lorazepam


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lorazepam

 [lor-az´ĕ-pam]
a benzodiazepine derivative used as an antianxiety agent, sedative-hypnotic, preanesthetic medication, and anticonvulsant, and as an antiemetic in cancer chemotherapy; administered orally, intravenously, or intramuscularly.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

lorazepam

Apo-Lorazepam (CA), Ativan, Dom-Lorazepam (CA), Novo-Lorazem (CA), Nu-Loraz (CA), PHL-Lorazepam (CA), PMS-Lorazepam (CA), Pro-Lorazepam (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.

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 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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved

lorazepam

(lôr-ăz′ə-păm′)
n.
A benzodiazepine drug, C15H10Cl2N2O2, that acts as a sedative and antianxiety agent and is used therapeutically to control seizures.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

lorazepam

Neuropharmacology A benzodiazepine anxiolytic, antidepressant, sedative, hypnotic
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

lorazepam

A benzodiazepine tranquillizer drug similar to diazepam). A brand name is Ativan.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005
References in periodicals archive ?
A total of 20 patients treated with silexan suffered from 26 adverse events compared to 18 patients (19 adverse events) treated with lorazepam. In the silexan group, a causal relationship to the study medication could not be ruled out for 11 adverse events (10 patients), and 7 adverse events (7 patients) in the lorazepam group were judged to be potentially related to the study medication.
Both lorazepam and clonidine can be tapered and discontinued once the withdrawal is complete.
Increased lorazepam doses IV along with haloperidol were given as needed.
Among the 10 patients who received lorazepam, a bolus dose of up to 1 mg by intravenous push, symptoms resolved and temperatures normalized in 8 of the women within 90 minutes.
Revenues from sales of lorazepam reportedly rose from $9 million in 1997 to $133 million in 1998.
As part of the protocol, a physician may decide to have the nurse administer an initial dose of 1 mg of lorazepam if there is a strong history of alcohol consumption and a high CAGE score (Fig 1).
Lorazepam in its undiluted form also appears as a small white tablet that comes in various shapes or as white powder.
Diazepam, lorazepam, and clonazepam are central nervous system inhibitors and not only decrease muscle tone but may also cause sleepiness and drooling, and interfere with swallowing.
W receives a benzodiazepine challenge with lorazepam, 2 mg IM.
There, he was treated intermittently with doses of intravenous (IV) lorazepam 1mg (we are unsure of the total dose) and quetiapine 25mg/day.
It later transpired that Nichols had administered lorazepam, a non-prescribed medication that is commonly used to treat anxiety disorders.