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Lorazepam – Usages, Side effects, Risk factors, Precautions
Here in this post, we are discussing “Lorazepam “. You can read usages, side effects, Risk factors, and warning information. Keep visiting Psychology Roots.
About Lorazepam
Lorazepam is an antianxiety agent, anxiolytics, and nonbenzodiazepines.
Brand name
Lorazepam is available with the following brand name.
- Ativan
- Loreev XR
Forms of Lorazepam
Lorazepam is available in the following form
- Tablets
- Capsule
- Oral suspension
- Injectable solution
Tablet
Tablets are available in the following doses:
- 5mg
- 1mg
- 2mg
Capsule
Capsules are available in the following doses:
- 1mg
- 2mg
- 3mg
Oral suspension
The oral suspension is available in the following dose:
- 2mg/ml
Injectable solution
The injectable solution is available in the following dose:
- 2mg/ml
- 4mg/ml
Disorder to treat
It is used for the treatment of the following disorder
- Anxiety disorders
Anxiety disorder
Indicated for management of anxiety disorders or for the short-term relief of symptoms of anxiety or anxiety associated with depressive symptoms. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic. Efficacy in long-term use (ie, >4 months), has not been assessed by systematic clinical studies.
Adults
In adults Lorazepam is administered as:
Tablets
- Initially, 2-3 mg orally is given every 8-12hr.
- PRN; not to exceed 10 mg per day.
- Maintenance: 2-6 mg per day is orally given in a divided dose every 8-12hr.
Extended-release capsules (Loreev XR)
- Indicated for anxiety disorders in adults who are receiving stable, evenly divided in three times a day dosing with lorazepam tablets.
- Recommended dose: Administer capsule orally every morning; dose equals the total daily dose of previously administered lorazepam tablets.
- Dosage adjustment: Discontinue Loreev XR and switch to lorazepam tablets to adjust the dosage.
- Short-Term Treatment of Insomnia
- Tablets: 2-4 mg is orally given every night.
Children
- 05-0.1 mg per kg IV over 2-5 minutes. It should not exceed 4 mg per dose. It may repeat every 10-15min PRN.
- Alternatively, 0.1 mg per kg at a slow IV rate not to exceed the rate of 2 mg per min. It should not exceed a dose of 4 mg.
Adolescents
Intravenously 4 mg slowly is given. if seizure persists after 10-15 minutes, administer 4 mg IV again.
Older adults
Preferred agent in elderly because it is short-acting and has inactive metabolites.
- A lower initial dose is recommended. Orally 1-2 mg given in a divided dose every 8-12hr.
Adverse effects
There are the following side effects of lorazepam:
- Dizziness
- Sedation
- Drowsiness
- Blood dyscrasias
- Vertigo
- Impotence
- Asthenia
- Hypotension
- Dysarthria
- Unsteadiness
- Weakness
- Change in libido
- Visual disturbances
- Ataxia
- Fatigue
- Convulsions/seizures
- Confusion
- Sleep apnea
- Jaundice
- Nausea
- Increased bilirubin
- Increase in ALP
- Disorientation
- Constipation
- Tremor
- Increased liver transaminases
- Respiratory depression
- Amnesia
- Change in appetite
- Depression
- Extrapyramidal symptoms
- Suicidal ideation/attempt
- Hypersensitivity reactions
- Paradoxical reactions (anxiety, excitation, agitation, hostility, aggression, rage)
Warnings
Risks From Concomitant Use With Opioids:
- Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death.
- Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate.
- Limit dosages and durations to the minimum required.
- Follow patients for signs and symptoms of respiratory depression and sedation.
Addiction, abuse, and misuse
In September 2020, FDA addressed serious risks of benzodiazepine addiction, abuse, and misuse, which can lead to overdose and death.
Abuse and misuse of benzodiazepines commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes; before prescribing and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction.
Physical dependence can occur when taken steadily for several days to weeks, even as prescribed.
Risks of dependence and withdrawal increase with longer treatment duration and higher daily dose; although injection is indicated only for intermittent use, if used more frequently than recommended, abrupt discontinuation or rapid dosage reduction may precipitate acute withdrawal reactions, including seizures, which can be life-threatening; use gradual taper when discontinuing therapy to reduce withdrawal reactions risk.
Assess each patient’s risk prior to prescribing and monitor regularly for the development of these conditions.
Contraindications
There are the following contraindications
- Hypersensitivity
- Acute narrow-angle glaucoma
- Intra-arterial administration
- Severe respiratory depression
- Sleep apnea
- Use of injectable dosage form in premature infants (contains benzyl alcohol)
Cautions
Following are the cautions of Lorazepam:
- Concomitant use of benzodiazepines, including lorazepam, and opioids may result in profound sedation, respiratory depression, coma, and death.
- Advise both patients and caregivers about the risks of respiratory depression and sedation when lorazepam is used with opioids; advise patients not to drive or operate heavy machinery until the effects of concomitant use with the opioid have been determined.
- The use of benzodiazepines, including lorazepam, both used alone and in combination with other CNS depressants, may lead to potentially fatal respiratory depression.
- Not recommended for use in patients with primary depressive disorder or psychosis.
- The injection contains benzyl alcohol associated with potentially fatal “gasping syndrome” in neonates and an increased incidence of kernicterus, particularly in small preterm infants; if the patient requires more than recommended dosages or other medications containing this preservative, the practitioner must consider the daily metabolic load of benzyl alcohol from combined sources.
- Prolonged use may lead to physical and psychological dependence especially in patients with a history of alcohol or drug abuse; risk of dependence is decreased with short-term treatment (eg, 2-4 weeks); evaluate the need for continued treatment prior to extending therapy duration.
- Use of drugs, particularly in patients at elevated risk, necessitates counseling about risks and proper use of drugs along with monitoring for signs and symptoms of abuse, misuse, and addiction; do not exceed recommended dosing frequency.
- Avoid or minimize concomitant use of CNS depressants and other substances associated with abuse, misuse, and addiction (eg, opioid analgesics, stimulants); advise patients on proper disposal of the unused drug; if a substance use disorder is suspected, evaluate patient and institute (or refer them for) early treatment, as appropriate.
- For patients using treated more frequently than recommended, to reduce the risk of withdrawal reactions, use a gradual taper to discontinue therapy (a patient-specific plan should be used to taper the dose).
- Patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages and those who have had longer durations of use.
- In some cases, benzodiazepine users have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months.
- Use caution in patients with a history of suicide attempts or drug abuse.
- May cause CNS depression, impairing physical and mental abilities; caution patients to not operate dangerous machinery or motor vehicles.
- Anterograde amnesia was reported with use.
- Use caution in patients with respiratory disease, including COPD or sleep apnea.
- Hyperactive or aggressive behavior and other paradoxical reactions are reported with use.
- Caution patients that tolerance for alcohol and other CNS depressants will be diminished.
Pregnancy
The risk of serious adverse effects, including CNS and respiratory depression, exist.
Minor tranquilizers should be avoided in the first trimester of pregnancy, due to the increased risk of congenital malformations.
Maternal use shortly before delivery is associated with floppy infant syndrome (good and consistent evidence).
Prenatal benzodiazepine exposure slightly increased oral cleft risk (limited or inconsistent evidence).
Lactation
Excretion in milk unknown/not recommended
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