overview of the application. Psychiatry and psychopharmacotherapy. 2016; 18 (4): 19-27.

Lorazepam’s clinical utility: a literature review

R.A.Bekker1, Yu.V.Bykov2

1 David Ben-Gurion University of the Negev. 8410501, Israel, Beersheba;

2Stavropol State Medical University of the Ministry of Health of the Russian Federation. 355017, Russian Federation, Stavropol, ul. Mira, d. 310

Lorazepam is a high-potency benzodiazepine with several unique pharmacokinetic characteristics, including low lipophilicity, low propensity to accumulate in body tissues and fluids, relatively short half-life, and elimination by glucuronization in the kidneys, not by P450-dependent oxidative hepatic metabolism.Thus, it is safer to prescribe to patients in advanced age, to drug and alcohol abusers and to patients with impaired hepatic function. Lorazepam has wide spectrum of clinical activity. Its psychotropic effects include sedative and hypnotic, anxiolytic, amnestic, antiagressive and antimanic, and the ability to augment antidepressants and antipsychotics, while simultaneously decreasing some of their side effects, e.g. nausea and akathisia. Lorazepam also has several somatotropic effects: antiemetic, myorelaxant, vestibulolytic, vegetative stabilization properties, along with immunosupressive, antiinflammatory, antipruritic and antiallergic effects.

Key words: lorazepam, benzodiazepine, anxiolytic, antidepressants, antipsychotics, anxiety disorders, agitation, insomnia, major depression, mania, psychosis.

[email protected]

For citation: Bekker R.A., Bykov Yu.V. Lorazepam’s clinical utility: a literature review. Psychiatry and Psychopharmacotherapy. 2016; 18 (4): 19-27.

Introduction

Lorazepam is a highly potent benzodiazepine anxiolytic (T.A. Voronina et al., 2008) [3]. It was first synthesized and patented in 1963, and went on sale in the United States in 1977 (E.Shorter, 2005) [76]. Initially, the patent for lorazepam belonged to the Wyeth company, which sold it in the USA under the trade names Ativan and Temesta (C. Braestrup, R. Squires, 1978) [18]. Despite such a venerable age, lorazepam is still one of the most used and prescribed benzodiazepines in the United States and Western Europe and is included in the list of the most essential drugs by the World Health Organization (WHO, 2015) [88].The only version of lorazepam available on the Russian market is Lorafen from Polfa Tarkhomin, available in the form of tablets of 1 and 2.5 mg. The same company produces diazepam (Relium), clonazepam, oxazepam (Tazepam), Elenium, etc.

In the United States and Western Europe, lorazepam is also available in injectable form for intravenous and intramuscular administration, as an oral solution and syrup for children, as a patch and gel for application to the skin in combination with haloperidol and diphenhydramine ABH Gel (in this combination it is used as antiemetic; J.Bleicher et al., 2008) [17]. However, in the United States, oral forms of lorazepam are not approved for children under 12 years of age (efficacy and

the safety of the drug during this period; C. Griffin 3rd et al., 2013) [33].

Mechanism of therapeutic action

The main inhibitory mediator in the central nervous system (CNS) is g-aminobutyric acid (GABA). Its receptors are subdivided into two subtypes – GABAA (conjugated with a chlorine ion channel) and GABAB (metabotropic).On the GABAA receptors, in addition to the site for binding the main ligand (GABA), there are also additional “control” sites for allosteric binding of such endogenous ligands as endozepins (endogenous analogs of benzodiazepines), methobarbital (endogenous barbiturate), neurosteroids, in particular allopregnenolone. Lorazepam, like other representatives of benzodiazepines, exerts its therapeutic effect by binding to the benzodiazepine site of the GABAA receptor and increasing the affinity of the GABAA receptor for GABA, thereby increasing GABAergic neurotransmission (M.Kelly et al., 2002) [44]. The benzodiazepine binding sites on GABAA receptors are subdivided into two main subtypes, BZ1 and BZ2 (C. Griffin 3rd et al., 2013) [33]. The first subtype of benzodiazepine sites (BZ1) is found mainly in the cerebral cortex, thalamus and cerebellum and is responsible for the sedative effect of lorazepam (W. Kaufmann et al., 2003) [43]. BZ2 sites are concentrated mainly in the limbic system, motor neurons and dorsal horns of the spinal cord, the effect on which is caused by the anxiolytic and muscle relaxant effect of benzodiazepines (W.Kaufmann et al., 2003) [43].

It is believed that lorazepam binds to GABAA receptors with a lower affinity than alprazolam, but with a higher affinity than clonazepam (C. Griffin E. 3rd et al., 2013) [33].

Lorazepam is rapidly and easily absorbed, reaching peak blood levels approximately 2 hours after oral administration. The half-life (T1 / 2) is about 12 hours. Conjugation with glucuronic acid is the main route of metabolism of lorazepam: 70–75% of the administered dose is excreted in the urine as lorazepam glucuronide.The entire drug is completely eliminated from the body within 1 week after the last dose is prescribed (A. Kyriakopoulos et al., 1978) [50]. Due to the fact that lorazepam is not metabolized in the liver, but undergoes glucuronization in the kidneys (C. Griffin E. 3rd et al., 2013) [33], it is considered safer than most other benzodiazepines in elderly patients (in whom hepatic the metabolism of benzodiazepines slows down and the clearance of benzodiazepines decreases with age), as well as in patients with alcoholism, severe liver damage (Yu.P. Sivolap, 2014) [9]. It is believed that the relatively short T1 / 2 of lorazepam facilitates its titration and selection of an adequate dose until the desired sedative effect is achieved (for example, in alcoholic delirium, acute psychomotor agitation) and reduces the likelihood of cumulation or overdose (AKyriakopoulos et al., 1978) [50].

As noted in 1975 by T.A. Klygul et al. [6], lorazepam differs from all other benzodiazepines in its great therapeutic breadth, powerful anxiolytic action and a wide range of other pharmacological effects, which are manifested even in small doses.They believed that lorazepam was more effective than any other benzodiazepine on the market at the time and called it the “next generation benzodiazepine”.

There is evidence that lorazepam has atypical effects (both behavioral and physiological) that distinguish it from other benzodiazepines (S. Pompéia et al., 2003, 2005) [66, 67]. For example, lorazepam has been shown to have, atypical for benzodiazepines, a relatively favorable profile of effects on human cognitive functions (S.Pompéia et al., 2005) [67]. It is assumed that the atypical profile of lorazepam may be associated with a predominant effect on those subtypes of benzodiazepine receptors that are currently poorly understood (S. Pompéia et al., 2005) [67].

Let us consider the main indications and effectiveness of this benzodiazepine in various mental, neurological and general somatic pathologies.

Lorazepam in psychiatry

Panic Disorder

One small Russian study investigated the effectiveness of combination therapy with an antidepressant group of selective serotonin reuptake inhibitors (SSRIs) paroxetine (20 mg / day for 12 weeks) and the benzodiazepine anxiolytic lorazepam (2.5 mg / day for the first 6 weeks) for panic disorder (CR) versus paroxetine monotherapy and placebo.This study enrolled 32 patients with AR in the exacerbation period. The duration of the disease of the trial participants from the moment of debut to the moment of inclusion in the study ranged from 1.5 to 8 years. The study obtained results indicating a statistically significant advantage of combined treatment over paroxetine monotherapy and over placebo in terms of a reduction in the severity of anxiety and depression, the frequency and severity of panic attacks, and an improvement in the overall quality of life.The combination therapy group also showed a faster onset of the therapeutic effect and fewer side effects such as an initial exacerbation of anxiety, nausea, and insomnia when taking SSRIs (OV Vorobyova, 2006) [1]. The authors of another work (G. Chouinard, 2004) [21] found lorazepam to be effective in the treatment of both PR without agoraphobia and PR with agoraphobia.

Social phobia

Lorazepam (both in monotherapy and in combination with an antidepressant of the SSRIs, selective serotonin and norepinephrine reuptake inhibitors – SSRIs, monoamine oxidase inhibitors – MAOIs, with pregabalin) is also effective for social phobia (M.Pollack, 1993) [65], including both during the course of treatment and a single admission before any stressful social situations for the patient. It has been shown that lorazepam in the context of social phobia has less cognitive toxicity (i.e., gives fewer side effects on the cognitive sphere) than the antipsychotic olanzapine, which is often used for potentiation in this context, and than other benzodiazepine with a longer action and a higher probability of cumulation – clonazepam (I.Hindmarch, 2009) [39].

Generalized anxiety disorder

As shown in one of the recent reviews (OV Vorobyova, 2016) [2], lorazepam is the drug of choice in the treatment of acute anxiety. This drug, both in monotherapy (R. Hidalgo et al., 2007) [38] and in combination with the antidepressants buspirone, pregabalin or gabapentin, is effective in generalized anxiety disorder – GAD (M.Pollack, 1993) [65]. However, one meta-analysis covering 7 randomized clinical trials did not show any advantages of lorazepam over placebo in the treatment of GAD, probably due to the high percentage of placebo responders in this pathology (J.Martin et al., 2007) [59]. In another study, lorazepam showed the same efficacy as buspirone in relieving anxiety in GAD and a statistically significant advantage over placebo (G. Laakmann et al., 1998) [52].

Obsessive-compulsive disorder

Despite the fact that lorazepam does not have a true anti-obsessive effect, it, by reducing anxiety associated with obsessions, helps to reduce them and potentiates the anti-obsessive effect of antidepressants and antipsychotics, while reducing a number of their side effects (M.Pollack, 1993) [65].

Depersonalization-derealization syndrome

High doses of powerful benzodiazepines, such as lorazepam, phenazepam, are one of the main treatments for this very resistant and difficult to treat condition (YL Nuller, IN Mikhailenko, 1988) [8]. At the same time, according to Yu.L. Nuller, doses of phenazepam could reach 30 mg (!), Lorazepam – up to 24 mg (!), And the average therapeutic doses of phenazepam were up to 10-15 mg, lorazepam – up to 6-8 mg, and a higher efficacy of lorazepam compared to phenazepam was noted (Yu.L. Nuller, I. N. Mikhailenko, 1988) [8].

Tics and Tourette’s syndrome

Lorazepam does not have a true antidyskinetic effect in tic conditions and Tourette’s syndrome. However, having the ability to reduce subjective discomfort, anxiety, “internal itching” accompanying the urge to tic, it can help to reduce tics and enhance the antidyskinetic effect of D2 blockers (antipsychotic or metoclopramide) and SSRIs, while reducing their side effects such as akathisia or nausea (M.Pollack, 1993) [65].

Acute catatonia

It has been shown that lorazepam is able to relieve catatonic symptoms (VA Tochilov, 2006) [10]. Also, according to V.A. Tochilov, lorazepam, along with phenazepam, has the most pronounced anxiolytic effect among benzodiazepine tranquilizers. It is known that benzodiazepines are the drugs of choice for the relief of catatonia, regardless of the initial state (P. Sienaert et al., 2014) [77], but lorazepam is the drug of choice for the relief of acute catatonia among all benzodiazepines, demonstrating an overall efficacy of more than 79% and the most the high frequency of use of this drug in this condition (J.Hawkins et al., 1995) [37]. The dose of lorazepam for the relief of acute catatonia varies within the range of 8-24 mg / day, while it is noted that this dose is well tolerated by patients with acute catatonia, without excessive sedation (D. Dhossche et al., 2014) [26]. According to another study, in 66 children and adolescents, the administration of lorazepam led to the relief of catatonia in 65% of cases with a low level of side effects (M. Raffin et al., 2015) [70].

Manic states

Lorazepam in mania contributes not only to the relief of psychomotor agitation, anxiety, aggressiveness and dysphoria and the normalization of sleep, but also to the true reduction of manic affect, which makes it possible to reduce the doses of antipsychotics and normotimics, reduce their side effects and avoid overdose and intoxication (M.Pollac, 1993; F. Curtin, P. Schulz, 2004) [24, 65]. And in mild hypomanic conditions, lorazepam monotherapy may be sufficient to stop hypomania (M.Pollack, 1993) [65]. In delirious mania (manic delirium), high doses of lorazepam and electrical stimulation therapy (ECT) are the first line of therapy due to the poor tolerance of antipsychotics in this category of patients (N. Jacobowski et al., 2013) [41].

Psychoses

The indirect antidopaminergic effect inherent in benzodiazepines due to their potentiating effect on GABAergic neurotransmission has served as the basis for attempts to use them in psychosis, schizophrenia to potentiate the action of antipsychotics (M.Pollack, 1993) [65]. The use of lorazepam in combination with antipsychotics contributes not only to a more rapid relief of psychomotor agitation, anxiety, insomnia and aggressiveness, but also to an increase in the true antipsychotic effect, a faster reduction of hallucinatory and delusional phenomena (M.Pollack, 1993) [65]. Yu.L. Nuller singled out among psychoses the so-called “anxiety psychosis” – psychoses occurring with a high specific gravity of acute anxiety, agitation, insomnia, and pointed out that in many such cases, the use of highly potent benzodiazepines (in particular, lorazepam) in monotherapy even without the addition of antipsychotics may in itself be sufficient to relieve psychosis (Yu.L. Nuller, I. N. Mikhailenko, 1988) [8].

Acute psychomotor agitation, aggressiveness

Lorazepam is capable of arresting acute psychomotor agitation, aggressiveness, and insomnia, suppressing the REM phase (and hence nightmares) and normalizing the phase structure of sleep, regardless of the genesis of arousal, aggressive behavior, and insomnia (M.Pollack, 1993) [65]. However, one of the meta-analyzes did not show the efficacy of benzodiazepines, including lorazepam, in the relief of this pathology, either as monotherapy or in combination with antipsychotics (D.Gillies et al., 2013) [31].

Depressive states

Lorazepam does not appear to have true antidepressant activity. Nevertheless, the combination of lorazepam with an antidepressant often leads to potentiation (enhancement) of the effect of the latter, a decrease in depressive symptoms, as well as an improvement in the tolerance of an antidepressant (a decrease in side effects such as nausea, akathisia, an initial exacerbation of anxiety, agitation, insomnia during antidepressant therapy) and an increase in compliance of patients (M.Pollack, 1993) [65]. The addition of lorazepam is especially effective in case of a high proportion of anxiety, insomnia, agitation or dysphoria in the picture of depression, i.e. with anxious, agitated or mixed (dysphoric) depression (M. Polack, 1993) [65]. In a comparative study of depression with the use of lorazepam, amitriptyline, alprazolam and placebo, it was shown that, compared with monotherapy with antidepressants and placebo, the antidepressant effect occurred faster when benzodiazpepines were used in combination with antidepressants (G.Laakman et al., 1995) [51].

Akathisia

Lorazepam is effective in the prevention and relief of akathisia, including akathisia that occurs during psychopharmacotherapy with antidepressants and / or antipsychotics (J. Lohr et al., 2015) [56]. It is possible that it is precisely the antiacatizative activity of lorazepam, as well as the well-known property of akathisia to aggravate any existing psychopathology, increase arousal, delirium, hallucinations, and not true potentiation by antipsychotics, in part, which is partly due to the actually observed increase in the antipsychotic effect when lorazepam is combined with an antipsychotic (J.Lohr et al., 2015) [56].

Acute dystonic reactions

Lorazepam (in monotherapy or in combination with central anticholinergics, amantadine, etc.) is also effective in the prevention and relief of acute dystonic reactions that occur during psychopharmacotherapy when antipsychotics and / or antidepressants are prescribed (M. Polack, 1993; N. Goyal et al. , 2005) [32, 65]. Intravenous, intramuscular or sublingual administration of lorazepam not only contributes to the rapid (minutes) relief of acute dystonia, but also reduces the often accompanying feeling of extreme fear, anxiety, agitation, subjective discomfort, increases the adherence of patients to the continuation of antipsychotic or antidepressant therapy after an episode of acute dystonia (N …Goyal et al., 2005) [32]. Thus, a case of acute dystonia in a teenager with mania after intramuscular administration of olanzapine (Zyprex), which was quickly stopped by sublingual administration of lorazepam, was described (N. Goyal et al., 2005) [32]. Acute dystonic reactions also occur with the introduction of metoclopramide, in connection with which it was proposed to initially combine metoclopramide with lorazepam and / or diphenhydramine, which not only prevents acute dystonia, but also enhances the antiemetic effect of metoclopramide (E.Hagen et al., 2001) [35].

In the West, a combined injection form is even available, containing in 1 ampoule haloperidol (5 mg / ml), lorazepam (2 mg / ml) and biperiden (2 mg / ml), which contributes not only to more rapid psychomotor sedation of agitated and aggressive patients, but and prevention of acute dystonic reactions and akathisia at the beginning of treatment with haloperidol, and prevention of “forgetfulness” in the appointment of correctors and benzodiazepines by the doctor, and is recommended for use instead of haloperidol solution in most cases to achieve “rapid tranquilization”, except when benzodiazepines are contraindicated and / or central anticholinergics (M.Powney et al., 2012) [68]. The use of monotherapy with haloperidol without benzodiazepine and central anticholinergics in the absence of contraindications to them is recognized by the authors of this review as inhumane and unethical.

Tardive dyskinesias

Lorazepam, like other benzodiazepines (clonazepam, etc.) and other GABAergics (valproate, pregabalin, gabapentin, zolpidem, etc.), is effective in reducing tardive dyskinesias that occur during long-term (many months or many years) treatment with antipsychotics (H.Khouzam, 2015; P. Lerner et al., 2015) [45, 54].

Malignant neuroleptic syndrome

Since neuroleptic malignant syndrome (NMS) has both clinical and pathophysiological similarities with febrile catatonia, in which benzodiazepines are highly effective, they have long been tried to use them for the treatment of NMS (F. Luchini et al., 2013) [58]. Thus, in particular, a case of postoperative NNS was described in a patient with TR, provoked by the use of droperidol, in which intravenous diazepam and subsequent sublingual administration of lorazepam led to a sharp clinical improvement (S.Kishimoto et al., 2013) [47]. Other authors report about three cases of NNS development (olanzapine and clozapine), when the administration of lorazepam led to the relief of clinical symptoms of NNS (A. Yacoub, A. Francis, 2006) [90].

Serotonin syndrome

Lorazepam, along with 5-HT2 blockers (cyproheptadine, some atypical antipsychotics, etc.) and 5-HT3 blockers (setrons), is effective in relieving serotonin syndrome, which occurs, for example, due to an overdose of antidepressants of the SSRIs, SSRIs, tricyclic antidepressants, tricyclic antidepressants (SSRI + MAOI, etc.) or occasionally as a reaction of intolerance during monotherapy with therapeutic doses of antidepressants (C. Frank, 2008; B. Arora, N. Kannikeswaran, 2010) [13, 27].

Lorazepam in neurology

Epilepsy and other convulsive syndromes

Lorazepam has a strong anticonvulsant activity and can be used to relieve epileptiform seizures of any etiology, including, for example, in status epilepticus (M.Pollack, 1993) [65]. The short duration of the anticonvulsant action of lorazepam makes it, along with midazolam, a more convenient means of terminating excessively prolonged seizures after ECT compared with diazepam, since the administration of lorazepam to terminate seizures does not reduce the effectiveness of the ECT session the next day, as it does with diazepam (M.Pollack, 1993) [65].

Medicinal parkinsonism, tremor

Lorazepam is not a true antiparkinsonian drug, but it is able to reduce some manifestations of drug parkinsonism, namely muscle hypertonicity, muscle rigidity, and tremor of any genesis (not only parkinsonian, but also, for example, sympathoadrenal, and essential, and orthostatic tremor; A. Hassan , 2016) [36], and relieves such other extrapyramidal side effects, which are often comorbid with drug parkinsonism, such as akathisia, acute dystonic reactions (M.Pollack, 1993) [65]. That is why the use of lorazepam in the complex therapy of drug parkinsonism along with central anticholinergics (biperiden, trihexyphenidyl) or amantadine is justified (M. Pollack, 1993) [65]. However, in Parkinson’s disease in the elderly, in contrast to drug-induced parkinsonism, the use of lorazepam, as well as the use of central anticholinergics, can be restrained by the presence of negative side effects on cognitive functions and the poorer tolerance of these groups of drugs by elderly patients (M.Pollack, 1993) [65].

Alzheimer’s disease and other dementias

Benzodiazepines are often used to relieve agitation, anxiety, aggressiveness, and behavioral disorders in dementia patients. At the same time, unlike antipsychotics, they do not cause metabolic disorders, obesity, worsening of the course of diabetes mellitus, hypertension or vascular atherosclerosis, do not cause motor immobilization and increase mortality in elderly patients (P.Jennum et al., 2015; Ballard et al., 2016) [15, 42], although they can cause excessive muscle relaxation and sedation, falls, hip fractures (G. Requena et al., 2015) [72]. The authors of one study concluded that lorazepam does not cause additional cognitive impairment in patients with Alzheimer’s disease (M. Defrancesco et al., 2015) [25]. However, these conclusions are still very cautious due to the small sample of the study and insufficient data on the long-term effects of this drug in such patients.

Insomnia

Lorazepam showed the same efficacy as zopiclone in the treatment of insomnic disorders in patients with acute cerebrovascular accident or traumatic brain injury (the dose of lorazepam in this case was 0.5-1 mg at bedtime for 7 days; R. Li Pi Shan, N . Ashworth, 2004) [55]. Of the short- to medium-acting benzodiazepines, lorazepam and oxazepam are the most commonly prescribed drugs for the treatment of insomnia (L.Frighetto et al., 2004) [28]. This drug is usually prescribed to patients with insomnia on the background of resistant depression, receiving ECT, due to the fact that lorazepam minimally lowers the seizure threshold (C. Andrade et al., 2000) [12].

Pain syndromes

Lorazepam does not have true analgesic activity, however, it reduces the subjective component of pain, its emotional color and anxiety associated with pain, and also potentiates the analgesic effect of local anesthetics, opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants and anticonvulsants, which is why it is widely used as part of “Lytic mixtures” for the so-called ataralgesia, or tranquiloanalgesia, or in preoperative premedication, and as one of the components of the complex therapy of various chronic pain syndromes together with narcotic and non-narcotic analgesics, NSAIDs, antidepressants, anticonvulsants, etc.(M. Polack, 1993) [65]. When using lorazepam in conjunction with opioids, however, one should bear in mind the possibility of potentiating not only the analgesic effect, but also the suppression of respiration, as well as excessive sedation and drowsiness (M. Polack, 1993) [65]. Lorazepam is especially effective due to its central muscle relaxant effect in pain associated with or accompanied by muscle tension, such as tension headaches, back pain, painful contractures (M. Polack, 1993) [65].

Lorazepam was effective in relieving pain during bone marrow puncture in hematological patients.The drug was administered intravenously at a dose of 1 mg as a premedication in an outpatient patient population (S. Park et al., 2008) [63]. Also, sublingual lorazepam effectively reduced pain, fear, and psychoemotional stress during catheter implantation into the central vein (subclavian or femoral; D. Chang et al., 2015) [20].

Syndromes associated with muscle spasticity

Lorazepam, as a strong central muscle relaxant, is also used in syndromes accompanied by muscle spasticity of central origin, in particular, spastic paralysis, spasticity in patients with cerebral palsy, etc.(M. Polack, 1993) [65]. Lorazepam is also able to enhance the action of other central muscle relaxants such as baclofen, tizanidine (Sirdalud), tolperisone (Midocalm), flupirtine (Katadolon), sodium oxybutyrate, etc. (M. Polack, 1993) [65]. According to other sources (A. Snaith, D. Wade, 2014) [80] lorazepam is effective in muscular dystonia of various origins.

Dizziness and tinnitus

Lorazepam as a drug with a sedative, anxiolytic, muscle relaxant, antidepressant, antiemetic and vestibulolytic effect, has positively proven itself in the treatment of tinnitus (E.I. Matsnev, E. E. Sigaleva, 2009) [7]. This is also confirmed by foreign researchers (M. Minen et al., 2014; J. Savage, A. Waddell, 2014) [62, 73]. Intravenous, intramuscular or sublingual administration of lorazepam is often used in combination with other antiemetics and vestibulolytics in acute attacks of Ménière’s disease and syndrome and allows them to be quickly stopped (J. Sharon et al., 2015) [75]. Benzodiazepines (including lorazepam) are effective for various forms of vertigo, not only psychogenic vertigo, but also, for example, benign positional vertigo (N.Bhattacharyya et al., 2008) [16], with vestibular neuronitis, acute labyrinthitis, sea and air sickness (T. Zajonc, P. Roland, 2006) [91].

Lorazepam in narcology

Lorazepam is safer compared to other benzodiazepines when used in patients with liver damage, since it is metabolized by glucuronization in the kidneys, besides, the drug does not have active metabolites, which is important when prescribing drug addicts (R. Ramanujam, R.Thimmaiah, 2015) [71]. That is why this drug has an advantage in patients with alcohol dependence, especially with severe liver damage (C. Kumar et al., 2009) [49]. Lorazepam is effective in the relief of alcohol withdrawal syndrome (AAS), including its most severe form – alcoholic delirium (M. Schuckit, 2014) [74], in the prevention of withdrawal seizures in alcoholism, as well as in the relief of opioid, barbituric, benzodiazepine, nicotine withdrawal syndrome (M.Pollack, 1993) [65]. Lorazepam is often used not only for the relief, but also for the prevention of AAS (G. Chhouinard, 2004) [21]. It has been shown that lorazepam is effective in combination with propofol during the period of severe abstinence in patients in intensive care with different addictions to psychoactive substances (while lorazepam monotherapy did not show good efficacy; K. Subramaniam et al., 2004) [83 ]. In another study, on the contrary, the effectiveness of lorazepam monotherapy in severe AAS was shown.At the same time, the average daily doses of this drug reached 40 mg / day, and the patients were in the intensive care unit, under the supervision of anesthesiologists and resuscitators (Stewart et al., 2016) [81]. For relief of AAS, it is recommended to prescribe tablet forms, 2 mg every 6 hours (a total of 4 times a day), and then with a transition to 1 mg every 6 hours (C. Griffin 3rd et al., 2013) [33].

Lorazepam in general somatic practice

Pulmonology

By rapidly decreasing central neurogenic hyperventilation and weakening the action of the “thoracic pump”, as well as reducing the total peripheral vascular resistance, lorazepam promotes more rapid relief of an attack of cardiac asthma or acute pulmonary edema (M.Pollack, 1993) [65]. The effect of lorazepam on the a4 and a5-subunits of the GABA-benzodiazepine receptor complex, which are present in the bronchial tree, potentiates the action of bronchodilators and promotes a more rapid relief of status asthmaticus in bronchial asthma simultaneously with the removal of concomitant anxiety and excitement; also effective is the introduction of lorazepam in laryngo- and bronchospasm against the background of general anesthesia (G. Pelaia et al., 1997; G. Gallos et al., 2012) [29, 64]. Benzodiazepines are also able to inhibit the release of histamine from immunocompetent cells of the respiratory tract, both mediated by allergens and conditioned reflex (stress-induced; M.Irie et al., 2004) [40]. There is a high degree of comorbidity between bronchial asthma, TR and depressive conditions, while successful treatment of anxiety and depression (including the use of benzodiazepines) improves the course of asthma (A. Valença et al., 2006) [86]. Benzodiazepines (including lorazepam), along with opioids such as codeine, morphine, are also effective in reducing persistent chronic cough and resistant dyspnea (dyspnea), but should be used with caution in patients with chronic obstructive pulmonary disease and severe hypoxia (S.Simon et al., 2012; R. Wiseman et al., 2013) [78, 89].

Dermatology

It is known that benzodiazepines in general (for example, oxazepam) are effective against itchy skin and enhance the antipruritic effect of antihistamines (L. Skorinkina, V. Poliakov, 1983) [79]. It has been shown that benzodiazepines (for example, diazepam) are not inferior to flupentixol, sulpiride and low doses of tricyclic antidepressants in terms of the effectiveness of the reduction of psychosomatic itching and are better tolerated (C.Meyers et al. 1985) [60]. Lorazepam has been shown to be effective as part of complex therapy for various dermatological diseases accompanied by itching, and in psycho- or neurogenic pruritus it is one of the first-line drugs (M. Gupta et al., 1986) [34]. It has been shown that benzodiazepines not only reduce anxiety and insomnia associated with itching, but also improve the course of the skin pathology itself, since they inhibit the release of histamine from immunocompetent cells, both mediated by allergens and conditioned reflex (mediated by stress), which is confirmed by laboratory experiments (in rodents; M.Irie et al., 2004) [40]. In another study, it was shown that non-sedative antihistamines of the new generation that do not penetrate the central nervous system are ineffective for pruritus not associated with allergies, while sedative antihistamines of the 1st generation (diphenhydramine, promethazine, chloropyramine, etc.) and benzodiazepines (nitrazepam, lorazepam) are highly effective (L. Krause, S. Shuster, 1983) [48].

Oncology

Lorazepam has been shown to be beneficial in patients with breast cancer in relieving concomitant anxiety (R.Vaidya et al., 2011) [85].

Immunology, Allergology and Rheumatology

GABA-benzodiazepine receptor complexes are present not only in the central nervous system, but also on the surface of immunocompetent cells (G. Prud’homme et al., 2015) [69]. It has been known for a long time that benzodiazepines are capable of exerting immunosuppressive, anti-allergic and anti-inflammatory effects and improve the course of autoimmune, allergic and rheumatological diseases. This improvement has been shown for some forms of autoimmune encephalitis, including anti-N-methyl-D-aspartate receptor encephalitis, multiple sclerosis and its experimental model (the so-called experimental autoimmune encephalomyelitis – EAE), autoimmune epilepsy, and rheumatoid arthritis an experimental rodent model (the so-called collagen-induced arthritis) and contact dermatitis.And given the presence of lorazepam and a number of other effects that can be clinically useful in, for example, multiple sclerosis or rheumatoid arthritis or autoimmune epilepsy, such as the effect on muscle spasticity, manifestations of anxiety, sleep disturbances, anticonvulsant action, increased action of analgesics, it the use of these autoimmune pathologies as part of complex therapy together with other immunosuppressants or disease-modifying drugs should be considered therapeutically justified (G.Prud’homme et al., 2015) [69].

And in one of the rare autoimmune pathologies, the so-called rigid person syndrome, or muscle stiffness syndrome (stiff person syndrome) associated with the formation of autoantibodies to the GABA-synthesizing enzyme glutamate decarboxylase (GAD65) or GABA receptors, the use of high doses of benzodiazepines is generally a means -th line of therapy in order to both symptomatic relief and achieve immunosuppression in the central nervous system (G. Prud’homme et al., 2015) [69]. It has been shown that lorazepam is also effective in allergic rhinitis (hay fever; M. Miller, 1975) [61].

Cardiology

The good tolerability of lorazepam allows it to be widely used in general somatic practice, for example, in cardiology. Thus, it was shown that the treatment of patients with coronary heart disease with severe anxiety leads not only to an improvement in the psychoemotional state (a decrease in the level of anxiety by an average of 37.9%, the severity of depression – by 25.0%), but also to an improvement in the course of coronary pathology itself. and a general improvement in the quality of life (there was an increase in indicators on the scales of stability of angina pectoris, perception of the disease and the general quality of life, respectively, by 45.6; 41.3 and 22.0%; A.D. Ibatov, 2006) [4]. Another study by Russian authors examined the effectiveness of lorazepam as an anxiolytic in cardiac surgery and psychiatric practice. Two groups of patients were observed: in one group there were patients who did not initially suffer from TR, but gave nosogenic acute anxiety reactions due to the news of the need for coronary artery bypass grafting for the treatment of coronary heart disease (15 patients), in the other – regular patients of psychiatric clinics with chronic TR ( 16 patients), the total sample was 31 patients.The dynamics of the patient’s condition was monitored using the Hamilton Anxiety Scale (HAM-A) and the Hospital Anxiety and Depression Scale (HADRS). At the same time, lorazepam as an anxiolytic was highly effective in 24 (77%) of 31 patients. Its efficacy did not differ in both subgroups of patients. The average effective doses of lorazepam were slightly higher in chronic anxiety disorders (3.7 ± 1.1 mg / day) than in situational nosogenic or preoperative anxiety (2.1 ± 0.6 mg / day).Good tolerance of lorazepam and a small number of side effects were noted (S. Ivanov et al., 2003) [5].

Gastroenterology

Lorazepam is effective in functional and psychosomatic disorders of the gastrointestinal tract, in particular irritable bowel syndrome, and as an adjuvant agent for gastritis, gastric ulcer and duodenal ulcer, for the prevention of postoperative and shock stress stomach ulcers, etc. (M. Abry et al., 1971) [11]. It is also successfully used as a component of premedication before fibrogastroduodeno- or colonoscopy, especially in anxious patients (E.Burkhalter, 1989) [19]. It has been shown that lorazepam not only reduces anxiety in patients with chronic enteritis, ulcerative colitis, Crohn’s disease, but also improves the course of intestinal pathology itself, probably due to its immunosuppressive effect (D.K. Stokes Jr., 1978) [82]. Reduction of sympathoadrenal hyperactivity and associated gastric stasis caused by lorazepam made it possible to successfully use it in combination with mirtazapine for resistant gastroparesis that did not respond to the use of such traditional prokinetics and antiemetic drugs as metoclopramide, domperidone, itopride, erythromycin (S.Kim et al., 2006) [46].

Lorazepam as an antiemetic

It has long been known that benzodiazepines are generally effective as adjuvant antiemetics (in addition to cetrons, metoclopramide and / or antipsychotics, antihistamines), including in radiation and chemotherapy of malignant tumors. However, among all benzodiazepines, it was lorazepam that won a special favor among clinicians in this capacity due to the low potential of drug-drug interactions, non-susceptibility to its hepatic metabolism, short T1 / 2 and unwillingness to cumulation, as well as good bioavailability with intramuscular administration (in contrast, for example, to diazepam; L.Lohr, 2008) [57]. Lorazepam is especially effective in preventing the so-called “vomiting of anticipation” associated with anxious expectation of side effects of chemotherapy and radiation during repeated courses (R. Cooper, P. Gent, 2002) [22]. Lorazepam is also absorbed through the skin, is effective in this form and in combination with diphenhydramine and haloperidol, and is even available in the West as a gel intended for use on the skin at home for nausea and vomiting during outpatient chemotherapy, which eliminates the need for injections and simplifies drug use in patients with vomiting who may have impaired oral absorption of lorazepam (J.Bleicher et al., 2008) [17].

It has also been shown that the inclusion of lorazepam in preoperative premedication reduces the incidence of vomiting during induction and the incidence of postoperative nausea and vomiting (M. Laraki et al., 1996) [53]. Moreover, lorazepam, along with haloperidol, has proven to be one of the few drugs that are effective in stopping vomiting in the context of cannabinoid hyperemetic syndrome (a condition in which vomiting is extremely difficult to stop with many “traditional” antiemetics, such as setrons, metoclopramide; B.Cox et al., 2012) [23]. Also, lorazepam in combination with haloperidol is effective in stopping resistant vomiting in migraine status (M.Backonja et al., 1989) [14]. Lorazepam is also successfully used for nausea and vomiting of pregnant women (D. Trachtenberg, 1991) [84]. Lorazepam is effective and safe for cyclic vomiting, including in children (W.van der Woerd et al., 2010) [87].

Lorazepam from a Modern Position: Yes or No? (Conclusions)

1. Lorazepam is a unique highly potent benzodiazepine with a wide spectrum of therapeutic action, including anti-anxiety, hypnotic-sedative, amnestic, anti-aggressive, anticonvulsant, anti-manic, central muscle relaxant, immunosuppressive and anti-inflammatory, anti-emetic action, anti-emetic action, anti-emetic action, anti-psychotics and anti-psychotic properties.

2. Good tolerance of lorazepam, its short T1 / 2 and the absence of a tendency to cumulation, active metabolites and the dependence of its clearance on the state of the liver make it more widely used in such vulnerable categories of patients as the elderly and the elderly, patients with liver lesions, drug addicts.

3. A wide range of somatotropic activity determines the advisability of using lorazepam in many pathologies encountered in general somatic practice.

4. The therapeutic potential of benzodiazepines and lorazepam, in particular in psychiatry, is often underestimated – their effectiveness is by no means limited to TR and insomnia.

5. Lorazepam is also able to stop or prevent a number of side effects of psychotropic drugs, such as akathisia, nausea, tremors, muscle hypertonicity, acute dystonic reactions, which makes its use especially justified at the initial stages of psychopharmacotherapy, when the most likely occurrence of “early” side effects …

6. Lorazepam can also be used as a premedication component before unpleasant endoscopic procedures (fibrogastroduodenoscopy, colonoscopy, etc.), before surgical interventions.

Information about the authors

Bekker Roman Aleksandrovich – Researcher in the field of psychopharmacotherapy, University. David Ben-Gurion in the Negev

Bykov Yuri Vitalievich – State Budgetary Educational Institution of Higher Professional Education, StSMU.E-mail: [email protected]

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