Classes
DEA Class; Rx
Common Brand Names; Ativan, Loreev XR
- Antianxiety Agents;
- Anxiolytics, Benzodiazepines;
- Anticonvulsants, Benzodiazepine
Description
Oral and parenteral intermediate-acting benzodiazepine with no active metabolites
Approved for anxiety, status epilepticus, perioperative sedation or amnesia induction, and the short-term treatment of insomnia in adults; several off-label uses
Avoid coadministration with opioids if possible due to potential for profound sedation, respiratory depression, coma, and death
Indications
Indicated for management of anxiety disorders or for the short-term relief of symptoms of anxiety or anxiety associated with depressive symptoms
Anxiety or tension associated with stress of everyday life usually does not require treatment with an anxiolytic
Indicated for anxiety disorders in adults who are receiving stable, evenly divided, TID dosing with lorazepam tablets
Short-Term Treatment of Insomnia
Contraindications
Documented hypersensitivity
Acute narrow angle glaucoma
Intra-arterial administration
Severe respiratory depression
Sleep apnea
Use of injectable dosage form in premature infants (contains benzyl alcohol)
Adverse Effects
- Sedation
- Dizziness
- Unsteadiness
- Weakness
- Fatigue
- Drowsiness
- Amnesia
- Confusion
- Disorientation
- Depression
- Suicidal ideation/attempt
- Vertigo
- Ataxia
- Sleep apnea
- Asthenia
- Extrapyramidal symptoms
- Respiratory depression
- Tremor
- Convulsions/seizures
- Visual disturbances
- Dysarthria
- Hypotension
- Blood dyscrasias
- Change in libido
- Impotence
- Jaundice
- Increased bilirubin
- Increased liver transaminases
- Increase in ALP
- Hypersensitivity reactions
- Nausea
- Constipation
- Change in appetite
- Paradoxical reactions (anxiety, excitation, agitation, hostility, aggression, rage)
Warnings
Concomitant use of benzodiazepines, including lorazepam, and opioids may result in profound sedation, respiratory depression, coma, and death (see BBW)
Advise both patients and caregivers about the risks of respiratory depression and sedation when lorazepam is used with opioids; advise patients not to drive or operate heavy machinery until the effects of concomitant use with the opioid have been determined
Use of benzodiazepines, including lorazepam, both used alone and in combination with other CNS depressants, may lead to potentially fatal respiratory depression
Not recommended for use in patients with primary depressive disorder or psychosis
Injection contains benzyl alcohol associated with potentially fatal “gasping syndrome” in neonates and an increased incidence of kernicterus, particularly in small preterm infants; if patient requires more than recommended dosages or other medications containing this preservative, practitioner must consider daily metabolic load of benzyl alcohol from combined sources
Prolonged use may lead to physical and psychological dependence especially in patients with history of alcohol or drug abuse; risk of dependence is decreased with short-term treatment (eg, 2-4 weeks); evaluate need for continued treatment prior to extending therapy duration
Use of drug, particularly in patients at elevated risk, necessitates counseling about risks and proper use of drug along with monitoring for signs and symptoms of abuse, misuse, and addiction; do not exceed recommended dosing frequency
Pregnancy and Lactation
Pregnancy category: D
Lactation: Excreted in human breast milk; not recommended
Maximum Dosage
10 mg/day PO; maximum IM and IV dose highly variable dependent upon indication.
10 mg/day PO; maximum IM and IV dose highly variable depending upon indication.
Up to 10 mg/day PO for anxiety disorders; 4 mg/day PO for insomnia. Safety and efficacy of extended-release capsules and parenteral lorazepam have not been established. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response.
12 years: Up to 10 mg/day PO for anxiety disorders; 4 mg/day PO for insomnia. Safety and efficacy of extended-release capsules and parenteral lorazepam have not been established. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response.
1 to 11 years: Safety and efficacy have not been established. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response.
Safety and efficacy have not been established. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response.
Safety and efficacy have not been established. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response.
How supplied
Lorazepam
tablet: Schedule IV
0.5mg
1mg
2mg
capsule, extended-release: Schedule IV
1mg
2mg
3mg
oral concentrate: Schedule IV
2mg/mL
injectable solution: Schedule IV
2mg/mL
4mg/mL
