Lorazepam

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

  1. agitation
  2. alcohol withdrawal
  3. amnesia induction
  4. anxiety
  5. chemotherapy-induced nausea/vomiting prophylaxis
  6. insomnia
  7. procedural sedation
  8. sedation induction
  9. sedation maintenance
  10. seizure prophylaxis
  11. status epilepticus

For the short-term management of anxiety

Side Effects

  1. agitation
  2. agranulocytosis
  3. alopecia
  4. amnesia
  5. anaphylactoid reactions
  6. anxiety
  7. apnea
  8. asthenia
  9. ataxia
  10. AV block
  11. blurred vision
  12. bradycardia
  13. cardiac arrest
  14. chills
  15. coagulopathy
  16. coma
  17. confusion
  18. constipation
  19. cystitis
  20. delirium
  21. depression
  22. diarrhea
  23. diplopia
  24. dizziness
  25. drowsiness
  26. dysarthria
  27. elevated hepatic enzymes
  28. erythema
  29. euphoria
  30. fatigue
  31. GI bleeding
  32. hallucinations
  33. headache
  34. hearing loss
  35. heart failure
  36. hostility
  37. hyperactivity
  38. hyperbilirubinemia
  39. hyperreflexia
  40. hypersalivation
  41. hypertension
  42. hyperventilation
  43. hyponatremia
  44. hypotension
  45. hypothermia
  46. hypoventilation
  47. hypoxia
  48. impotence (erectile dysfunction)
  49. infection
  50. injection site reaction
  51. insomnia
  52. irritability
  53. jaundice
  54. lactic acidosis
  55. mania
  56. memory impairment
  57. metabolic acidosis
  58. muscle paralysis
  59. myoclonia
  60. nausea
  61. neuroleptic malignant syndrome-like symptoms
  62. nightmares
  63. orgasm dysfunction
  64. pancytopenia
  65. pericardial effusion
  66. physiological dependence
  67. pneumothorax
  68. psychological dependence
  69. psychosis
  70. pulmonary edema
  71. pulmonary hypertension
  72. rash
  73. renal tubular necrosis
  74. respiratory arrest
  75. respiratory depression
  76. restlessness
  77. seizures
  78. SIADH
  79. sinus tachycardia
  80. suicidal ideation
  81. teratogenesis
  82. thrombocytopenia
  83. tolerance
  84. tremor
  85. urinary incontinence
  86. vertigo
  87. vomiting
  88. weakness
  89. 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
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