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How often to take ativan


Lorazepam: medicine to treat anxiety and problems sleeping

1. About lorazepam

Lorazepam belongs to a group of medicines called benzodiazepines.

It's used to treat anxiety and sleeping problems that are related to anxiety.

It can be taken to help you relax before an operation or other medical or dental treatment. This is known as a "pre-med".

Lorazepam is available on prescription only. It comes as tablets and as a liquid that you swallow.

It can also be given as an injection in hospital if you're having a seizure or fit.

It's also known by the brand name Ativan.

2. Key facts

  • Lorazepam tablets and liquid start to work in around 20 to 30 minutes. The full sedating effect lasts for around 6 to 8 hours.
  • The most common side effect is feeling sleepy (drowsy) during the daytime.
  • It's not recommended to use lorazepam for longer than 4 weeks.
  • If lorazepam makes you feel sleepy, do not drive, ride a bike or use tools or machinery.
  • Do not drink alcohol while taking lorazepam. It can make you sleep very deeply.

3. Who can and cannot take lorazepam

Lorazepam can be taken by adults and children aged 13 years and older for anxiety.

It can also be taken by adults and children aged 5 years or older as a "pre-med".

Lorazepam is not suitable for everyone.

To make sure it's safe for you, tell a doctor before starting lorazepam if you:

  • have had an allergic reaction to lorazepam or any other medicine in the past
  • have liver or kidney problems
  • have breathing or chest problems
  • have myasthenia gravis, a condition that causes muscle weakness
  • have sleep apnoea, a condition that causes breathing problems when you're asleep
  • have (or have had) depression or thoughts of harming yourself
  • have been diagnosed with personality disorder
  • have (or have had) problems with alcohol or drugs
  • have arteriosclerosis, a condition that affects blood flow
  • are trying to get pregnant, are already pregnant or breastfeeding
  • have glaucoma, a condition that causes high blood pressure in the eye
  • are going to have a general anaesthetic for an operation or dental treatment

4.

How and when to take it

Always take lorazepam exactly as a doctor or pharmacist has told you.

Lorazepam tablets come as 0.5mg, 1mg and 2.5mg tablets. The liquid contains 1mg of lorazepam in each 1ml.

The usual dose for:

  • anxiety – 1mg to 4mg each day; your doctor will tell you how often you need to take it
  • sleep problems – 1mg to 2mg before bedtime (lorazepam will start to work in around 20 to 30 minutes)
  • a pre-med for adults – 2mg to 3mg the night before the procedure and then 2mg to 4mg about 1 to 2 hours before your procedure
  • a pre-med for children aged 1 month to 11 years – dose will depend on the child's weight
  • a pre-med for children aged 12 to 17 years and up – 1mg to 4mg the night before the procedure and/or at least 1 hour before the procedure

If you're older than 65 years or have liver or kidney problems, a doctor may recommend a lower dose.

Will my dose go up or down?

Lorazepam is usually prescribed for a short time, from a few days to 4 weeks. Your dose may go up or down until your doctor is happy you're on the right dose.

Your doctor may gradually reduce your dose at the end of the course of treatment before stopping completely.

What if I forget to take it?

If you forget to take your lorazepam:

  • for anxiety – if it's less than 3 hours since your missed dose, take it as soon as you remember. If more than 3 hours have passed, skip the missed dose.
  • for sleep problems – leave out the missed dose if you have not taken it by bedtime. Take you usual dose the next night.
  • before an operation or procedure (pre-med) – read any information you were given by the hospital about your procedure, which may have advice about missed doses. If it does not, call the hospital to ask what to do next.

If you forget to take lorazepam, never take a double dose to make up for a forgotten tablet.

What if I take too much?

Urgent advice: Contact 111 for advice if:

  • you take too much lorazepam

Go to 111.nhs.uk or call 111

If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the lorazepam packet or leaflet inside it, plus any remaining medicine, with you.

5. Side effects

Like all medicines, lorazepam can cause side effects in some people, but many people have no side effects or only minor ones.

Common side effects

These common side effects happen to more than 1 in 100 people.

If you get these side effects, keep taking the medicine and speak to a doctor:

  • feeling sleepy or very tired in the daytime
  • muscle weakness
  • problems with your coordination or controlling your movements

Serious side effects

It happens rarely in less than 1 in 1000 people, but some people have serious side effects when taking lorazepam.

Tell a doctor straightaway if:

  • your breathing becomes very slow or shallow
  • your skin or the whites of your eyes turn yellow; this could be a sign of liver problems
  • you find it difficult to remember things (amnesia)
  • you see or hear things that are not there (hallucinations)
  • you think things that are not true (delusions)
  • you keep falling over
  • you notice mood changes such as talking too much, feeling overexcited, restless, irritable or aggressive

Mood changes can become serious and are more likely in children or if you're over 65.

Serious allergic reaction

In rare cases, lorazepam may cause a serious allergic reaction (anaphylaxis)

Immediate action required: Call 999 or go to A&E now if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital

These are not all the side effects of lorazepam. For a full list, see the leaflet inside your medicine packet.

Information:

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects

What to do about:

  • feeling sleepy, or unusually tired in the daytime – do not drive, ride a bike or use tools or machinery until you feel better. Do not drink any alcohol as this will make you feel worse. This side effect should get better as your body gets used to the medicine. If your symptoms do not improve after a week or get worse, speak to a doctor as you may need a lower dose.
  • muscle weakness – if you get unusual muscle weakness, which is not from exercise or hard work, talk to a doctor. You may need a blood test to find the cause.
  • problems with your coordination or controlling your movements – if your symptoms do not improve after a week or get worse, speak to a doctor as you may need a lower dose.

7. Pregnancy and breastfeeding

There's not enough information to know if lorazepam is safe to use in pregnancy. It might mean your baby is born with withdrawal symptoms.

If you become pregnant while taking lorazepam, speak to a doctor.

Your doctor can explain the risks and the benefits of taking lorazepam and will help you choose the best treatment for you and your baby.

You may need to keep taking lorazepam during pregnancy as it's important for you to remain well.

Lorazepam and breastfeeding

If a doctor or health visitor says your baby is healthy, you can use lorazepam during breastfeeding. It's recommended that you only take a low dose occasionally or for a very short time.

Lorazepam passes into breast milk in small amounts.

If you're breastfeeding or want to breastfeed, talk to a doctor or pharmacist, as there might be better medicines for you. It will depend on what you're taking lorazepam for.

If you notice that your baby is not feeding as well as usual, seems unusually sleepy, has unusual breathing, or if you have any other concerns, talk to a health visitor or doctor as soon as possible.

Non-urgent advice: Talk to a doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

8. Cautions with other medicines

Some medicines interfere with the way lorazepam works and increase the chances of you having side effects.

Speak to a doctor or pharmacist before starting lorazepam if you take any of the following:

  • antidepressants and antipsychotics used to treat mental health problems
  • anticonvulsants used to treat epilepsy
  • hypnotics used to treat anxiety or sleep problems
  • drowsy or sedating antihistamines, such as chlorphenamine or promethazine
  • strong painkillers, such as codeine, methadone, morphine, oxycodone, pethidine or tramadol
  • HIV medicines, such as ritonavir, atazanavir, efavirenz or saquinavir
  • rifampicin, a medicine for bacterial infections or antifungal medicines, such as fluconazole
  • proton pump inhibitors (PPIs) – medicines for reducing stomach acid, such as omeprazole or esomeprazole
  • muscle relaxants, such as baclofen and tizanidine
  • disulfiram, a medicine for alcohol addiction
  • isoniazid, a medicine for tuberculosis
  • theophylline, a medicine for asthma and other breathing problems

Mixing lorazepam with herbal remedies or supplements

There's very little information about taking herbal remedies and supplements with lorazepam.

Do not take herbal medicines for anxiety or insomnia, such as valerian or passionflower, with lorazepam. They can increase the drowsy effects of lorazepam and may also have other side effects.

Important

For safety, tell a doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions

How does lorazepam work?

Lorazepam belongs to a group of medicines called benzodiazepines.

It works by increasing the levels of a calming chemical, gamma-amino-butyric-acid (GABA), in your brain.

Depending on your health condition, this can make you feel calmer, relieve anxiety or stop a seizure or fit.

How will it make me feel?

Lorazepam will help you feel calmer and it can help reduce your feelings of anxiety.

It can also make you feel sleepy if you're having trouble falling asleep.

How long does it take to work?

Lorazepam tablets and liquid start to work in around 20 to 30 minutes. It reaches full sedating effect after 1 to 1.5 hours and lasts for around 6 to 8 hours.

A lorazepam injection works much faster but also lasts around 6 to 8 hours.

How long will I take it for?

How long you take lorazepam for depends on why you're taking it:

  • anxiety and sleep problems – it's usually only recommended for up to 4 weeks. Your dose may be reduced gradually to prevent withdrawal symptoms.
  • before an operation or procedure – you will usually only need 2 doses.

If you're having a seizure or fit, you'll only be given a lorazepam injection while you're in hospital.

If a doctor prescribes lorazepam for more than 4 weeks, they'll tell you how long to take it for.

Will I become addicted to lorazepam?

Lorazepam is not likely to be addictive if you take it at a low dose for a short time (2 to 4 weeks).

You're more likely to become addicted if you have, or have previously had, problems with alcohol or drugs.

Speak to a doctor if you've had problems with alcohol or recreational drugs. They may want to try you on a different medicine.

What happens when I want to stop taking lorazepam?

If a doctor recommends you stop taking lorazepam, they will reduce your dose gradually. This will be done by reducing the number of tablets you take and how often you take them.

This allows your body to get used to being without the medicine and reduces the chance of side effects when you stop taking it.

This is important if you have been taking a high dose or a doctor has prescribed it for more than 4 weeks.

If you stop taking lorazepam suddenly, you may get side effects, such as:

  • confusion
  • having a seizure or fit
  • depression
  • feeling nervous or irritable
  • sweating
  • diarrhoea

If you get any of these side effects, speak to a doctor.

Important

Do not stop taking lorazepam without talking to a doctor.

Are there other treatments I can try?

For anxiety, depending on your symptoms, you may need a medicine to treat your physical symptoms as well as your psychological ones.

Your doctor will usually start you on a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), such as sertraline, paroxetine or escitalopram.

There are also different types of talking therapies for anxiety, including cognitive behavioural therapy (CBT) and counselling.

For sleep, your doctor will discuss your condition with you and help you decide which medicine is best for you.

Can I drink alcohol with it?

Do not drink alcohol while you're taking lorazepam. Alcohol can increase the effects of lorazepam.

It can make you go into a very deep sleep. There's a risk you will not be able to breathe properly, and may have difficulty waking up.

Will recreational drugs affect it?

Using cannabis, heroin or methadone with lorazepam will increase the drowsy effects of lorazepam.

It can make you go into a very deep sleep. There's a risk you will not be able to breathe properly, and you may have difficulty waking up.

Using cocaine or other stimulants such as MDMA (ecstasy) and amphetamines with lorazepam can also lead to drowsiness.

Talk to a doctor if you think you might use recreational drugs while taking lorazepam.

Are there any foods and drink I need to avoid?

It's a good idea to avoid grapefruit or grapefruit juice while taking lorazepam. Grapefruit juice may increase the amount of lorazepam in your blood.

It's best to not have drinks such as coffee, tea and cola, or to eat a lot of chocolate because these contain caffeine. Caffeine is a stimulant and may reduce the calming effects of lorazepam.

Alcohol can increase the effects of lorazepam and make you go into a very deep sleep. It's important not to drink alcohol while you're taking lorazepam. There's a risk you will not be able to breathe properly, and you may have difficulty waking up.

Will it affect my contraception?

Lorazepam will not affect any contraception, including the combined pill and emergency contraception.

Some contraceptives may make lorazepam less effective. Talk to a doctor if you're taking a contraceptive and you think your lorazepam is not working very well.

Will it affect my fertility?

There's no evidence that lorazepam will affect fertility in either men or women.

Can I drive or ride a bike?

Do not drive a car or ride a bike if lorazepam makes you sleepy, gives you blurred vision, or makes you feel dizzy, clumsy or unable to concentrate or make decisions.

This may be more likely when you first start taking lorazepam, but could happen at any time (for example, when starting another medicine).

It's an offence to drive a car if your ability to drive safely is affected.

It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.

Even if your ability to drive is not affected, the police have the right to request a saliva sample to check how much lorazepam is in your body.

GOV.UK has more information on the law on drugs and driving.

Talk to a doctor or pharmacist if you're unsure whether it's safe for you to drive while taking lorazepam.

Can lifestyle changes help with anxiety or insomnia?

If you have anxiety, lifestyle changes you can make to help ease your symptoms include:

  • read a book or take an online course about anxiety
  • consider a talking therapy for anxiety, such as cognitive behavioural therapy (CBT) or counselling
  • exercise regularly
  • learn to relax
  • avoid caffeine
  • avoid smoking and alcohol
  • contact support groups run by charities such as Anxiety UK, Mind and Rethink Mental Illness

If you're having trouble sleeping, things you can do to help yourself get better sleep include:

  • set regular times for going to bed and waking up
  • relax before bedtime, such as listening to some calming music
  • use thick curtains or blinds, an eye mask and earplugs to stop you being woken up by light and noise
  • avoid caffeine, cigarettes (including e-cigarettes), alcohol, heavy meals and exercise for a few hours before going to bed
  • do not watch TV or use phones, tablets or computers just before going to bed
  • do not nap during the day
  • write a list of your worries, and any ideas about how to solve them, before you go to bed to help you forget about them until the morning

Forms, strengths, for sleep, and more

Ativan (lorazepam) is a prescription brand-name medication. The Food and Drug Administration (FDA) has approved it to:

  • treat sleep problems caused by anxiety or stress
  • treat certain seizures
  • treat anxiety
  • make you fall asleep before surgery

Ativan contains the active drug lorazepam and belongs to a drug class called benzodiazepines. Lorazepam is also the name of the generic form of Ativan.

Ativan comes as oral tablets and injections.

For information about the dosage of Ativan, including its forms, strengths, and how to take the medication, keep reading. For a comprehensive look at Ativan, see this article.

This article describes typical dosages for Ativan provided by the drug’s manufacturer. When taking Ativan, always follow the dosage prescribed by your doctor.

If your doctor prescribes Ativan, you may have questions about the drug’s dosage, such as:

  • What’s Ativan’s dosage range?
  • What are the usual dosage amounts of Ativan?
  • What’s considered a safe dose of Ativan?

Below is a basic dosage chart for Ativan (“mg” refers to milligrams).

Usual dosage rangeSafe dosage
2 mg to 6 mg total, divided into two or three dosesUp to 10 mg total per day

Ativan forms and strengths

Ativan comes as oral tablets and a vial that contains a liquid solution. The solution is given as an intravenous (IV) injection or intramuscular (IM) injection.

Here are the strengths for each form of Ativan:

  • Oral tablets: 0.5 mg, 1 mg, 2 mg
  • Liquid solution for injection: 2 mg per 1 milliliter (mL) of liquid solution (2 mg/mL), 4 mg/mL

Typical dosages

Depending on what you’re taking Ativan to treat and the dosage form your doctor prescribes, they may start you on a low dosage. Then they may adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly taken or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Dosage for sleep problems caused by anxiety or stress

To treat sleep problems caused by anxiety or stress, your doctor will prescribe Ativan tablets. The dosage range for this use is 2 mg to 4 mg once per day, taken at bedtime.

Dosage for certain seizures

To treat certain seizures, a healthcare professional will typically give you Ativan as an IV injection. In some cases, they may give you an IM injection.

The usual dosage is 4 mg given slowly (about 2 minutes). If the seizures continue after 10 to 15 minutes, you may be given another 4-mg dose.

Dosage for anxiety

To treat anxiety, your doctor will prescribe Ativan tablets. The dosage range for this use is 1 mg to 10 mg, which is usually split into two or three doses per day.

The typical dose is 2 mg to 6 mg, divided into two or three doses per day. For example, if your daily dosage is 4 mg, you would take 2 mg once in the morning and once in the evening.

Dosage for surgery

To make you sleep before surgery, a healthcare professional will typically give you an IM injection of Ativan.

For this use, Ativan is dosed based on body weight. You’ll likely receive an IM injection of 0.05 mg per kilogram (kg) of body weight, up to a maximum dose of 4 mg. (One kilogram equals about 2.2 pounds.)

Ativan may also be given by IV injection to make you sleep before surgery. The recommended dose for this use is either 2 mg or 0.02 mg per pound (0.044 mg/kg) of body weight, whichever is smaller.

The healthcare professional will determine what dose is right for you.

Long-term use

Using Ativan for more than 4 months in a row hasn’t been studied. Ativan is not meant to be taken as a long-term treatment. Your doctor will typically check from time to time whether you still need to take Ativan.

Children’s dosage

Ativan is not approved for children to take. The drug has not proven to be safe and effective to treat conditions in this group.

The maximum dose of Ativan in 24 hours is 10 milligrams (mg). This dose is typically taken for conditions that are treated with Ativan tablets, such as anxiety.

The 10-mg maximum dose is usually divided into two or three doses. For example, you may take 2 mg in the morning, 2 mg in the afternoon, and 6 mg before bed.

For making you sleep before surgery, the maximum dose of Ativan is 4 mg.

For more information about Ativan dosages, including what’s a safe dose of Ativan, see the “Ativan dosage” section just above.

Below are answers to some frequently asked questions about Ativan dosages.

What’s considered a ‘normal’ dosage of Ativan?

The “normal” (usual) dosage of Ativan is 2 milligrams (mg) to 6 mg total, divided into two or three doses. For example, to treat anxiety, you may take Ativan tablets at a dosage of 2 mg twice per day, for a total daily dosage of 4 mg.

For more information about Ativan dosages, including what’s a safe dose of Ativan, see the “Ativan dosage” section above. You can also speak with your doctor or pharmacist.

What’s the Ativan dosage for panic and anxiety attacks?

Ativan is not approved to treat panic or anxiety attacks. But the drug may be prescribed off-label for this use. Off-label use is when a drug is prescribed to treat a condition it isn’t approved to treat.

To learn more about using Ativan for panic or anxiety attacks and what the dosage would be, talk with your doctor or pharmacist.

Is Ativan used for dogs? If so, what’s the dosage for dogs?

Ativan is not approved for use in dogs, but your veterinarian might recommend Ativan for your dog in some situations. Ativan may be used in dogs to help reduce anxiety or stress, to sedate your dog during a surgery, or to treat seizures.

Do not give your dog Ativan unless your veterinarian recommends this. Your veterinarian can recommend whether this drug is safe for your dog and what dosage your dog might need. If you think your pet has eaten your Ativan medication, contact your veterinarian right away.

The Ativan dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of the condition you’re using Ativan to treat
  • the form of Ativan you take
  • your age
  • your body weight, depending on the form of the drug and what it’s treating

Other medical conditions you have can also affect your Ativan dosage.

Dosage adjustments

If you’re an older adult, you may need a lower dose of Ativan than usual. This is because Ativan affects your body differently as you age.

You may also need a dosage adjustment if you have kidney or liver problems. Your doctor will typically decrease your dose based on the severity of your liver or kidney condition.

Your doctor or pharmacist can tell you more about Ativan dosage adjustments.

How you take Ativan depends on the form of the drug you’re prescribed.

One form is oral tablets that you swallow. You can take them with or without food.

Ativan’s other form is a liquid solution that’s given as an intravenous (IV) injection or intramuscular injection. A healthcare professional will give you Ativan injections.

Be sure to take Ativan exactly as your doctor prescribes. You should not take more or less Ativan than prescribed without first speaking with them.

If you miss a dose of Ativan, take it as soon as you remember. But if it’s almost time for your next dose, skip the missed dose. Then take your next dose at your regular scheduled time.

You should not take more than one dose to try and make up for the missed dose. This can increase your risk for side effects from Ativan. (For more about Ativan’s side effects, see this article.)

To help make sure that you do not miss a dose, try using a medication reminder. This can include setting an alarm or timer on your phone or downloading a reminder app. A kitchen timer can work, too.

Ativan has a boxed warning regarding misuse and addiction. A boxed warning is the most serious warning given to a medication by the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

Taking Ativan can lead to misuse and addiction, even when you take an approved dosage. Misusing Ativan can cause serious side effects such as trouble breathing or coma. This risk increases if you take Ativan with certain other drugs or substances, including alcohol. Although rare, misusing Ativan can be fatal.

Misusing Ativan can also increase your risk for overdose. (To learn more, see the “Ativan and overdose” section below.

Because of the risk for misuse, Ativan is a controlled substance. This means its use is regulated by the government to prevent possible misuse. You should not share your Ativan prescription with anyone else. Be sure to take Ativan exactly as your doctor prescribes.

Also, it’s recommended that you store Ativan in a safe place, away from children.

If you take more Ativan than your doctor prescribes, you may develop serious side effects.

It’s important that you do not take more Ativan than your doctor advises.

Symptoms of an overdose

Overdose symptoms of Ativan can include:

  • confusion
  • drowsiness
  • low blood pressure
  • problems with coordination or balance
  • slowed reflexes
  • coma
  • in rare cases, death

If you take more than the recommended amount of Ativan

Call your doctor right away if you believe you’ve taken too much Ativan. Another option is to call the American Association of Poison Control Centers at 800-222-1222 or use its online tool. If you have severe symptoms, immediately call 911 or your local emergency number, or go to the nearest emergency room.

Ativan has a boxed warning regarding physical dependence and withdrawal. A boxed warning is the most serious warning given to a medication by the Food and Drug Administration. It alerts doctors and patients about drug effects that may be dangerous.

Using Ativan can lead to physical dependence. This could lead to withdrawal if you suddenly stop taking the drug, even if you take an approved dosage.

You should not suddenly stop taking Ativan. Doing so could cause serious or, rarely, life-threatening side effects that can include:

  • seizures
  • unusual movements, expressions, or responses
  • depression
  • hallucinations (seeing or hearing things that aren’t there)
  • losing touch with reality

In some people, withdrawal symptoms from benzodiazepines such as Ativan can cause symptoms that last for up to 12 months, such as:

  • anxiety
  • trouble remembering or concentrating
  • depression
  • trouble sleeping
  • feeling like insects are crawling under your skin
  • muscle weakness or twitching
  • tinnitus (ringing in your ears)

Instead of suddenly stopping Ativan treatment, your doctor will help you with a drug taper. This involves gradually lowering the dosage of the medication over time. A drug taper can help decrease your risk for withdrawal symptoms or make them less severe.

If you’re interested in stopping treatment with Ativan, be sure to talk with your doctor first. You should not suddenly stop taking the drug on your own.

The dosages in this article are typical dosages provided by the drug manufacturer. If your doctor recommends Ativan for you, they will prescribe the dosage that’s right for you. Always follow the dosage that your doctor prescribes for you.

As with any drug, never change your dosage of Ativan without your doctor’s recommendation. If you have questions about the dosage of Ativan that’s right for you, talk with your doctor.

Besides learning about dosage, you may want other information about Ativan. These additional articles might be helpful:

  • More about Ativan. For information about other aspects of Ativan, refer to this article.
  • Drug comparison. To find out how Ativan compares with Xanax, read this article.
  • Side effects. To learn about side effects of Ativan, see this article. You can also look at the prescribing information for Ativan tablets and solution.
  • Interactions. For details about what Ativan interacts with, see this article.
  • Details about your condition. For details about sleep problems, refer to our sleep hub and list of sleep articles. For more information about mental health and anxiety, see our mental health hub and list of anxiety articles. To learn more about the other conditions Ativan is prescribed for, talk with your doctor.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Arpimed

Tell your doctor if you are taking, have recently taken or might take any other medicines. It is especially important to note the following drugs:

If necessary, your doctor will reduce the dose of these drugs before you use lorazepam.

Avoid alcohol while taking lorazepam as this may increase the sedative properties of the drug.

Tell your doctor or pharmacist if you are taking Lorazepam before using any other medicines or when you are hospitalized.

Some elderly patients may experience dizziness and fainting after taking Lorazepam.

When taking Lorazepam, there is a risk of developing addiction, which can lead to a gradual decrease in effectiveness after several weeks of taking Lorazepam.

Lorazepam has the potential to develop dependence, particularly in patients with a history of alcohol and/or recreational drug abuse.

With the usual regimen of lorazepam, the development of dependence is unlikely, but the risk increases with increasing dose and duration of treatment, as well as in patients with a history of alcohol and / or recreational drug abuse, or in patients with a personality disorder. Therefore, lorazepam should be avoided in patients with a history of alcohol and/or recreational drug abuse.

Dependence can lead to the development of a withdrawal syndrome, especially when treatment is stopped abruptly. Therefore, it is necessary to cancel the drug gradually.

When taking lorazepam for more than 4 weeks, your doctor should conduct a study of the peripheral blood picture, as well as a biochemical blood test for liver markers, since drugs in this group can lead to impaired liver function.

Long-term use of Lorazepam may lead to the development of drug dependence. Therefore, Lorazepam is usually prescribed in short courses lasting from several days to 4 weeks, including a period of dose reduction and drug withdrawal. This reduces the risk of developing drug dependence or adverse side effects observed when the drug is discontinued. (See section "Cancellation of Lorazepam").

The dose of Lorazepam should be increased gradually to avoid side effects.

How to take Lorazepam

Lorazepam should be taken exactly as prescribed by your doctor. If you have any doubts, then you should consult with your doctor.

When Lorazepam is used to treat anxiety and insomnia, treatment usually lasts from a few days to 4 weeks, including a period of dose reduction and drug withdrawal.

The physician should prescribe the lowest effective dose, calculated for the shortest possible period of taking the drug.

Lorazepam tablets should be swallowed with water.

Adults and children over 13 years of age

For anxiety, the daily dose of Lorazepam is 1-4 mg taken in divided doses. Your healthcare provider will determine how often you should take Lorazepam. It is not recommended to take Lorazepam to children under 12 years of age with anxiety.

For sleep disturbances, 1-2 mg Lorazepam at bedtime is prescribed. Before taking the drug, you must be sure that you can sleep for 7-8 hours.

Lorazepam 2-3 mg is given the night before surgery and 2-4 mg 1-2 hours before surgery.

Children 5 to 13 years old

For surgery, the dose is usually 0.5-2.5 mg (depending on your child's weight) taken one hour before the procedure.

Lorazepam is not recommended for use in children 5 to 13 years of age for the treatment of anxiety and sleep disorders, and in children under 5 years of age.

Elderly

The physician should prescribe lorazepam to elderly or malnourished patients at low doses.

The drug may be effective at half or even less than the recommended dose in elderly patients, but if necessary, the dose should be adjusted.

Patients with renal and hepatic insufficiency

In case of impaired renal function or mild to moderate hepatic insufficiency, Lorazepam is allowed to be taken only in low doses.

Lorazepam is contraindicated in patients with severe hepatic impairment.

If you forget to take Lorazepam

If you forget to take Lorazepam to treat anxiety and if less than 3 hours have passed from your scheduled appointment time, you should take it as soon as you remember. If more than 3 hours have passed from the appointed time, do not worry, take the next dose at the appointed time. Do not take a double dose to make up for a missed one.

If you forget to take Lorazepam to treat a sleep disorder, take it if you are sure you can sleep for 7-8 hours after taking the drug.

If you have taken more Lorazepam than recommended

If you have taken more Lorazepam than prescribed by your doctor, get medical help right away, call your doctor or go to the nearest hospital. Take the medicine package with you, even if there are no pills left.

Stopping Lorazepam

After completing the prescribed course of treatment, your doctor will decide whether to continue further treatment.

The dose and frequency of lorazepam should be reduced gradually until the drug is discontinued. This allows your body to adjust to the absence of Lorazepam and reduce the risk of adverse effects when the drug is discontinued. Your doctor will explain to you how to do this.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

Withdrawal

Abrupt discontinuation of Lorazepam may result in withdrawal symptoms such as headaches, muscle pain, anxiety, tension, depression, restlessness, dizziness, nausea, diarrhea, loss of appetite, irritability, confusion, confusion agitation, tremors, abdominal pain, heart rhythm disturbances, short-term memory loss, fever, and sweating. Possible relapse of insomnia. If you have any of these symptoms, contact your doctor.

Do not stop taking Lorazepam suddenly. This can lead to more severe withdrawal symptoms such as loss of sense of reality, feelings of unreality or detachment from everyday life, loss of the ability to feel emotions.

Some patients experience numbness or tingling of the hands or feet, vomiting, ringing in the ears, muscle twitches, hallucinations, seizures, and hypersensitivity to light, sound, and touch. If you have any of these symptoms, contact your doctor immediately.

Lorazepam - description of the substance, pharmacology, use, contraindications, formula

Contents

  • Russian name
  • English name
  • Latin name of the substance Lorazepam
  • Chemical name
  • Gross formula
  • Pharmacological group of the substance Lorazepam
  • Nosological classification
  • CAS code
  • Pharmacological action
  • Characteristic
  • Pharmacology
  • Use of the substance Lorazepam
  • Contraindications
  • Restrictions for use
  • Use in pregnancy and lactation
  • Side effects of the substance Lorazepam
  • Interaction
  • Overdose
  • Dosage and administration
  • Precautions
  • Special instructions
  • Trade names with the active substance Lorazepam

Structural formula

Russian name

Lorazepam

English name

Lorazepam

Latin name of the substance Lorazepam

Lorazepamum ( genus Lorazepami)

Chemical name

7-Chloro-5-(2-chlorophenyl)-1,3-dihydro-3-hydroxy-2H-1,4-benzodiazepin-2-one

Generic formula

C 15 H 10 Cl 2 N 2 O 2

Pharmacological group of the substance Lorazepam 9002

Anxiolytics

Nosological classification

ICD-10 code list

  • R45. 1 Anxiety and agitation
  • F51.0 Insomnia of non-organic etiology
  • G47.0 Disorders of falling asleep and maintaining sleep [insomnia]
  • F10.5 Alcoholic psychosis
  • F91 Conduct disorders
  • F30 Manic Episode
  • F42 Obsessive-compulsive disorder
  • F25 Schizoaffective disorders
  • F41.0 Panic disorder [episodic paroxysmal anxiety]
  • Z100* CLASS XXII Surgical practice
  • F60 Specific personality disorders
  • G44. 2 Tension headache type
  • R45.0 Nervousness
  • R45.7 State of emotional shock and stress, unspecified
  • F32 Depressive episode
  • F43.1 Post-traumatic stress disorder
  • F40.0 Agoraphobia
  • F43.2 Adjustment disorder
  • F34.1 Dysthymia
  • F41.1 Generalized anxiety disorder
  • F43.0 Acute stress reaction
  • G40 Epilepsy
  • F10.3 Withdrawal state

CAS code

846-49-1

Pharmacological action

Pharmacological action - anxiolytic , muscle relaxant , anticonvulsant , sedative , hypnotic , central .

Characteristics

Anxiolytic, benzodiazepine derivative.

Almost white powder, very slightly soluble in water.

Pharmacology

Interacts with specific benzodiazepine receptors of the GABA-benzodiazepine receptor complex, increases the sensitivity of GABA receptors to GABA. As a result, the frequency of opening of transmembrane channels for chloride ions increases, the postsynaptic membrane of the neuron is hyperpolarized, neuronal activity is inhibited, and interneuronal transmission to the CNS is inhibited. The effects are due to the influence on various parts of the central nervous system: the amygdala complex of the limbic system (anxiolytic), the reticular formation of the brain stem and nonspecific nuclei of the thalamus, hypothalamus (sedative and hypnotic), spinal cord (muscle relaxant), hippocampus (anticonvulsant). It reduces the excitability of subcortical formations (limbic system, thalamus, hypothalamus) responsible for the implementation of emotional reactions, and inhibits the interaction of these structures with the cerebral cortex. Stabilizes vegetative functions.

Suppresses anxiety, fear, reduces psychomotor agitation, emotional stress. It has anti-panic and amnestic (mainly for parenteral use) action. It is effective for insomnia caused by anxiety or a short-term stressful situation: it facilitates the onset of sleep (shortens the period of falling asleep), reduces the number of night awakenings, and increases the duration of sleep. It inhibits polysynaptic spinal reflexes and lowers the tone of skeletal muscles.

Lorazepam has low toxicity and wide therapeutic range.

An animal reproduction study showed that administration of lorazepam at doses of 40 mg/kg orally and 4 mg/kg or more IV to rabbits resulted in fetal resorption and an increased incidence of fetal death. Causes developmental anomalies in rabbits, regardless of dose. In an 18-month study in rats, no carcinogenic activity was found.

Good but slowly absorbed from the gastrointestinal tract when taken orally, bioavailability is 90%. max "> C max is achieved within 2 hours and is dose dependent: at a dose of 2 mg max"> C max is 20 ng / ml. About 85% binds to plasma proteins. The equilibrium concentration in the blood is usually reached after 2-3 days. Passes through the BBB and the placental barrier. It is rapidly metabolized in the liver by conjugation to form the main inactive metabolite, lorazepam glucuronide. 1/2 "> T 1/2 unconjugated lorazepam - about 12 hours, the main metabolite - 18 hours. Excreted mainly by the kidneys, mainly in the form of glucuronide.

When administered intramuscularly, max "> C max is achieved in 60-90 minutes. 1/2"> T 1/2 when administered parenterally is 16 hours. When used for 6 months, no cumulation phenomena are observed. The pharmacokinetic parameters of lorazepam do not change in the elderly.

Application of the substance Lorazepam

Neuroses accompanied by anxiety, agitation, incl. generalized anxiety disorder, post-traumatic stress disorder, phobias, obsessive-compulsive disorder, psychoreactive states, emotional reactive disorders, anxiety in depressive states of various origins (usually in combination with antidepressants), insomnia, psychosomatic disorders (including heart - vascular, gastrointestinal and other diseases), premedication before surgical and diagnostic manipulations (in combination with analgesics), tension headache; nausea and vomiting caused by chemotherapy, epilepsy (as part of combination therapy), alcoholic delirium and withdrawal syndrome in chronic alcoholism (as part of combination therapy).

Contraindications

Hypersensitivity, incl. to other benzodiazepines, myasthenia gravis, angle-closure glaucoma, acute intoxication with CNS depressants, respiratory depression, liver failure, pregnancy (especially the first trimester), breast-feeding, age up to 18 years.

Restrictions on use

Chronic respiratory failure, sleep apnea syndrome, open-angle glaucoma, drug and alcohol dependence, depression (see Precautions), psychosis, severe renal impairment.

Use during pregnancy and lactation

Contraindicated during pregnancy (especially in the first trimester). At the time of treatment should stop breastfeeding.

Side effects of the substance Lorazepam

From the side of the nervous system and sensory organs: lethargy, fatigue, drowsiness, disorientation, headache, dizziness, depression, ataxia, sleep disturbance, agitation, visual impairment, episodes of amnesia.

From the digestive tract: dry mouth, nausea, vomiting, diarrhoea, change in appetite.

From the side of the skin: erythema, urticaria.

Other: changes in blood composition (leukopenia), increased LDH activity.

May develop addiction, drug dependence, withdrawal syndrome, rebound syndrome (see "Precautions").

Interaction

Lorazepam enhances the effect of CNS depressants, incl. phenothiazines, narcotic analgesics, barbiturates, antidepressants, hypnotics, anticonvulsants, antihistamines with a sedative effect. Potentiates the action of general and local anesthetics, enhances the action of curare-like drugs. With simultaneous use with alcohol, in addition to increasing the inhibitory effect on the central nervous system, paradoxical reactions are possible (psychomotor agitation, aggressive behavior, a state of pathological intoxication). Nicotine inhibits the activity of lorazepam (accelerates its metabolism).

Overdose

Symptoms: drowsiness, arterial hypotension, confusion, depression of reflexes, coma.

Treatment: induction of vomiting, gastric lavage, intravenous administration of norepinephrine to increase blood pressure, symptomatic therapy, monitoring of vital signs. The introduction of a specific antidote - an antagonist of benzodiazepine receptors flumazenil (in a hospital setting).

Dosage and administration

Inside. The dosage regimen and the duration of the course of treatment are set strictly individually.

In neurological practice - 1 mg 2-3 times a day; in psychiatric practice - 4-6 mg / day; with insomnia - 1-2 mg 30 minutes before bedtime. In elderly and debilitated patients, the dose should not exceed 2 mg / day (in divided doses). In patients with liver and / or kidney disease, as well as in patients with cerebral sclerosis, hypotension, heart failure, underweight, dose adjustment is recommended.

Precautions

Use with caution in depressed patients due to suicidal tendencies. In patients with drug and alcohol dependence, use under close medical supervision.

Side effects are usually observed at the beginning of therapy. The possibility of a more frequent occurrence of side effects in elderly and debilitated patients should be taken into account.

During treatment and for 2 days after its completion, it is necessary to exclude the intake of alcoholic beverages; drivers of vehicles and people whose work requires a quick mental and physical reaction, and is also associated with increased concentration of attention, should not engage in professional activities during this period.

With prolonged use, addiction and drug dependence may occur (especially when taking high doses). In this regard, lorazepam should not be used for longer than 4-6 weeks. If long-term treatment is necessary, weekly breaks in taking the drug should be periodically taken. With a sharp cessation of treatment, a withdrawal syndrome may occur (tremor, convulsions, abdominal or muscle cramps, vomiting, perspiration), and symptoms similar to those of the disease (anxiety, agitation, irritability, emotional stress, insomnia, convulsions) may also occur.

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