Lorazepam
Lorazepam
Definition
Lorazepam, a mild tranquilizer in the class of drugs known as benzodiazepines , is sold in the United States under the brand names Alzapam, Ativan, or Loraz. It is also available generically.
Purpose
Lorazepam is used for management of anxiety , nausea and vomiting, insomnia , and seizures (the injectable form). Lorazepam is also used prior to surgery to produce sedation, sleepiness, drowsiness, relief of anxiety, and a decreased ability to recall the events surrounding the surgery.
Description
Lorazepam is a member of the benzodiazepine family. Benzodiazepines primarily work by enhancing the function of a certain naturally occurring brain chemical, gamma-aminobutyric acid (GABA), which is responsible for inhibiting the transmission of nervous impulses in the brain and spinal cord. At the same time, the enhancement of GABA in the brain decreases symptoms associated with anxiety. Lorazepam differs from drugs such as diazepam (Valium) and chlordiazepoxide (Librium) in that it is shorter-acting and does not accumulate in the body after repeated doses.
Lorazepam is available in 0.5-mg, 1-mg, and 2-mg tablets and in an injectable form.
Recommended dosage
Lorazepam is taken several times daily by mouth or injected to treat anxiety. Dosage ranges from 1-2 mg taken either every 12 or every eight hours. The maximum daily total dosage for anxiety is 10 mg given in two to three divided doses. For sleep, patients may take from 2 to 4 mg at bedtime. Doses taken before surgery range from 2.5 to 5 mg.
Between 0.5 mg and 1 mg of lorazepam may be taken every six to eight hours to help control treatment-related nausea and vomiting (nausea and vomiting that occur as a side effect of a drug or medical treatment). Two mg of lorazepam is often given half an hour before chemotherapy to help prevent stomach upset. An additional 2 mg may be taken every four hours as needed.
The usual dose to treat seizures is 4 mg given intravenously (through a vein). This dose may be increased to 8 mg in patients who do not respond to the 4-mg dose.
Precautions
Lorazepam, like other drugs of this type, can cause physical and psychological dependence. Patients should not increase the dose or frequency of this drug on their own, nor should they suddenly stop taking this medication. Instead, when stopping the drug, the dosage should gradually be decreased, and then discontinued. If the drug is stopped abruptly, patients may experience agitation, irritability, difficulty sleeping, convulsions, and other withdrawal symptoms.
Patients allergic to benzodiazepines should not take lorazepam. Those with narrow-angle glaucoma, preexisting depression of the central nervous system, severe uncontrolled pain, or severe low blood pressure should not take lorazepam. This drug should be used with caution in patients with a history of drug abuse. Children under age 12 should not take lorazepam. Children between the ages of 12 and 18 may take the drug by mouth, but not intravenously. Pregnant women and those trying to become pregnant should not take lorazepam. This drug has been associated with damage to the developing fetus when taken during the first three months of pregnancy. Patients taking this drug should not breast-feed.
Side effects
Drowsiness and sleepiness are common and expected effects of lorazepam. Patients should not drive, operate machinery, or perform hazardous activities that require mental alertness until they have a sense of how lorazepam will affect their alertness.
KEY TERMS
Benzodiazepine —A group of central nervous system depressants used to relieve anxiety or to induce sleep.
Patients over age 50 may experience deeper and longer sedation after taking lorazepam. These effects may subside with continued use or dosage reduction.
The effects of an injection may impair performance and driving ability for 24-48 hours. The impairment may last longer in older patients and those taking other central nervous system depressants, such as some pain medication.
Lorazepam may also make patients feel dizzy, weak, unsteady, or clumsy. Less frequently, they may feel depressed, disoriented, nauseous, or agitated while taking this drug. Other side effects include headache, difficulty sleeping, rash, yellowing eyes, vision changes, and hallucinations. Redness and pain may occur at the injection site.
Patients may experience high or low blood pressure and difficulty in breathing after an injection of lorazepam. Nausea, vomiting, dry mouth, and constipation may also occur. The patient’s sex drive may decrease, but this side effect is reversible once the drug is stopped. Patients should alert their physician to confusion, depression, excitation, nightmares, impaired coordination, changes in personality, changes in urinary pattern, chest pain, heart palpitations, or any other side effects.
Interactions
Alcohol and other central nervous system depressants can increase the drowsiness associated with this drug. Some over-the-counter medications depress the central nervous system. The herbal remedies kava kava and valerian may increase the effects of lorazepam. Patients should check with their doctors before starting any new medications while taking lorazepam. People should not drink alcoholic beverages when taking lorazepam and for 24-48 hours before receiving an injection prior to surgery.
Resources
BOOKS
Lacy, Charles F. Drug Information Handbook. Lexi-Comp, 2002.
Preston, John D., John H. O’Neal, and Mary C. Talaga. Handbook of Clinical Psychopharmacology for Therapists. 4th ed. Oakland, CA: New Harbinger Publications, 2004.
PERIODICALS
Giersch, Anne, and others. “Impairment of Contrast Sensitivity in Long-Term Lorazepam Users.” Psychopharmacology 186.4 (July 2006): 594–600.
Hung, Yi-Yung, and Tiao-Lai Huang. “Lorazepam and Diazepam Rapidly Relieve Catatonic Features in Major Depression.” Clinical Neuropharmacology 29.3 (May-June 2006): 144–47.
Izaute, M., and E. Bacon. “Effects of the Amnesic Drug Lorazepam on Complete and Partial Information Retrieval and Monitoring Accuracy.” Psychopharmacology 188.4 (Nov. 2006): 472–81.
Kamboj, Sunjeev K., and H. Valerie Curran. “Neutral and Emotional Episodic Memory: Global Impairment After Lorazepam or Scopolamine.” Psychopharmacology 188.4 (Nov. 2006): 482–88.
Pomara, Nunzio, and others. “Dose-Dependent Retrograde Facilitation of Verbal Memory in Healthy Elderly After Acute Oral Lorazepam Administration.” Psychopharmacology 185.4 (May 2006): 487–94.
Verster, Joris C., Dieuwke S. Veldhuijzen, and Edmund R. Volkerts. “Is It Safe to Drive a Car When Treated with Anxiolytics? Evidence from On-the-Road Driving Studies During Normal Traffic.” Current Psychiatry Reviews 1.2 (June 2005): 215–25.
Yacoub, Adee, and Andrew Francis. “Neuroleptic Malignant Syndrome Induced by Atypical Neuroleptics and Responsive to Lorazepam.” Neuropsychiatric Disease and Treatment 2.2 (2006): 235–40.
Debra Wood, RN
Ajna Hamidovic, Pharm.D.
Ruth A. Wienclaw, PhD
Lorazepam
Lorazepam
Definition
Lorazepam, a mild tranquilizer in the class of drugs known as benzodiazepines is a sold in the United States under brand names Alzapam, Ativan, or Loraz. It is also available generically.
Purpose
Lorazepam is used for management of anxiety, nausea and vomiting, insomnia , and seizures . Lorazepam is also used prior to surgery to produce sedation, sleepiness, drowsiness, relief of anxiety, and a decreased ability to recall the events surrounding the surgery.
Description
Lorazepam is a member of the benzodiazepine family. Benzodiazepines primarily work by enhancing the function of a certain naturally occurring brain chemical, gamma aminobutyric acid (GABA), that is responsible for inhibiting the transmission of nervous impulses in the brain and spinal cord. At the same time, the enhancement of GABA in the brain decreases symptoms associated with anxiety. Lorazepam differs from drugs such as diazepam (Valium) and chlordiazepoxide (Librium) in that it is shorter acting and does not accumulate in the body after repeated doses.
Lorazepam is available in 0.5-mg, 1-mg, and 2-mg tablets and in an injectable form.
Recommended dosage
Lorazepam is taken several times daily by mouth or injected to treat anxiety. Dosage ranges from 1–2 mg taken either every 12 or every eight hours. The maximum daily total dosage for anxiety is 10 mg given in two to three divided doses. For sleep, patients may take from 2–4 mg at bedtime. Doses taken before surgery range from 2.5–5 mg.
Between 0.5 mg and 1 mg of lorazepam may be taken every six to eight hours to help control treatment-related nausea and vomiting (nausea and vomiting that occur as a side effect of a drug or medical treatment). Two mg of lorazepam is often given half an hour before chemotherapy to help prevent stomach upset. An additional 2 mg may be taken every four hours as needed.
The usual dose to treat seizures is 4 mg given intravenously (through a vein). This dose may be increased to 8 mg in patients who do not respond to the 4-mg dose.
Precautions
Lorazepam, like other drugs of this type, can cause physical and psychological dependence. Patients should not increase the dose or frequency of this drug on their own, nor should they suddenly stop taking this medication. Instead, when stopping the drug, the dosage should gradually be decreased, then discontinued. If the drug is stopped abruptly, the patient may experience agitation, irritability, difficulty sleeping, convulsions, and other withdrawal symptoms.
Patients allergic to benzodiazepines should not take lorazepam. Those with narrow-angle glaucoma, pre-existing depression of the central nervous system, severe uncontrolled pain, or severe low blood pressure should not take lorazepam. This drug should be used with caution in patients with a history of drug abuse. Children under age 12 should not take lorazepam. Children between the ages of 12 and 18 may take the drug by mouth, but not intravenously. Pregnant women and those trying to become pregnant should not take lorazepam. This drug has been associated with damage to the developing fetus when taken during the first three months of pregnancy. Patients taking this drug should not breast-feed.
Side effects
Drowsiness and sleepiness are common and expected effects of lorazepam. Patients should not drive, operate machinery, or perform hazardous activities that require mental alertness until they have a sense of how lorazepam will affect their alertness. Patients over age 50 may experience deeper and longer sedation after taking lorazepam. These effects may subside with continued use or dosage reduction.
The effects of an injection may impair performance and driving ability for 24–48 hours. The impairment may last longer in older people and those taking other central nervous system depressants, such as some pain medications.
Lorazepam may also make patients feel dizzy, weak, unsteady, or clumsy. Less frequently, people may feel depressed, disoriented, nauseous, or agitated while taking this drug. Other side effects include headache, difficulty sleeping, rash, yellowing eyes, vision changes, and hallucinations . Redness and pain may occur at the injection site.
Patients may experience high or low blood pressure and difficulty breathing after an injection of lorazepam. Nausea, vomiting, dry mouth, and constipation may also occur. The patient's sex drive may decrease, but this side effect is reversible once the drug is stopped. Patients should alert their physician to confusion, depression, excitation, nightmares, impaired coordination, changes in personality, changes in urinary pattern, chest pain, heart palpitations, or any other side effects.
Interactions
Alcohol and other central nervous system depressants can increase the drowsiness associated with this drug. Some over-the-counter medications depress the central nervous system. The herbal remedies kava kava and valerian may increase the effects of lorazepam. Patients should check with a doctor before starting any new medication while taking lorazepam. People should not drink alcoholic beverages when taking lorazepam and for 24–48 hours before receiving an injection prior to surgery.
Resources
BOOKS
Gilman, Alfred G. The Pharmacological Basis of Therapeutics. New York: McGraw-Hill, 1996.
Kaplan, Harold. Comprehensive Textbook of Psychiatry. ladelphia: Lippincott, Williams and Wilkins, 1995.
Lacy, Charles F. Drug Information Handbook. Lexi-Comp, Inc. 2002.
Debra Wood, R.N. Ajna Hamidovic, Pharm.D.
Lorazepam
Lorazepam
Definition
Lorazepam is a tranquilizing drug used in managing anxiety, nausea and vomiting , insomnia, and seizures.
Purpose
Lorazepam decreases anxiety. Doctors may order it to treat muscle spasms that may accompany severe pain. Lorazepam may also be given with other drugs to help control nausea and vomiting associated with cancer treatment. It may be given just prior to the administration of chemotherapy to decrease the chances of nausea and vomiting. Patients experiencing difficulty sleeping may receive lorazepam. It is sometimes given prior to surgery or other procedures to help the patient relax, feel drowsy, and decrease his or her memory about the procedure.
Description
Lorazepam depresses the central nervous system when taken at the recommended dose.
Recommended dosage
Lorazepam may be given by mouth, injected into a muscle or administered through a vein. Patients should take the smallest dose possible that relieves symptoms. The dose should be adjusted, based on the patient's reaction to the drug. Between 0.5 mg and 1 mg of Lorazepam may be given every six to eight hours to aid in controlling treatment-related nausea and vomiting. When given prior to chemotherapy to decrease the risk of this side effect, 2 mg is usually administered a half-hour before treatment. An additional 2 mg may be given every four hours as needed. To control anxiety, 1 mg to 3 mg at two to three times per day is the typical dose. For sleep, patients may take from 2 mg to 4 mg at bedtime. Older or debilitated adults may be given 0.5 mg to 2 mg per day in divided doses. If a dose is missed, the patient should take it as soon as possible, but patients should not take two pills at the same time. This drug may be taken with or without food.
Precautions
Lorazepam, like other drugs of this type, can create physical and mental dependence. Patients should not take more than the amount ordered and should not suddenly stop taking this medication. The amount taken should gradually be decreased, then discontinued. If the drug is abruptly stopped, the patient may experience agitation, irritability, difficulty sleeping, convulsions, and other withdrawal symptoms.
Patients allergic to this type of anti-anxiety drug should not take lorazepam. Those with narrow-angle glaucoma, pre-existing depression of the central nervous system, severe uncontrolled pain, or severe decrease in blood pressure should avoid taking it. This drug should be used cautiously in patients with kidney or liver disease, myasthenia gravis , lung disease, alcohol intoxication, or anyone with a history of drug abuse. This drug should not be given to children under 12. Children between 12 and 18 may receive the drug by mouth, but not through a vein. Pregnant women and those trying to become pregnant should not take lorazepam. This drug has been associated with fetal malformations when taken during the first three months of pregnancy. Patients taking this drug should not breast feed.
Side effects
Drowsiness and sleepiness are common and expected effects of lorazepam. Patients should not drive or operate machinery or appliances while taking this drug. Patients older than 50 years of age may experience greater and longer sedation after receiving lorazepam. These effects may subside with continued use or if the dose is reduced. Patients may experience difficulty walking or fall easily for up to eight hours after receiving an injection of lorazepam, and should ask for assistance when walking. The effects of an injection may impair performance and driving ability for 24 to 48 hours. The impairments may last longer in older patients and those taking other central nervous system depressants, such as pain medication.
Lorazepam may also make patients feel dizzy, weak, unsteady or clumsy. Less frequently, they may also feel depressed, disoriented, nauseous, or agitated while taking this drug. Other side effects include headache, difficulty sleeping, rash, yellowing eyes, vision changes, and hallucinations. Redness and pain may occur at the injection site. Patients may experience high or low blood pressure and partial blockage of the airway after an injection of lorazepam. Nausea, vomiting, dry mouth, and constipation may occur. Sex drive may decrease, but this side effect is reversible. Patients should alert their physician to any side effects of confusion, depression, excitation, depression, nightmares, impaired coordination, changes in personality, changes in urinary pattern, chest pain, heart palpitations, or any other side effects.
Interactions
Alcohol and other central nervous system depressants can increase the drowsiness associated with this drug. Some over-the-counter medications depress the central nervous system. The herbal remedies kava and valerian may increase the effects of this type of drug. Patients should check with the doctor before starting any new medication. A patient's tolerance for alcohol will be diminished. Patients should refrain from drinking alcoholic beverages when taking lorazepam and for 24 to 48 hours after receiving an injection before a procedure.
When lorazepam is administered in a muscle or vein, it may interact with scopolamine , causing drowsiness, odd behavior, and hallucinations.
Debra Wood, R.N.
KEY TERMS
Hallucinations
—Seeing or hearing things that are not present
Tranquilizer
—In pharmacology, a drug that calms and relieves anxiety