lorazepam

lorazepam /lor·a·ze·pam/ (lor-az´ĕ-pam) a benzodiazepine used as an antianxiety agent, sedative-hypnotic, preanesthetic medication, and anticonvulsant.

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lor·az·e·pam (lôr-z-pm)

n.

A whitish powder that acts as a sedative and antianxiety agent and is used therapeutically to control seizures.

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lorazepam

[lôrā′zəpam]

a benzodiazepine tranquilizer.

indications It is prescribed in the treatment of anxiety, nervous tension, and insomnia and is given intravenously to abort status epilepticus and for preanesthesia.

contraindications Acute glaucoma, psychosis, pregnancy, or known hypersensitivity to this drug or to any benzodiazepine prohibits its use.

adverse effects Among the more serious adverse effects are drowsiness and fatigue. Withdrawal symptoms may occur on discontinuation of the drug, especially after prolonged use or high dosage.

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lorazepam

(lôraz´pam),
n.pr brand name: Ativan, Lorazepam Intensol;
drug class: benzodiazepine antianxiety (Controlled Substance Schedule IV);
action: depresses subcortical levels of the central nervous system, including limbic system and reticular formation;
uses: anxiety, preoperative sedation, acute alcohol withdrawal symptoms, muscle spasm.

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lorazepam

a benzodiazepine derivative used as an antianxiety agent.

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lorazepam

Apo-Lorazepam (CA), Ativan, Novo-Lorazem (CA), Nu-Loraz (CA)

Pharmacologic class: Benzodiazepine

Therapeutic class: Anxiolytic

Controlled substance schedule IV

Pregnancy risk category D

Action

Unknown. Thought to depress CNS at limbic system and disrupt neurotransmission in reticular activating system.

Availability

Injection: 2 mg/ml, 4 mg/ml

Solution (concentrated): 2 mg/ml

Tablets: 0.5 mg, 1 mg, 2 mg

⊘Indications and dosages

➣ Anxiety

Adults: 2 to 3 mg P.O. daily in two or three divided doses. Maximum dosage is 10 mg daily.

➣ Insomnia

Adults: 2 to 4 mg P.O. at bedtime

➣ Premedication before surgery (as antianxiety agent, sedative-hypnotic, or amnestic)

Adults: 0.05 mg/kg (not to exceed 4 mg) deep I.M. injection at least 2 hours before surgery, or 0.044 mg/kg (not to exceed 2 mg) I.V. 15 to 20 minutes before surgery. For greater amnestic effect, give up to 0.05 mg/kg (not to exceed 4 mg) I.V. 15 to 20 minutes before surgery.

➣ Status epilepticus

Adults: 4 mg I.V. given slowly (no faster than 2 mg/minute). If seizures continue or recur after 10 to 15 minutes, repeat dose. If seizure control isn't established after second dose, other measures should be used. Don't exceed 8 mg in 12 hours.

Dosage adjustment

• Elderly or debilitated patients

Off-label uses

• Acute alcohol withdrawal syndrome

Contraindications

• Hypersensitivity to drug, other benzodiazepines, polyethylene or propylene glycol, or benzyl alcohol
• Acute angle-closure glaucoma
• Coma or CNS depression
• Hepatic or renal failure

Precautions

Use cautiously in:
• hepatic or renal impairment
• history of suicide attempt, drug abuse, depressive disorder, or psychosis
• elderly patients
• pregnant or breastfeeding patients.

Administration

• For I.V. use, dilute with equal volume of compatible diluent, such as normal saline solution or dextrose 5% in water. Keep resuscitation equipment and oxygen at hand.
☞ Give each 2 mg of I.V. dose slowly, over 2 to 5 minutes. Don't exceed rate of 2 mg/minute.
• Don't give parenteral form to children younger than age 18.

Route	Onset	Peak	Duration
P.O.	15-45 min	1-6 hr	Up to 48 hr
I.V.	Rapid	15-20 min	Up to 48 hr
I.M.	15-30 min	1-2 hr	Up to 48 hr

Adverse reactions

CNS: amnesia, agitation, ataxia, depression, disorientation, dizziness, drowsiness, headache, incoordination, asthenia CV (with too rapid I.V. administration): hypotension, bradycardia, tachycardia, apnea, cardiac arrest, cardiovascular collapse

EENT: blurred vision, diplopia, nystagmus

GI: nausea, abdominal discomfort

Other: increased or decreased appetite

Interactions

Drug-drug. CNS depressants (including antidepressants, antihistamines, benzodiazepines, sedative-hypnotics): additive CNS depression

Hormonal contraceptives: increased lorazepam clearance

Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression

Drug-behaviors. Alcohol use: increased CNS depression

Smoking: increased metabolism and decreased efficacy of lorazepam

Patient monitoring

☞ During I.V. administration, monitor ECG and cardiovascular and respiratory status.
• Monitor vital signs closely.
• Evaluate for amnesia.
• Watch closely for CNS depression. Institute safety precautions as needed to prevent injury.
☞ Monitor for signs and symptoms of overdose (such as confusion, hypotension, coma, and labored breathing).
• Assess liver function tests and CBC.

Patient teaching

• Tell patient and family about drug's possible CNS effects. Recommend appropriate safety precautions.
• Explain that with long-term use, drug must be discontinued slowly (typically over 8 to 12 weeks).
• Instruct patient to avoid alcohol, because it increases drowsiness and other CNS effects.
• Caution patient to avoid smoking, because it speeds drug breakdown in body.
• Advise female patient to inform prescriber if she is pregnant or breastfeedcAdvise female patient to inform prescriber if she is pregnant or breastfeeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.

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lorazepam

Neuropharmacology A benzodiazepine anxiolytic, antidepressant, sedative, hypnotic