Lorazepam maximum dosage
Forms, strengths, how to take, 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 range | Safe dosage |
| 2 mg to 6 mg total, divided into two or three doses | Up 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.
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.
- 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.
Forms, strengths, how to take, 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 range | Safe dosage |
| 2 mg to 6 mg total, divided into two or three doses | Up 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.
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.
- 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.
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-oneGross 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.
