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What is Lorazepam?

Lorazepam is a benzodiazepine medication used to treat anxiety disorders, insomnia, and as a preoperative sedative. Benzodiazepines work by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity. This results in a sedative effect that relieves anxiety and promotes sleep.

Lorazepam goes by the brand names Ativan and Temesta. It is available in tablet, disintegrating tablet, and liquid forms. Lorazepam is prescribed for short-term use because it can be habit-forming. It provides rapid anxiety relief and has a relatively long half-life compared to other benzodiazepines.

Medical Uses

Lorazepam is primarily used for the treatment of anxiety disorders. It is FDA approved for the short-term treatment of anxiety, insomnia, acute seizures, and alcohol withdrawal.

Some common medical uses of lorazepam include:

• Generalized anxiety disorder
• Panic disorder
• Social anxiety disorder
• Insomnia
• Alcohol withdrawal
• Nausea and vomiting
• Epileptic seizures
• Agitation

How Lorazepam Works ?

Lorazepam is a benzodiazepine medication that enhances the activity of gamma-aminobutyric acid (GABA), the major inhibitory neurotransmitter in the central nervous system. By enhancing GABA activity, lorazepam exerts sedative, hypnotic, anti-seizure, muscle relaxant, and amnesic effects.

Specifically, lorazepam binds to benzodiazepine receptors located on GABA-A receptors. This increases the affinity of GABA for its receptor, allowing more chloride ions to flow into the neuron. This hyperpolarizes the neuron membrane, making it more difficult for nerve impulses to propagate.

The sedative and hypnotic effects of lorazepam induce drowsiness, relieve anxiety, and promote sleep. Its anti-seizure effects help prevent and control epileptic seizures. The muscle relaxant properties relieve muscle spasms and tightness. Finally, the amnesic effects cause short-term anterograde amnesia, meaning it impairs the formation of new memories.

Dosage

Lorazepam is available in oral tablet and injectable solution forms. The typical dosage depends on the condition being treated:

• Anxiety : The starting oral dose is 2-3 mg per day, given in divided doses. Maximum daily dose is 10 mg.
• Insomnia : The starting oral dose is 2-4 mg at bedtime.
• Seizures : Initial IV dose is 4 mg, may repeat every 10-15 minutes until seizures stop. Maximum dose is 8-10 mg. Maintenance oral dose is 2-8 mg daily in divided doses.
• Alcohol withdrawal : Initial dose is 2-10 mg, then 2-10 mg repeated every 1-6 hours as needed. Oral or IV.
• Pre-op sedation : 0.05 mg/kg IV, 30-90 minutes before procedure.

Lower doses are used for elderly patients and those with liver/kidney impairment. Injectable solution can be given IV or IM. Tablets are usually taken 2-3 times per day.

Warnings

Lorazepam should be used with caution in elderly patients as they may be more sensitive to the drug’s effects. The elderly are more likely to experience confusion, sedation, loss of coordination, and respiratory depression. Lower doses should be used in older adults.

Lorazepam is contraindicated in patients with:

• Known hypersensitivity to benzodiazepines
• Acute narrow-angle glaucoma
• Severe respiratory insufficiency

The sedative effects of lorazepam are increased when used with other CNS depressants like alcohol, opioids, antihistamines, antipsychotics, antidepressants, anticonvulsants, and anesthetics. Concurrent use should be avoided.

Lorazepam may enhance the CNS depressant effects of levodopa or dopamine agonists. Monitor patients closely when using these drugs together.

Overdose

Overdose occurs when someone takes more than the normal or recommended amount of lorazepam. An overdose can be accidental or intentional.

Signs and Symptoms of Overdose

Some common signs and symptoms of a lorazepam overdose include:

• Excessive drowsiness or sleepiness
• Confusion
• Slurred speech
• Poor coordination
• Slowed or delayed reflexes
• Coma
• Respiratory depression or slowed breathing
• Low blood pressure
• Heart rhythm changes

The more lorazepam someone takes, the more severe the symptoms will be. A very high overdose can lead to coma, respiratory arrest, and death.

Treatment for Overdose

Treatment focuses on managing symptoms and stabilizing the patient. Steps may include:

• Monitoring vital signs, especially respiration
• Administering activated charcoal to prevent further absorption
• Pumping the stomach to remove unabsorbed lorazepam
• Using IV fluids and medications to increase blood pressure if too low
• Placing a breathing tube for respiratory support if needed
• Treating seizures if they occur

Benzodiazepine antagonists like flumazenil may also be used as an antidote to reverse the effects of the overdose. However, these are used cautiously, as they can trigger seizures and other complications in lorazepam-dependent patients.

The patient will need to be closely monitored even after initial treatment until the medication has fully cleared their system, which may take 1-3 days depending on the dose taken. Psychological counseling may also be recommended after recovery to address any underlying mental health issues that may have contributed to an intentional overdose.

Patient Education

It is important for patients taking lorazepam to follow their doctor’s instructions carefully. Lorazepam should only be taken as prescribed, and patients should not increase their dose or stop taking it suddenly without medical supervision.

1. Patients should also avoid sharing their lorazepam prescription with others, as it has a high potential for abuse and addiction. Even individuals who do not have a history of substance abuse can become dependent on lorazepam relatively quickly.
2. Stopping lorazepam suddenly after regular use can lead to dangerous withdrawal symptoms such as seizures, tremors, insomnia, anxiety, and restlessness. Patients who wish to stop taking lorazepam should consult their doctor, who can create a gradual tapering schedule to safely wean them off the medication. This helps minimize withdrawal effects.
3. Overall, lorazepam is a useful anti-anxiety medication when used responsibly under medical supervision. However, patients need to be aware of the risks and follow dosage instructions carefully to avoid problems with misuse, dependence, and withdrawal.