LorazepamPA study guide
Known brand names include Ativan.
A benzodiazepine (Schedule IV controlled substance) taken by mouth for anxiety, or given IV or IM to stop status epilepticus and to sedate patients before surgery.
Known brand names include Ativan.
A benzodiazepine (Schedule IV controlled substance) taken by mouth for anxiety, or given IV or IM to stop status epilepticus and to sedate patients before surgery.
Labeled use. IV or IM in adults for sedation, anxiety relief, and reduced recall.
Sources: [1]
Labeled use. Oral, for anxiety disorders and short-term relief of anxiety symptoms; long-term use beyond 4 months has not been studied.
Sources: [1]
Labeled use. IV, as the first step; maintenance antiepileptic therapy is usually needed.
Lorazepam is a first-line IV benzodiazepine for status epilepticus. Because it is cleared by glucuronidation without active metabolites, it is often preferred over diazepam or chlordiazepoxide in older adults and liver disease, including alcohol withdrawal. For chronic anxiety, SSRIs or SNRIs are preferred; reserve lorazepam for short-term use given dependence risk.
Binds the benzodiazepine site on the GABA-A receptor complex and increases the affinity of GABA for its receptor, which strengthens inhibitory signaling. Effects include less anxiety, sedation, amnesia, and fewer seizures. It is conjugated to an inactive glucuronide excreted in urine, with a half-life of about 12 hours.
The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.
Sources: [1]
Doses come from the FDA label. Study tool, not for clinical decisions.
No adjustment for single injected doses, but use caution with frequent doses over a short period. Propylene glycol and polyethylene glycol toxicity from the injection vehicle is more likely in renal impairment. For oral use, follow the usual precautions for impaired renal function.
Use with opioids can cause profound sedation, respiratory depression, coma, and death; limit doses and durations and monitor closely. Benzodiazepines carry risks of abuse, misuse, and addiction. Continued use causes physical dependence; abrupt stop or rapid dose cuts can cause life-threatening withdrawal, so taper gradually.
Flumazenil, a benzodiazepine receptor antagonist, can reverse sedation but is an adjunct to airway support, IV fluids, and other supportive care. It can trigger withdrawal and seizures, especially with long-term benzodiazepine use or mixed overdose with tricyclic antidepressants, and is contraindicated when a benzodiazepine is controlling a life-threatening condition such as status epilepticus.
Sources: [1]
Observational data do not show a clear link between benzodiazepines and major birth defects. Use late in pregnancy can cause neonatal sedation (respiratory depression, floppiness) and withdrawal; monitor exposed newborns. A pregnancy registry for psychiatric medications exists.
Lorazepam passes into breast milk. Infants exposed to benzodiazepines through milk have had sedation, poor feeding, and poor weight gain; monitor for these signs.
Sources: [1]
Oral: not established under age 12. Injection: safety for status epilepticus is not established in children, and preanesthetic use under age 18 is not recommended. Paradoxical excitation is more common in young children. Benzyl alcohol in the injection can cause fatal gasping syndrome in neonates.