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Lorazepam 5 mg dose


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: 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: 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

Ativan, Loreev XR (lorazepam) dosing, indications, interactions, adverse effects, and more

  • albuterol

    lorazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • alfentanil

    lorazepam and alfentanil both increase sedation. Use Caution/Monitor.

  • alprazolam

    alprazolam and lorazepam both increase sedation. Use Caution/Monitor.

  • amitriptyline

    lorazepam and amitriptyline both increase sedation. Use Caution/Monitor.

  • amobarbital

    amobarbital and lorazepam both increase sedation. Use Caution/Monitor.

  • amoxapine

    lorazepam and amoxapine both increase sedation. Use Caution/Monitor.

  • apomorphine

    lorazepam and apomorphine both increase sedation. Use Caution/Monitor.

  • arformoterol

    lorazepam increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • aripiprazole

    lorazepam and aripiprazole both increase sedation. Use Caution/Monitor.

  • armodafinil

    lorazepam increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • azelastine

    azelastine and lorazepam both increase sedation. Use Caution/Monitor.

  • baclofen

    lorazepam and baclofen both increase sedation. Use Caution/Monitor.

  • belladonna and opium

    lorazepam and belladonna and opium both increase sedation. Use Caution/Monitor.

  • benperidol

    lorazepam and benperidol both increase sedation. Use Caution/Monitor.

  • benzphetamine

    lorazepam increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • brexanolone

    brexanolone, lorazepam. Either increases toxicity of the other by sedation. Use Caution/Monitor.

  • brompheniramine

    brompheniramine and lorazepam both increase sedation. Use Caution/Monitor.

  • buprenorphine

    lorazepam and buprenorphine both increase sedation. Use Caution/Monitor.

  • buprenorphine buccal

    lorazepam and buprenorphine buccal both increase sedation. Use Caution/Monitor.

  • buprenorphine subdermal implant

    lorazepam increases toxicity of buprenorphine subdermal implant by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Studies have shown that the combination of benzodiazepines and buprenorphine altered the usual ceiling effect on buprenorphine-induced respiratory depression, making the respiratory effects of buprenorphine appear similar to those of full opioid agonists. There have been postmarketing reports of coma and death with coadministration of buprenorphine and benzodiazepines. In many, but not all of these cases, buprenorphine was misused by self-injection. If a benzodiazepine must be used for an indication other than seizures, lower the benzodiazepine initial dose and cautiously titrate to clinical response.

  • buprenorphine, long-acting injection

    lorazepam increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

  • butabarbital

    butabarbital and lorazepam both increase sedation. Use Caution/Monitor.

  • butalbital

    butalbital and lorazepam both increase sedation. Use Caution/Monitor.

  • butorphanol

    lorazepam and butorphanol both increase sedation. Use Caution/Monitor.

  • caffeine

    lorazepam increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • cannabidiol

    cannabidiol will increase the level or effect of lorazepam by decreasing metabolism. Modify Therapy/Monitor Closely. Cannabidiol may potentially inhibit UGT2B7 activity. Consider reducing the dose when concomitantly using UGT2B7 substrates.

  • carbinoxamine

    carbinoxamine and lorazepam both increase sedation. Use Caution/Monitor.

  • carisoprodol

    lorazepam and carisoprodol both increase sedation. Use Caution/Monitor.

  • cenobamate

    cenobamate, lorazepam. Either increases effects of the other by sedation. Use Caution/Monitor.

  • chloral hydrate

    lorazepam and chloral hydrate both increase sedation. Use Caution/Monitor.

  • chlordiazepoxide

    chlordiazepoxide and lorazepam both increase sedation. Use Caution/Monitor.

  • chlorpheniramine

    chlorpheniramine and lorazepam both increase sedation. Use Caution/Monitor.

  • chlorpromazine

    lorazepam and chlorpromazine both increase sedation. Use Caution/Monitor.

  • chlorzoxazone

    lorazepam and chlorzoxazone both increase sedation. Use Caution/Monitor.

  • cinnarizine

    cinnarizine and lorazepam both increase sedation. Use Caution/Monitor.

  • clemastine

    clemastine and lorazepam both increase sedation. Use Caution/Monitor.

  • clobazam

    lorazepam, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

  • clomipramine

    lorazepam and clomipramine both increase sedation. Use Caution/Monitor.

  • clonazepam

    clonazepam and lorazepam both increase sedation. Use Caution/Monitor.

  • clonidine

    clonidine, lorazepam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.

  • clorazepate

    clorazepate and lorazepam both increase sedation. Use Caution/Monitor.

  • clozapine

    lorazepam and clozapine both increase sedation. Use Caution/Monitor.

    lorazepam, clozapine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Possible risk of cardiorespiratory collapse.

  • codeine

    lorazepam and codeine both increase sedation. Use Caution/Monitor.

  • cyclizine

    cyclizine and lorazepam both increase sedation. Use Caution/Monitor.

  • cyclobenzaprine

    lorazepam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

  • cyproheptadine

    cyproheptadine and lorazepam both increase sedation. Use Caution/Monitor.

  • dantrolene

    lorazepam and dantrolene both increase sedation. Use Caution/Monitor.

  • daridorexant

    lorazepam and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

  • desflurane

    desflurane and lorazepam both increase sedation. Use Caution/Monitor.

  • desipramine

    lorazepam and desipramine both increase sedation. Use Caution/Monitor.

  • deutetrabenazine

    lorazepam and deutetrabenazine both increase sedation. Use Caution/Monitor.

  • dexchlorpheniramine

    dexchlorpheniramine and lorazepam both increase sedation. Use Caution/Monitor.

  • dexfenfluramine

    lorazepam increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • dexmedetomidine

    lorazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

  • dexmethylphenidate

    lorazepam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • dextroamphetamine

    lorazepam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • dextromoramide

    lorazepam and dextromoramide both increase sedation. Use Caution/Monitor.

  • diamorphine

    lorazepam and diamorphine both increase sedation. Use Caution/Monitor.

  • diazepam

    diazepam and lorazepam both increase sedation. Use Caution/Monitor.

  • diazepam intranasal

    diazepam intranasal, lorazepam. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

  • dichlorphenamide

    dichlorphenamide, lorazepam. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

  • diethylpropion

    lorazepam increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • difelikefalin

    difelikefalin and lorazepam both increase sedation. Use Caution/Monitor.

  • difenoxin hcl

    lorazepam and difenoxin hcl both increase sedation. Use Caution/Monitor.

  • dimenhydrinate

    dimenhydrinate and lorazepam both increase sedation. Use Caution/Monitor.

  • diphenhydramine

    diphenhydramine and lorazepam both increase sedation. Use Caution/Monitor.

  • diphenoxylate hcl

    lorazepam and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

  • dipipanone

    lorazepam and dipipanone both increase sedation. Use Caution/Monitor.

  • dobutamine

    lorazepam increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • dopamine

    lorazepam increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • dopexamine

    lorazepam increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • dosulepin

    lorazepam and dosulepin both increase sedation. Use Caution/Monitor.

  • doxepin

    lorazepam and doxepin both increase sedation. Use Caution/Monitor.

  • doxylamine

    lorazepam and doxylamine both increase sedation. Use Caution/Monitor.

  • droperidol

    lorazepam and droperidol both increase sedation. Use Caution/Monitor.

  • ephedrine

    lorazepam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • epinephrine

    lorazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • epinephrine racemic

    lorazepam increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • esketamine intranasal

    esketamine intranasal, lorazepam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

  • estazolam

    estazolam and lorazepam both increase sedation. Use Caution/Monitor.

  • ethanol

    lorazepam and ethanol both increase sedation. Use Caution/Monitor.

  • etomidate

    etomidate and lorazepam both increase sedation. Use Caution/Monitor.

  • fenfluramine

    lorazepam increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • flibanserin

    lorazepam and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

  • fluphenazine

    lorazepam and fluphenazine both increase sedation. Use Caution/Monitor.

  • flurazepam

    flurazepam and lorazepam both increase sedation. Use Caution/Monitor.

  • formoterol

    lorazepam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • gabapentin

    gabapentin, lorazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

  • gabapentin enacarbil

    gabapentin enacarbil, lorazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

  • ganaxolone

    lorazepam and ganaxolone both increase sedation. Use Caution/Monitor.

  • haloperidol

    lorazepam and haloperidol both increase sedation. Use Caution/Monitor.

  • hyaluronidase

    hyaluronidase, lorazepam. Other (see comment). Use Caution/Monitor. Comment: Drug combination has been found to be incompatible.

  • hydromorphone

    lorazepam and hydromorphone both increase sedation. Use Caution/Monitor.

  • hydroxyzine

    hydroxyzine and lorazepam both increase sedation. Use Caution/Monitor.

  • iloperidone

    lorazepam and iloperidone both increase sedation. Use Caution/Monitor.

  • imipramine

    lorazepam and imipramine both increase sedation. Use Caution/Monitor.

  • isoproterenol

    lorazepam increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • ketamine

    ketamine and lorazepam both increase sedation. Use Caution/Monitor.

  • ketotifen, ophthalmic

    lorazepam and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

  • lasmiditan

    lasmiditan, lorazepam. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

  • lemborexant

    lemborexant, lorazepam. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

  • levalbuterol

    lorazepam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • levorphanol

    lorazepam and levorphanol both increase sedation. Use Caution/Monitor.

  • lisdexamfetamine

    lorazepam increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • lofepramine

    lorazepam and lofepramine both increase sedation. Use Caution/Monitor.

  • lofexidine

    lorazepam and lofexidine both increase sedation. Use Caution/Monitor.

  • loprazolam

    loprazolam and lorazepam both increase sedation. Use Caution/Monitor.

  • lormetazepam

    lorazepam and lormetazepam both increase sedation. Use Caution/Monitor.

  • loxapine

    lorazepam and loxapine both increase sedation. Use Caution/Monitor.

    lorazepam, loxapine. Mechanism: unknown. Use Caution/Monitor. Risk of resp. depression, hypotension.

  • loxapine inhaled

    lorazepam and loxapine inhaled both increase sedation. Use Caution/Monitor.

    lorazepam, loxapine inhaled. Mechanism: unknown. Use Caution/Monitor. Risk of resp. depression, hypotension.

  • lurasidone

    lurasidone, lorazepam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

  • maprotiline

    lorazepam and maprotiline both increase sedation. Use Caution/Monitor.

  • marijuana

    lorazepam and marijuana both increase sedation. Use Caution/Monitor.

  • melatonin

    lorazepam and melatonin both increase sedation. Use Caution/Monitor.

  • meperidine

    lorazepam and meperidine both increase sedation. Use Caution/Monitor.

  • meprobamate

    lorazepam and meprobamate both increase sedation. Use Caution/Monitor.

  • metaproterenol

    lorazepam increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • metaxalone

    lorazepam and metaxalone both increase sedation. Use Caution/Monitor.

  • methadone

    lorazepam and methadone both increase sedation. Use Caution/Monitor.

  • methamphetamine

    lorazepam increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • methocarbamol

    lorazepam and methocarbamol both increase sedation. Use Caution/Monitor.

  • methylenedioxymethamphetamine

    lorazepam increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • methylphenidate transdermal

    methylphenidate transdermal will increase the level or effect of lorazepam by decreasing metabolism. Modify Therapy/Monitor Closely. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. Monitor for drug toxiticities when initiating or discontinuing methylphenidate.

  • midazolam

    lorazepam and midazolam both increase sedation. Use Caution/Monitor.

  • midazolam intranasal

    midazolam intranasal, lorazepam. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

  • midodrine

    lorazepam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • mirtazapine

    lorazepam and mirtazapine both increase sedation. Use Caution/Monitor.

  • modafinil

    lorazepam increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • morphine

    lorazepam and morphine both increase sedation. Use Caution/Monitor.

  • motherwort

    lorazepam and motherwort both increase sedation. Use Caution/Monitor.

  • moxonidine

    lorazepam and moxonidine both increase sedation. Use Caution/Monitor.

  • nabilone

    lorazepam and nabilone both increase sedation. Use Caution/Monitor.

  • nalbuphine

    lorazepam and nalbuphine both increase sedation. Use Caution/Monitor.

  • norepinephrine

    lorazepam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • nortriptyline

    lorazepam and nortriptyline both increase sedation. Use Caution/Monitor.

  • olanzapine

    lorazepam and olanzapine both increase sedation. Use Caution/Monitor.

  • oliceridine

    oliceridine, lorazepam. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

  • opium tincture

    lorazepam and opium tincture both increase sedation. Use Caution/Monitor.

  • orlistat

    orlistat decreases levels of lorazepam by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Risk of convulsions.

  • orphenadrine

    lorazepam and orphenadrine both increase sedation. Use Caution/Monitor.

  • oxazepam

    lorazepam and oxazepam both increase sedation. Use Caution/Monitor.

  • oxycodone

    lorazepam and oxycodone both increase sedation. Use Caution/Monitor.

  • oxymorphone

    lorazepam and oxymorphone both increase sedation. Use Caution/Monitor.

  • paliperidone

    lorazepam and paliperidone both increase sedation. Use Caution/Monitor.

  • papaveretum

    lorazepam and papaveretum both increase sedation. Use Caution/Monitor.

  • papaverine

    lorazepam and papaverine both increase sedation. Use Caution/Monitor.

  • pentazocine

    lorazepam and pentazocine both increase sedation. Use Caution/Monitor.

  • pentobarbital

    pentobarbital and lorazepam both increase sedation. Use Caution/Monitor.

  • perampanel

    perampanel and lorazepam both increase sedation. Use Caution/Monitor.

  • perphenazine

    lorazepam and perphenazine both increase sedation. Use Caution/Monitor.

  • phendimetrazine

    lorazepam increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • phenobarbital

    phenobarbital and lorazepam both increase sedation. Use Caution/Monitor.

  • phentermine

    lorazepam increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • phenylephrine

    lorazepam increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • phenylephrine PO

    lorazepam increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

  • pholcodine

    lorazepam and pholcodine both increase sedation. Use Caution/Monitor.

  • pimozide

    lorazepam and pimozide both increase sedation. Use Caution/Monitor.

  • pirbuterol

    lorazepam increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • pregabalin

    pregabalin, lorazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

  • primidone

    primidone and lorazepam both increase sedation. Use Caution/Monitor.

  • prochlorperazine

    lorazepam and prochlorperazine both increase sedation. Use Caution/Monitor.

  • promethazine

    promethazine and lorazepam both increase sedation. Use Caution/Monitor.

  • propofol

    propofol and lorazepam both increase sedation. Use Caution/Monitor.

  • propylhexedrine

    lorazepam increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • protriptyline

    lorazepam and protriptyline both increase sedation. Use Caution/Monitor.

  • quazepam

    lorazepam and quazepam both increase sedation. Use Caution/Monitor.

  • quetiapine

    lorazepam and quetiapine both increase sedation. Use Caution/Monitor.

  • ramelteon

    lorazepam and ramelteon both increase sedation. Use Caution/Monitor.

  • remimazolam

    remimazolam, lorazepam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

  • risperidone

    lorazepam and risperidone both increase sedation. Use Caution/Monitor.

  • salmeterol

    lorazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • scullcap

    lorazepam and scullcap both increase sedation. Use Caution/Monitor.

  • secobarbital

    secobarbital and lorazepam both increase sedation. Use Caution/Monitor.

  • sevelamer

    sevelamer decreases levels of lorazepam by increasing elimination. Use Caution/Monitor.

  • sevoflurane

    sevoflurane and lorazepam both increase sedation. Use Caution/Monitor.

  • shepherd's purse

    lorazepam and shepherd's purse both increase sedation. Use Caution/Monitor.

  • stiripentol

    stiripentol, lorazepam. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

  • sufentanil

    lorazepam and sufentanil both increase sedation. Use Caution/Monitor.

  • suvorexant

    suvorexant and lorazepam both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

  • tapentadol

    lorazepam and tapentadol both increase sedation. Use Caution/Monitor.

  • teduglutide

    teduglutide increases levels of lorazepam by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.

  • temazepam

    lorazepam and temazepam both increase sedation. Use Caution/Monitor.

  • terbutaline

    lorazepam increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • thioridazine

    lorazepam and thioridazine both increase sedation. Use Caution/Monitor.

  • thiothixene

    lorazepam and thiothixene both increase sedation. Use Caution/Monitor.

  • topiramate

    lorazepam and topiramate both increase sedation. Modify Therapy/Monitor Closely.

  • tramadol

    lorazepam and tramadol both increase sedation. Use Caution/Monitor.

  • trazodone

    lorazepam and trazodone both increase sedation. Use Caution/Monitor.

  • triazolam

    lorazepam and triazolam both increase sedation. Use Caution/Monitor.

  • triclofos

    lorazepam and triclofos both increase sedation. Use Caution/Monitor.

  • trifluoperazine

    lorazepam and trifluoperazine both increase sedation. Use Caution/Monitor.

  • trimipramine

    lorazepam and trimipramine both increase sedation. Use Caution/Monitor.

  • triprolidine

    triprolidine and lorazepam both increase sedation. Use Caution/Monitor.

  • xylometazoline

    lorazepam increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • yohimbine

    lorazepam increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

  • ziconotide

    lorazepam and ziconotide both increase sedation. Use Caution/Monitor.

  • ziprasidone

    lorazepam and ziprasidone both increase sedation. Use Caution/Monitor.

  • zotepine

    lorazepam and zotepine both increase sedation. Use Caution/Monitor.

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

    Contents

    • Structural formula
    • 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
    • Route of administration and doses
    • 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

    Gross formula

    C 15 H 10 Cl 2 N 2 O 2

    Pharmacological group of the substance Lorazepam 9004 9002 Anxiolytics

    Nosological classification

    ICD-10 code list

    • R45. 1 Restlessness 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.

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

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

    On the part of the skin: erythema, urticaria.

    Others: 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 functions. 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.

    With prolonged use, it is necessary to periodically monitor the picture of peripheral blood, liver and kidney function.

    Special instructions

    Note that anxiety or tension associated with everyday stress does not usually require treatment with anxiolytics.

    Trade names with active substance Lorazepam

    Reset filters

    Lek. the form All lek. dragee forms substance-powder tablets, coated tablets, film-coated

    Dosage All dosages 1 mg 2.5 mg No dosage

    Manufacturer All manufacturers of Cambrex Propharmaco Milan S.r.L. Moscow Endocrine Plant Federal State Unitary Enterprise Tarkhominsk Pharmaceutical Plant Polfa, JSC

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

    Contents

    • Structural formula
    • 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

    Name

    Lorazes

    9000 )-1,3-dihydro-3-hydroxy-2H-1,4-benzodiazepin-2-one

    Gross formula

    C 15 H 10 Cl 2 N 2 O 2

    Pharmacological group of the substance Lorazepam

    Anxiolytics

    Nosological classification

    ICD-10 code list

    • R45. 1 Restlessness 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
    • 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.

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

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

    On the part of the skin: erythema, urticaria.

    Others: 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 functions. 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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