Lorazepam

Tranquilizer, Sedative/Hypnotic · Benzodiazepine

Indications

Moderate to severe anxiety states. Psychoneurotic disorders.

Dosage

Anxiety/hypnotics: Adults: Initial: 2-3 mg/day given 2-3 doses. Usual: 2-6 mg/day. Insomnia: Adults: 2-4 mg at bed time. Elderly: 0.5-2 mg daily. Children: Not recommended.

Adverse Effects

Drowsiness, which may continue into the following day. Confusions, dizziness, depression, fatigue, muscle weakness, ataxia, asthaenia, GI upset, hypotension, visual disturbances, rash, impaired alertness and dexterity, headache. Rarely blood dyscrasias, raised liver enzymes. Dependence. Paradoxical reactions, anterograde amnesia. Reports of angioedema.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Positive evidence of risk: Use only when no safer alternative exists for a serious problem. Lactation: Contraindicated or not recommended. Contraindications: Acute pulmonary insufficiency, sleep apnoea, myasthaenia gravis. Severe hepatic impairment. Precautions: Chronic pulmonary insufficiency, coma, shock, narrow-angle glaucoma, renal impairment, Mild to moderate hepatic impairment, depression, personality disorders, sleep apnoea, history of drug or alcohol abuse. Elderly or debilitated patients. Avoid long term use. Withdraw gradually.

Interactions

Alcohol, CNS depressants including valproate, clozapine, haloperidol. Theophylline, aminophylline, CYP3A4 inhibitors or inducers (e.g. cimetidine, rifampicin), probenecid.

Advice to Patient

Take with or without meals. Do not take prescription medications or OTC medications especially pain medications, sedatives, antihistamines, hypnotics during therapy without consulting prescriber. Contact prescriber if there is headache, fatigue, dizziness, confusion, depression, increased sleepiness, excitation, nightmares, agitation, lack of sleep, change in personality, change in memory, change in urinary pattern, change in vision, fast heartbeat, chest pain, palpitations, ringing in ears, muscle cramps, weakness, rigidity or tremors, abdominal cramping, constipation, loss of appetite, vomiting, ringing in ears or if there is worsening of condition. Avoid alcohol during therapy. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. Avoid direct sunlight. Use sunscreen, wear proper clothing and eyewear to prevent…

Pharmacokinetics

Onset of action: Anticonvulsant: IV: Within 10 mins. Hypnosis: IM: 20-30 mins. Sedation: IV: Within 2-3 mins. Duration: Anaesthesia premedication: Adults: IM, IV: Approx. 6-8 hrs. Absorption: IM: Rapid and complete absorption; Oral: Readily absorbed. Metabolism: Hepatic; rapidly conjugated to lorazepam glucuronide (inactive). Bioavailability: Oral: 90%. Half-life elimination: Full-term neonates: IV: 40.2 ± 16.5 hrs. Paediatric patients: IV: 5 mths to <3 yrs: 15.8 hrs. 3 to <13 yrs: 16.9 hrs. 13 to <18 yrs: 17.8 hrs. Adults: Oral: Approx. 12 hrs; IV: Approx. 14 hrs; IM: Approx. 13-18 hrs; End-stage renal disease (ESRD): Approx. 18 hrs. Time to peak: IM: =3 hrs; Oral: Approx. 2 hrs; Sublingual tab: 1 hr. Excretion: Urine (approx. 88%; predominantly as inactive metabolites). Faeces (approx. 7%).

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Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.