Lorazepam (generic)

Ativan (brand)

Classification: Benzodiazepine anxiolytic (anti-anxiety agent).

Common usage: Lorazepam is indicated for the management of anxiety disorders or the short-term (up to 4 months) relief of the symptoms of anxiety or anxiety associated with depressive symptoms in adults. Lorazepam is also used for the treatment of insomnia due to anxiety or transient situational stress. The safety and effectiveness of lorazepam have not been established in children under 12 years of age.

Warnings: Pre-existing depression may emerge or worsen during use of benzodiazepines, including lorazepam. Lorazepam is not recommended for use in patients with a primary depressive disorder or psychosis. In patients with depression, a possibility for suicide should be borne in mind, and lorazepam should not be used in such patients without adequate antidepressant therapy (see “Interactions with Other Medications”). When used in combination with other central nervous system (CNS) depressants, it may lead to potentially fatal respiratory depression.

Alcoholic beverages should not be consumed for at least 24 to 48 hours after receiving lorazepam injectable. Lorazepam can increase the effects of alcohol.

Use of benzodiazepines, including lorazepam, may lead to physical and psychological dependence. Lorazepam may have abuse potential, especially in patients with a history of drug and/or alcohol abuse.

Lorazepam should not be used in individuals with narrow-angle glaucoma or myasthenia gravis (a neuromuscular disease leading to skeletal muscle weakness).

The sedative effects of lorazepam may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines.

Common side effects: Most adverse reactions to benzodiazepines are dose-dependent, with more severe effects occurring with high doses. The most frequent side effects reported with lorazepam are sedation, dizziness, weakness, unsteadiness, slurred speech, and memory problems. Occasional disinhibition is seen. The incidence of weakness and unsteadiness increases with age. Withdrawal symptoms, such as convulsions, tremors, or muscle cramps, have occurred after the abrupt withdrawal of lorazepam, although most severe withdrawal symptoms occur in people who have taken large doses of the medication over an extended period of time. When lorazepam is stopped after extended therapy, the dose must be gradually reduced over time under expert supervision. Stopping use of lorazepam suddenly can result in unpleasant withdrawal symptoms, such as convulsions.

If you are pregnant, planning to become pregnant, or nursing, the potential benefits of this drug must be weighed against the risks. Discuss these issues in advance with all of your health care providers.

This is not a complete list of all known or potential adverse effects. Notify your prescriber or pharmacist of any symptoms that have started since you began taking this medication, changing its dose, or adding or changing other medication or diet. Take care when performing any task that requires your attention (such as driving or operating machinery) until you have experience with this drug and are confident that you can perform the task safely.

Interactions with other medications: Lorazepam depresses the central nervous system when given with alcohol or sedating medications, such as barbiturates, monoamine oxidase inhibitors (MAOIs), antidepressants, and antipsychotics.

This is not a complete list of all known or potential drug interactions. To help prevent problems, always make sure that your pharmacist and all prescribers know about all medications you are taking, including over-the-counter drugs; dietary herbal supplements; folk or home remedies; or unusual foods, drinks, or dietary habits.

Common dosage: The usual dosage range for lorazepam is 2 to 6 mg daily in adults, given in divided doses. For anxiety or restlessness, an initial dose of 2 to 3 mg given two or three times daily is common. For insomnia due to transient situational stress, a single bedtime dose of 2 to 4 mg may be given. The dose can then be adjusted every few days as needed to achieve the desired effect. When a higher dose is indicated, the evening dose should be increased before the daytime dose. The usual dose for geriatric anxiety is 1 to 2 mg per day in divided doses.

Identification: Lorazepam oral tablets are available in strengths of 0.5 mg, 1 mg, and 2 mg. The tablets vary in appearance according to the manufacturer. Injectable forms of lorazepam are available in 2 and 4 mg per mL. Ask your pharmacist for the specific identifier for your medication.

Storage: Store tablets at a controlled room temperature (68°F to 77°F) in a tightly closed, child-, light-, and moisture-resistant container. If you have difficulty opening child-resistant containers, your pharmacist can provide you with a container that is easier to open. Keep the medication out of direct sunlight and avoid storing it in a warm and humid area, such as the bathroom or kitchen, to avoid deterioration. To prevent accidental poisoning, keep all medications out of the reach of children or adults with dementia. Do not take expired medication. Do not transfer medication from one container to another. Carefully discard discontinued medication where children or adults with dementia cannot find it.