Home Drug Guide Lorazepam

Drug Guide

Generic Name

Lorazepam

Brand Names Ativan, Loraz, Lorazepam Intensol, Lorazepam Preservative Free, Loreev Xr

Classification

Therapeutic: Anxiolytic, Sedative, Hypnotic, Anticonvulsant

Pharmacological: Benzodiazepine

FDA Approved Indications

Anxiety disorders
Insomnia due to anxiety or transient stress
Preoperative sedation
Status epilepticus

Mechanism of Action

Lorazepam enhances the effect of gamma-aminobutyric acid (GABA) at the GABA-A receptor, increasing neuronal inhibition and producing sedative, anxiolytic, anticonvulsant, and muscle-relaxant effects.

Dosage and Administration

Adult: Typically 2-4 mg orally, 2-3 times daily; IV doses for status epilepticus often 4 mg, repeated as necessary.

Pediatric: Dosing varies; generally 0.05-0.2 mg/kg orally, IV or IM dosing as per clinical guidelines.

Geriatric: Start at lower doses, usually 1-2 mg daily, titrate carefully considering increased sensitivity.

Renal Impairment: Use with caution; dose adjustments may be necessary due to decreased clearance.

Hepatic Impairment: Reduced dosage recommended, as metabolism may be impaired.

Pharmacokinetics

Absorption: Well absorbed orally with peak plasma concentrations in 2 hours.

Distribution: Widely distributed, crosses the blood-brain barrier, and is about 85% protein-bound.

Metabolism: Primarily hepatically metabolized via conjugation; minimal CYP450 involvement.

Excretion: Renal excretion of conjugated metabolites; a small amount of unchanged drug.

Half Life: Approx. 12-16 hours in healthy adults.

Contraindications

Hypersensitivity to benzodiazepines or such components.
Acute narrow-angle glaucoma.
Severe respiratory insufficiency.

Precautions

Use with caution in elderly, hepatic impairment, history of substance abuse, or depression. Avoid abrupt discontinuation to prevent withdrawal symptoms. Pregnancy category D: risks outweigh benefits; use only if clearly needed. Lactation: may pass into breast milk; weigh risks and benefits.

Adverse Reactions - Common

Drowsiness (Common)
Dizziness (Common)
Weakness (Common)

Adverse Reactions - Serious

Respiratory depression (Rare)
Anterograde amnesia (Uncommon)
Paradoxical reactions (e.g., agitation, aggressiveness) (Rare)
Dependence and withdrawal symptoms (Risk with long-term use)

Drug-Drug Interactions

CNS depressants (opioids, alcohol, other sedatives) increase sedative effects and risk of respiratory depression.
Cimetidine and ranitidine may increase lorazepam levels.
Other medications affecting hepatic enzymes may alter lorazepam metabolism.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for CNS depression, respiratory status, and signs of dependence.

Diagnoses:

Risk for injury due to sedation or impaired coordination.
Risk for dependence.

Implementation: Administer dose as prescribed, preferably at bedtime for sedative effect, monitor patient response, assess for signs of oversedation.

Evaluation: Efficacy in reducing anxiety or seizure activity; monitor for adverse effects.

Patient/Family Teaching

Advise against alcohol or other CNS depressants.
Warn about potential drowsiness and avoid driving or operating machinery.
Do not abruptly stop medication; taper under medical supervision.

Special Considerations

Black Box Warnings:

Risk of respiratory depression, especially when combined with other CNS depressants.
Risks of dependence, abuse, and withdrawal.

Genetic Factors: None specific reported.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Excessive sedation, respiratory depression, coma.

Treatment: Supportive care, airway management, oxygen, monitoring; flumazenil can be considered but with caution due to seizure risk.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended conditions; check expiration date.