Lorazepam

Lorazepam is a benzodiazepine used to treat anxiety disorders or provide temporary relief from anxiety symptoms. It can be used(off-label) to treat a variety of diseases, including social phobia, post-traumatic stress disorder, agitation in acute mania and psychosis, acute alcohol withdrawal, and more. 

How does Lorazepam work?

Lorazepam binds to certain receptor sites in the brain. On the membrane of nerve cells, receptors are particular locations that receive signals from neurotransmitters, which are neurochemicals. The signal is converted to an electrical or other chemical signal by a neurotransmitter once it binds to the receptor and proceeds down the neuron. 

• These are also called benzodiazepine receptors. 

What is the recommended dose of Lorazepam?

Lorazepam’s recommended starting dosage is 0.5 mg three times per day. It can then be increased to a therapeutic dosage of 4-6 mg per day, divided into two doses. The dosage may be increased up to a maximum of 8 mg per day, depending on how severe the symptoms are.

What happens if you take an overdose of Lorazepam?

Oral benzodiazepine overdoses are rarely lethal. Benzodiazepines sometimes cause mortality when taken with other CNS depressants, particularly alcohol, narcotics, and barbiturates. 

Drowsiness, confusion, somnolence, weariness, dropped coordination, clumsiness while walking (ataxia), and sluggish reflexes are some of the mild indications of benzodiazepine overdose. When taken alone, benzodiazepines hardly cause death. When some drugs participate in benzodiazepine overdose, severe symptoms such as trouble breathing, slowing heart rate, decreased blood pressure, lack of coordination, and loss of consciousness lead to coma and death. 

• Every potential overdose should be considered an emergency at the ER. The prescription bottle of the drug along with any extra drugs linked to the overdose should also be brought, as the data on the prescription label can help the treating physician estimate the quantity of pills consumed.

What are the side effects of Lorazepam?

Sedation and drowsiness are the most often reported, particularly in the early stages of therapy. Other common symptoms include difficulty focusing and remembering things, a dissociative or “spacey” feeling, and trouble with coordination.

• Constipation, change in appetite, decreased interest in sexual intercourse.

In some individuals, benzodiazepines may possess paradoxical effects. In susceptible individuals, the drug stimulates enthusiasm, aggression, hostility, uncontrolled behavior, and wrath, rather than the expected depressive effects. These reactions are especially common in the elderly, people with brain injuries, and people with personality and impulse control difficulties. 

• Dizziness, headache, nausea, Facial or muscle twitching, Muscle weakness, balance disorder, painful or difficult urination, slow heart rate, slow breathing, chills, and dark urine.

What are the precautions for Lorazepam usage?

• Lorazepam, like other benzodiazepines, is categorized as a restricted substance due to its potential for misuse and dependence, according to state and federal laws.
• Lorazepam impairs awareness and coordination; therefore, patients should use caution when driving or performing other tasks that require alertness while taking this medicine.

Seniors may be more vulnerable due to impaired coordination and reflexes, perhaps leading to falls and injuries.

• Co-administration with other central nervous system (CNS) depressants such as alcohol, opioids, and barbiturates may exacerbate these CNS effects. So quit drinking while taking the drug.
• Prolonged usage of benzodiazepines could end in dependence. When the medicine is abruptly stopped, withdrawal symptoms may appear. Headaches, vomiting, decreased attention, confusion, tremors, muscle cramps, and seizures are among the withdrawal symptoms.
• Benzodiazepines are systemic acting depressants that might reduce breathing. This is especially challenging for people with chronic obstructive lung disease and emphysema. The respiratory depressive effect of benzodiazepines may further suppress respiratory drive in these patients, putting them at greater risk for respiratory depression and death.

If you miss a dose, take it right away. If it is near the next planned dose, cancel the missed dose and resume your normal dosing schedule. Avoid taking double the prescribed dose. Lorazepam can be taken before or after meals.

• Keep the medication in the original labeled, light-resistant container, away from heat and moisture, to avoid drug degradation by them.
• Keep Lorazepam away from your children.

What are the effects of Lorazepam on pregnancy and lactation?

• Lorazepam is classified as Pregnancy category D.

Benzodiazepines and their metabolites are known to cross the placenta and accumulate in the fetal circulation. They are associated with a risk of congenital malformations when used during pregnancy, causing cleft lip and heart deformities in the fetus.

•  Benzodiazepines such as lorazepam should be avoided during pregnancy, particularly in the first trimester. The use of benzodiazepines during pregnancy should be considered only when the need for the medication outweighs its risk and alternative therapies have failed.

Nursing mothers should not take Lorazepam because it will pass into breast milk and be ingested by the baby. If stopping the drug is not an alternative, breastfeeding should not be started or should be discontinued.

What drugs are contraindicated with lorazepam?

Lorazepam is excreted hepatically by cytochrome P450 by glucuronidation to give an inactive metabolite.

• So coadministration of any Cytochrome P450 inhibitors, inducers, or metabolites could affect its excretion and concentration.

CNS depressants (alcohol, narcotics, barbiturates, and hypnotics) and antihistamines could affect coordination and breathing while increasing drowsiness. Taking lorazepam with oral contraceptives may raise its clearance rate, potentially reducing its effectiveness.

Cimetidine, fluoxetine, ketoconazole, propranolol, divalproex sodium, propoxyphene, and disulfiram; may inhibit the metabolism of Lorazepam, thus increasing the level and pharmacological effects of the drug and producing excessive sedation and other adverse CNS effects.  

• Lorazepam may raise digoxin levels in the blood, which may contribute to toxicity. Patients should have their digoxin levels constantly monitored when taking lorazepam.