lorazepam

Action and Spectrum

Actions and Spectrum: 

The main actions of lorazepam include: 

• Anxiolytic: lorazepam is primarily used as an anxiolytic, which means it can help reduce feelings of anxiety and tension. 

• Sedative/hypnotic: lorazepam can also have a sedative or hypnotic effect, which means it can help induce sleep or promote relaxation. 

• Anticonvulsant: lorazepam is also used as an anticonvulsant to help prevent or control seizures. 

The spectrum of lorazepam refers to the range of conditions that it can be used to treat. In addition to anxiety, insomnia, and seizures, lorazepam may also be used to treat conditions such as: 

• Alcohol withdrawal: lorazepam can help manage the symptoms of alcohol withdrawal, including anxiety, agitation, and seizures. 

• Nausea and vomiting lorazepam may be used to treat nausea and vomiting associated with chemotherapy or other medical conditions. 

• Muscle spasms: lorazepam can help relieve muscle spasms caused by medical conditions such as multiple sclerosis or spinal cord injuries. 

• Panic attacks: lorazepam can be used to help manage the symptoms of panic attacks including anxiety, rapid heartbeat, and sweating. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Sedation 

Dizziness 

Unsteadiness 

Weakness 

Fatigue 

Drowsiness 

Amnesia 

Confusion 

Disorientation 

Depression 

Suicidal ideation 

Vertigo 

Ataxia 

Sleep apnea 

Asthenia 

Impotence 

Jaundice 

Increased bilirubin 

Black Box Warning

lorazepam carries a black box warning which is the most serious warning that the U.S. Food and Drug Administration (FDA) requires. The black box warning for lorazepam is related to the potential for abuse, dependence, and addiction. 

The black box warning states that lorazepam has a high potential for abuse and that its use can lead to physical and psychological dependence. It also warns the risk of dependence increases with higher doses, longer use, and that withdrawal symptoms may occur if the drug is stopped abruptly. 

Other potential side effects of lorazepam include drowsiness, dizziness, confusion, impaired coordination, memory problems, and respiratory depression (slowed breathing). 

Lorazepam should be used with caution in patients with a history of substance abuse or addiction as well as in patients with liver or kidney disease, respiratory disease, history of depression, or suicidal thoughts. 

Patients should be advised to take lorazepam only as directed by their healthcare provider and to never share the medication with others. They should also be advised to avoid alcohol and other drugs that can cause drowsiness or respiratory depression while taking lorazepam. 

Contraindication / Caution

Contraindication/Caution: 

lorazepam is contraindicated (it should not be used) in the following conditions: 

• Hypersensitivity: lorazepam should not be used in patients who have a known hypersensitivity to benzodiazepines or any of the components of lorazepam. 

• Acute narrow-angle glaucoma: lorazepam should not be used in patients with acute narrow-angle glaucoma as it can worsen this condition. 

lorazepam should be used with caution in following conditions: 

• Respiratory depression: lorazepam can cause respiratory depression especially in patients with respiratory disease or those who are taking other medications that can cause respiratory depression. 

• Liver or kidney disease: lorazepam is metabolized by the liver and excreted by the kidneys so it should be used with caution in patients with liver or kidney disease. 

• Depression or suicidal thoughts: lorazepam can increase the risk of depression or suicidal thoughts especially in patients with a history of these conditions. 

• Pregnancy and breastfeeding: lorazepam can cross the placenta and is excreted in breast milk so it should be used with caution in pregnant or breastfeeding women. 

• Elderly patients: lorazepam should be used with caution in elderly patients as they may be more sensitive to its effects and more prone to side effects such as dizziness and confusion. 

Pregnancy / Lactation

Pregnancy consideration:  

lorazepam should only be used by pregnant females in an emergency when no other safer available. 

Breastfeeding warnings: Lactating females should not breastfeed during the treatment. 

Continue breastfeeding after the two days of the last dose. 

Pregnancy category: 

• Category A: Satisfactory and well-controlled studies show no risk to the fetus in the first or later trimester. 

• Category B: There is no affirmation of risk to the fetus found in animal reproduction studies, and there are not enough studies on pregnant women. 

• Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for a product in humans; Pregnant women must take care of the potential risks. 

• Category D: There is adequate data available with sufficient evidence of human fetal risk from various platforms. However, despite potential dangers may be used only in emergency cases for potential benefits. 

• Category X: Drugs listed in this category outweigh risks over benefits. The drug is not for pregnant women. 

• Category N: No data is available for the drug under this category. 

Pharmacology

lorazepam is a benzodiazepine medication that acts on the central nervous system to produce its effects. It enhances the activity of a neurotransmitter called gamma-aminobutyric acid (GABA) by binding to specific receptors in the brain. 

When GABA binds to its receptors, it produces inhibitory effects in the brain, which can help reduce anxiety, promote relaxation, and suppress seizures. By enhancing the activity of GABA, lorazepam can produce similar effects, making it useful in the treatment of anxiety disorders, insomnia, and seizures. 

lorazepam is rapidly absorbed after oral administration, and peak blood levels are typically reached within 2 hours. It is metabolized by the liver, and the metabolites are excreted primarily in the urine. 

The duration of action of lorazepam depends on several factors, including the dose, route of administration, and individual patient characteristics. Generally, the effects of lorazepam last for several hours, with a half-life of approximately 10-20 hours. 

Pharmacodynamics: 

lorazepam is a benzodiazepine medication that acts as an anxiolytic, anticonvulsant, sedative, and muscle relaxant. Its pharmacological effects are due to its ability to bind to and modulate the activity of gamma-aminobutyric acid (GABA) receptors in the brain. GABA is the primary inhibitory neurotransmitter in the central nervous system (CNS), and its activation leads to a decrease in neuronal excitability. Lorazepam enhances the activity of GABA by increasing the frequency of chloride channel opening in response to GABA, thereby enhancing its inhibitory effects on neurotransmission. 

The pharmacodynamic effects of lorazepam include anxiolytic, sedative, hypnotic, anticonvulsant, and muscle-relaxant effects. It has a relatively rapid onset of action, and its effects are dose dependent. At low doses, lorazepam produces anxiolytic effects, reducing feelings of anxiety and stress. At higher doses, it produces sedative and hypnotic effects, promoting sleep and reducing wakefulness. At therapeutic doses, lorazepam has anticonvulsant properties, making it useful in the treatment of epilepsy and other seizure disorders. 

The duration of action of lorazepam is relatively long, ranging from 6-8 hours after oral administration. Its pharmacological effects can be prolonged in elderly patients or those with liver dysfunction, leading to a risk of excessive sedation or respiratory depression. In summary, lorazepam is a benzodiazepine medication that enhances the activity of GABA in the CNS, leading to anxiolytic, sedative, hypnotic, anticonvulsant, and muscle-relaxant effects. Its pharmacological effects are dose-dependent and have a relatively long duration of action. 

Adminstartion

lorazepam can be administered orally or intravenously. The route of administration depends on the patient condition and intended therapeutic effect. 

Oral administration: lorazepam is available as tablets and oral solutions. The dosage and frequency of administration depend on patient age, weight, medical condition, and response to treatment. The usual adult dose of lorazepam for anxiety is 2-3 mg taken 2-3 times daily while the usual dose for insomnia is 2-4 mg taken at bedtime. The maximum daily dose of lorazepam should not exceed 10 mg/day. 

Intravenous administration: lorazepam can be given intravenously for the management of acute seizures, anxiety, and agitation. The intravenous route is preferred for patients who are unable to swallow have severe anxiety or agitation or require rapid onset of action. The usual intravenous dose for anxiety and agitation is 2-4 mg given over 2-5 minutes with a maximum single dose of 4 mg. For management of seizures the usual intravenous dose is 4 mg given over 2-5 minutes with a maximum dose of 8 mg. 

It is essential to monitor patients receiving lorazepam for adverse effects such as dizziness, drowsiness, confusion, and respiratory depression. lorazepam should not be abruptly discontinued and dosage should be gradually tapered to prevent withdrawal symptoms such as anxiety, insomnia, and seizures. 

Patient Information Leaflet

Generic Name: lorazepam 

Pronounced: Lo-rah-zeh-paam 

Why do we use lorazepam? 

• Anxiety disorders: lorazepam is commonly used to manage symptoms of anxiety including worry, fear, and nervousness. It is effective in reducing the intensity, frequency of anxiety, and symptoms which leading to improved quality of life for patients. 

• Panic disorder: lorazepam can be used as a short-term treatment for panic attacks that helps to reduce the severity and duration of symptoms such as palpitations, sweating, and shortness of breath. 

• Insomnia: lorazepam can be used as a sleep aid in patients with insomnia which helps to improve quality and duration of sleep. 

• Seizure disorders: lorazepam is used as an anticonvulsant to manage seizures which are associated with epilepsy. 

• Alcohol withdrawal syndrome: lorazepam manages the symptoms of alcohol withdrawal syndrome including anxiety, agitation, and tremors. It can also helps to prevent seizures that may occur during withdrawal.