Generic
Lorazepam
4 brands available in the market
At a glance
Lorazepam is a benzodiazepine used for anxiety disorders, panic attacks, and sleep problems. It suppresses abnormal nerve cell activity by enhancing the effects of GABA in the brain.
Description
Lorazepam is a short-acting benzodiazepine that acts as an agonist at benzodiazepine receptors in the CNS. It increases neuronal membrane permeability to chloride ions by binding to stereospecific benzodiazepine receptors on postsynaptic GABA neurons, enhancing GABA's inhibitory effects, resulting in hyperpolarization and stabilization.
Indications
- Anxiety disorders (generalized anxiety, phobias, OCD, panic attacks)
- Insomnia associated with anxiety
- Chemotherapy-related nausea and vomiting
- Preoperative medication
- Status epilepticus
Therapeutic class
Benzodiazepine Hypnotics & Sedatives
Pharmacological class
Benzodiazepine Receptor Agonist
Pharmacology
Lorazepam exerts a depressant action on the CNS by potentiating the inhibitory actions of GABA, resulting in diminution of the ascending activating systems, particularly the serotonergic and noradrenergic pathways from brain stem to the cerebral cortex.
Mechanism of action
Suppresses abnormal nerve cell activity by enhancing GABA action.
Dosage
Anxiety (Adult): 1-6 mg/day in 2-3 divided doses; max 10 mg/day
Insomnia: 1-4 mg at bedtime
Premedication: 2-3 mg night before surgery
Status Epilepticus (Adult): 4 mg slow IV; repeat after 5-10 min if needed
Children: Status Epilepticus: 0.05-0.1 mg/kg IV over 2-5 min; max 4 mg/dose
Elderly/Debilitated: Half the usual adult dose or less
Administration
- Swallow tablet whole; do not chew, crush or break
- May be taken with or without food, but at a fixed time is preferable
- Take at the same time each day
Missed dose
If you miss a dose, take it as soon as you remember. If it's almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.
Side effects
Common Side Effects:
- Dizziness
- Weakness
- Sedation
- Balance disorder
- Confusion
- Depression
- Nausea
Precautions & warnings
- Very high addiction/habit-forming potential; take only as per dose and duration advised
- Avoid driving or activities requiring concentration (may cause dizziness and drowsiness)
- Avoid alcohol (may increase dizziness and drowsiness)
- Do not stop suddenly (may cause nausea, anxiety, agitation, sweating, tremor, confusion)
- Consult doctor during pregnancy and lactation
Contraindications
- Severe hepatic impairment
- Respiratory depression
- Acute narrow-angle glaucoma
- Myasthenia gravis
- Previous sensitivity to benzodiazepines
- Pregnancy and lactation
Drug interactions
- Additive CNS effects with CNS depressants (barbiturates, phenothiazines, antidepressants, MAOIs)
- Scopolamine may increase sedation, hallucinations, and irrational behavior
- Caffeine, theophylline, or aminophylline may reduce sedative and anxiolytic effects
- Sodium valproate or probenecid may increase plasma levels
Food interactions
Alcohol consumption with Lorazepam is unsafe.
Use in pregnancy
Use in Pregnancy: Lorazepam is unsafe during pregnancy (Category D); definite evidence of risk to the fetus. Use only in life-threatening situations with doctor's advice.
Pregnancy Category: D — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Lorazepam is probably unsafe during breastfeeding; may pass into breast milk. Use for short periods and monitor baby for sleepiness. Withdraw gradually.
Pediatric use
Not recommended for anxiety in children; may be used as premedication before surgery at 0.05 mg/kg in children aged 5 to 13 years.
Geriatric use
Elderly or debilitated patients: initial dosage of 1-2 mg/day in divided doses is recommended.
Renal / hepatic impairment
Renal Impairment: Caution in severe kidney disease; dose adjustment may be needed; caution in mild-moderate impairment.
Hepatic Impairment: Mild-moderate: reduced doses may be needed; severe: not recommended.
Overdose effects
Overdose: CNS depression (drowsiness to coma), ataxia, hypotension; symptomatic treatment.
Storage conditions
Store below 30°C, away from light and moisture; keep out of reach of children.
Chemical structure
Lorazepam