Lorazepam Brand Name– Ativan
What is Lorazepam
Lorazepam is a short-acting oral and parenteral benzodiazepine indicated for the treatment of anxiety, status epilepticus (parenteral), perioperative sedation or amnesia induction (parenteral), and the short-term treatment of insomnia secondary to anxiety or transient situational stress.
Common off-label uses include chemotherapy-induced nausea/vomiting, agitation of various etiologies, and acute alcohol withdrawal.
In general, benzodiazepines should be prescribed for short periods only due to the potential for dependence and cognitive impairment, and the availability of safer alternatives.
When treating anxiety disorders, benzodiazepines are generally reserved for the temporary management of anxiety symptoms as an adjunct to first-line pharmacotherapies (e.g., SSRI or SNRI) or for treatment-resistant cases. In general, lorazepam is preferred over long-acting benzodiazepines (e.g., diazepam) in patients with hepatic impairment or in geriatric adults because of a shorter half-life and no active metabolites.
According to the American Psychiatric Association guidelines for alcohol use disorder (AUD), benzodiazepines should be reserved for treating acute alcohol withdrawal or in patients with a co-morbid disorder for which a benzodiazepine is indicated.
If possible, avoid coadministration of benzodiazepines and opioids due to the potential for profound sedation, respiratory depression, coma, and death; patients receiving the combination should be monitored for respiratory depression and sedation.
Indications
- agitation
- alcohol withdrawal
- amnesia induction
- anxiety
- chemotherapy-induced nausea/vomiting prophylaxis
- insomnia
- procedural sedation
- sedation induction
- sedation maintenance
- seizure prophylaxis
- status epilepticus
For the short-term management of anxiety
Side Effects
- agitation
- agranulocytosis
- alopecia
- amnesia
- anaphylactoid reactions
- anxiety
- apnea
- asthenia
- ataxia
- AV block
- blurred vision
- bradycardia
- cardiac arrest
- chills
- coagulopathy
- coma
- confusion
- constipation
- cystitis
- delirium
- depression
- diarrhea
- diplopia
- dizziness
- drowsiness
- dysarthria
- elevated hepatic enzymes
- erythema
- euphoria
- fatigue
- GI bleeding
- hallucinations
- headache
- hearing loss
- heart failure
- hostility
- hyperactivity
- hyperbilirubinemia
- hyperreflexia
- hypersalivation
- hypertension
- hyperventilation
- hyponatremia
- hypotension
- hypothermia
- hypoventilation
- hypoxia
- impotence (erectile dysfunction)
- infection
- injection site reaction
- insomnia
- irritability
- jaundice
- lactic acidosis
- mania
- memory impairment
- metabolic acidosis
- muscle paralysis
- myoclonia
- nausea
- neuroleptic malignant syndrome-like symptoms
- nightmares
- orgasm dysfunction
- pancytopenia
- pericardial effusion
- physiological dependence
- pneumothorax
- psychological dependence
- psychosis
- pulmonary edema
- pulmonary hypertension
- rash
- renal tubular necrosis
- respiratory arrest
- respiratory depression
- restlessness
- seizures
- SIADH
- sinus tachycardia
- suicidal ideation
- teratogenesis
- thrombocytopenia
- tolerance
- tremor
- urinary incontinence
- vertigo
- vomiting
- weakness
- withdrawal
Monitoring Parameters
- laboratory monitoring not necessary
Contraindications
- abrupt discontinuation
- alcoholism
- benzodiazepine dependence
- benzodiazepine hypersensitivity
- benzyl alcohol hypersensitivity
- bipolar disorder
- breast-feeding
- children
- chronic obstructive pulmonary disease (COPD)
- closed-angle glaucoma
- CNS depression
- coadministration with other CNS depressants
- coma
- congenital heart disease
- dementia
- depression
- driving or operating machinery
- ethanol ingestion
- ethanol intoxication
- geriatric
- GI disease
- hepatic disease
- hepatic encephalopathy
- infants
- intraarterial administration
- labor
- neonates
- neuromuscular disease
- obstetric delivery
- Parkinson’s disease
- pregnancy
- premature neonates
- psychosis
- pulmonary disease
- pulmonary hypertension
- renal failure
- renal impairment
- respiratory depression
- respiratory insufficiency
- seizure disorder
- sleep apnea
- status asthmaticus
- status epilepticus
- substance abuse
- suicidal ideation
Interactions
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Codeine
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Diphenhydramine
- Acetaminophen; Guaifenesin; Phenylephrine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Pentazocine
- Acetaminophen; Propoxyphene
- Acetaminophen; Tramadol
- Acrivastine; Pseudoephedrine
- Aldesleukin, IL-2
- Alfentanil
- Alprazolam
- Amobarbital
- Amoxapine
- Amphetamine; Dextroamphetamine Salts
- Apomorphine
- Apraclonidine
- Aripiprazole
- Asenapine
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Oxycodone
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Azelastine
- Azelastine; Fluticasone
- Barbiturates
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Belladonna; Opium
- Benzhydrocodone; Acetaminophen
- Benztropine
- Brimonidine
- Brimonidine; Brinzolamide
- Brimonidine; Timolol
- Brompheniramine
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Guaifenesin
- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Buprenorphine
- Buprenorphine; Naloxone
- Buspirone
- Butabarbital
- Butorphanol
- Caffeine
- Caffeine; Ergotamine
- Cannabidiol
- Carbamazepine
- Carbetapentane; Chlorpheniramine
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbetapentane; Pyrilamine
- Carbinoxamine
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Cariprazine
- Cenobamate
- Cetirizine
- Cetirizine; Pseudoephedrine
- Chlophedianol; Dexbrompheniramine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlophedianol; Guaifenesin; Phenylephrine
- Chlorcyclizine
- Chlorpheniramine
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dextromethorphan
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorthalidone; Clonidine
- Cisapride
- Clemastine
- Clobazam
- Clonidine
- Clozapine
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Colchicine; Probenecid
- Colesevelam
- COMT inhibitors
- Cyclizine
- Cyproheptadine
- Desflurane
- Deutetrabenazine
- Dexchlorpheniramine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmedetomidine
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Guaifenesin; Phenylephrine
- Dichlorphenamide
- Dicyclomine
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Dimenhydrinate
- Diphenhydramine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Diphenhydramine; Phenylephrine
- Doxylamine
- Doxylamine; Pyridoxine
- Dronabinol
- Droperidol
- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
- Enflurane
- Esketamine
- Eszopiclone
- Ethanol
- Ethinyl Estradiol
- Ethinyl Estradiol; Desogestrel
- Ethinyl Estradiol; Ethynodiol Diacetate
- Ethinyl Estradiol; Etonogestrel
- Ethinyl Estradiol; Levonorgestrel
- Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
- Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
- Ethinyl Estradiol; Norelgestromin
- Ethinyl Estradiol; Norethindrone
- Ethinyl Estradiol; Norethindrone Acetate
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Ethinyl Estradiol; Norgestimate
- Ethinyl Estradiol; Norgestrel
- Ethotoin
- Etomidate
- Fenfluramine
- Fentanyl
- Flumazenil
- Fluoxetine; Olanzapine
- food
- Fosphenytoin
- Fospropofol
- Gabapentin
- General anesthetics
- Green Tea
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guaifenesin; Phenylephrine
- Guanabenz
- Guanfacine
- Haloperidol
- Halothane
- Homatropine; Hydrocodone
- Hydantoins
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Hydroxychloroquine
- Hydroxyzine
- Ibuprofen; Oxycodone
- Iloperidone
- Iohexol
- Iopamidol
- Isoflurane
- Ketamine
- Lasmiditan
- Lemborexant
- Levocetirizine
- Levomethadyl
- Levomilnacipran
- Levorphanol
- Lisdexamfetamine
- Lithium
- Lofexidine
- Loxapine
- Lumateperone
- Lurasidone
- Magnesium Salts
- Maprotiline
- Meclizine
- Mefloquine
- Melatonin
- Meperidine
- Meperidine; Promethazine
- Mephobarbital
- Meprobamate
- Methadone
- Methocarbamol
- Methohexital
- Methscopolamine
- Methyldopa
- Metoclopramide
- Metyrapone
- Metyrosine
- Milnacipran
- Minocycline
- Mirtazapine
- Molindone
- Monoamine oxidase inhibitors
- Morphine
- Morphine; Naltrexone
- Nabilone
- Nalbuphine
- Nitroglycerin
- Olanzapine
- Oxybutynin
- Oxycodone
- Oxymorphone
- Paliperidone
- Papaverine
- Pemoline
- Pentazocine
- Pentazocine; Naloxone
- Pentobarbital
- Perampanel
- Phenobarbital
- Phenothiazines
- Phentermine; Topiramate
- Phenylephrine
- Phenylephrine; Promethazine
- Phenytoin
- Pimozide
- Pramipexole
- Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
- Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
- Pregabalin
- Primidone
- Probenecid
- Procarbazine
- Propofol
- Propoxyphene
- Pyrimethamine
- Pyrimethamine; Sulfadoxine
- Quetiapine
- Ramelteon
- Rasagiline
- Remifentanil
- Risperidone
- Ropinirole
- Rotigotine
- Safinamide
- Scopolamine
- Secobarbital
- Sedating H1-blockers
- Segesterone Acetate; Ethinyl Estradiol
- Sevoflurane
- Sincalide
- Skeletal Muscle Relaxants
- Sodium Oxybate
- Sufentanil
- Suvorexant
- Tapentadol
- Teduglutide
- Tetrabenazine
- Thalidomide
- Theophylline, Aminophylline
- Thiopental
- Thiothixene
- Tiagabine
- Tizanidine
- Topiramate
- Tramadol
- Trazodone
- Tricyclic antidepressants
- Trihexyphenidyl
- Trimethobenzamide
- Triprolidine
- Valerian, Valeriana officinalis
- Valproic Acid, Divalproex Sodium
- Vancomycin
- Vigabatrin
- Vilazodone
- Zaleplon
- Ziprasidone
- Zolpidem
