Lorazepam

Indications

Lorazepam is a benzodiazepine medicine used for the short-term relief of severe anxiety, for sleeplessness linked to anxiety, and to calm patients before surgery or medical procedures. In hospital, the injection is used to stop prolonged seizures (status epilepticus) and to manage severe agitation or alcohol withdrawal. It is a prescription-only controlled medicine.

How It Works

Lorazepam increases the effect of GABA, the brain main calming chemical messenger. This reduces over-activity of nerve cells, which relieves anxiety, causes sleepiness, relaxes muscles and stops seizures. It also causes some loss of memory for events shortly after a dose, which is useful before procedures.

Dosage and Administration

Take exactly as prescribed. The dose depends on the reason for use, age and response, and older or frail people need lower doses. Tablets are usually taken in divided doses through the day or at bedtime for sleep problems. It is normally used for the shortest possible time, usually no more than 2 to 4 weeks, because dependence can develop. The injection is given only by a doctor or nurse. Do not stop suddenly after regular use; your doctor will reduce the dose slowly.

Interactions

Opioid medicines such as Tramadol, Codeine or Morphine taken with Lorazepam can cause severe drowsiness, slowed breathing, coma and death; use together only when a doctor decides it is necessary. Alcohol, sleeping pills, antihistamines, antipsychotics, antidepressants and antiepileptics increase sleepiness. Valproate and Probenecid can raise Lorazepam levels. Clozapine used with it may cause severe low blood pressure and breathing problems.

Contraindications

• Allergy to Lorazepam or other benzodiazepines.
• Severe breathing problems, such as severe lung disease or sleep apnoea.
• Myasthenia gravis (a condition with severe muscle weakness).
• Severe liver failure.
• Acute narrow-angle glaucoma.

Side Effects

Common effects include drowsiness, tiredness, dizziness, unsteadiness, muscle weakness, slowed reactions, forgetfulness and confusion, especially in older people, who may also fall more easily. Some people feel low in mood. Rarely, people become restless, aggressive or excited instead of calm.

Get urgent medical help for very slow or shallow breathing, extreme sleepiness or difficulty waking, severe confusion, thoughts of self-harm, or an allergic reaction with swelling or breathing difficulty.

Pregnancy and Lactation

Avoid in pregnancy unless your doctor says it is essential. Use in early pregnancy may carry some risk, and use near delivery can cause floppiness, breathing problems and withdrawal symptoms in the newborn. It passes into breast milk and may make the baby sleepy; it is generally not recommended while breastfeeding.

Precautions and Warnings

• Dependence and withdrawal can occur, even at normal doses; misuse is dangerous.
• Do not drive or use machines if you feel drowsy.
• Avoid alcohol completely.
• Use with care in older people, those with lung, liver or kidney disease, depression or a history of drug or alcohol misuse.
• Stopping suddenly can cause anxiety, sleeplessness, shaking, sweating and even fits.

Overdose

Overdose causes deep sleepiness, confusion, poor coordination, slowed breathing and coma, and is more dangerous when combined with alcohol or Opioids. Get emergency medical help at once.

Therapeutic Class

Benzodiazepine; anxiolytic, sedative and anticonvulsant.

Storage

Store tablets below 30°C in a dry place, away from light and out of the reach of children. The injection is usually kept in a fridge at 2 to 8°C, protected from light; do not freeze.