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Benzodiazepine

Lorazepam | Ativan

Clinical Overview

Lorazepam is a intermediate-acting benzodiazepine indicated for the management of anxiety disorders and short-term relief of anxiety symptoms. It is also used for preoperative sedation and status epilepticus treatment. Its intermediate duration of action and reliable absorption make it a preferred benzodiazepine in many clinical situations.

Primary Clinical Applications

Lorazepam is effective for generalized anxiety disorder, panic disorder, and situational anxiety. It is also commonly used in hospital settings for acute agitation, alcohol withdrawal, and as preoperative medication. Its predictable pharmacokinetics make it suitable for both acute and short-term chronic use.

Mechanism and Onset

Lorazepam enhances GABA activity at benzodiazepine receptors, producing anxiolytic, sedative, and anticonvulsant effects. Oral absorption is reliable with onset in 1-2 hours, while IV administration provides immediate effects for emergency situations.

Clinical Advantages

Unlike some benzodiazepines, lorazepam is not significantly affected by hepatic impairment and has no active metabolites, making it safer in elderly patients and those with liver disease.

Prescribing Information

Dosing & Administration

Anxiety Disorders – Adults:

  • Initial: 2-3 mg daily in divided doses (0.5-1 mg 2-3 times daily)
  • Range: 1-10 mg daily in divided doses
  • Maximum: 10 mg daily

Elderly or Debilitated:

  • Initial: 0.5-1 mg daily in divided doses
  • Titrate slowly based on response and tolerance

Insomnia (short-term):

  • Dose: 2-4 mg at bedtime

Preoperative Sedation:

  • IM: 0.05 mg/kg (maximum 4 mg) 2 hours before surgery
  • IV: 0.044 mg/kg (maximum 2 mg) 15-20 minutes before surgery

Indications

  • Anxiety disorders
  • Short-term relief of anxiety symptoms
  • Anxiety associated with depression
  • Preoperative sedation
  • Status epilepticus (IV)

Contraindications

  • Hypersensitivity to benzodiazepines
  • Acute narrow-angle glaucoma
  • Sleep apnea syndrome
  • Severe respiratory insufficiency
  • Myasthenia gravis

Warnings & Precautions

  • Boxed Warning: Risk of abuse, misuse, dependence; respiratory depression when combined with opioids
  • Physical and psychological dependence with prolonged use
  • Withdrawal syndrome with abrupt discontinuation
  • Cognitive impairment and falls risk in elderly
  • Respiratory depression, especially with concurrent CNS depressants

Drug Interactions

  • Opioids: Increased risk of respiratory depression and death
  • CNS depressants: Enhanced sedation and respiratory depression
  • Alcohol: Dangerous potentiation of effects
  • Probenecid: May increase lorazepam levels

Adverse Reactions

Common (>10%):

  • Sedation, dizziness, weakness, unsteadiness

Cognitive:

  • Memory impairment, confusion, depression

Serious:

  • Respiratory depression, paradoxical reactions, dependence

Special Populations

  • Elderly: Start with 0.5-1 mg daily, increased fall risk
  • Hepatic Impairment: No dose adjustment needed (not hepatically metabolized)
  • Pregnancy: Category D – avoid in pregnancy
  • Lactation: Enters breast milk, use caution
Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. Always consult with qualified healthcare professionals before making any treatment decisions. Individual patient circumstances may vary significantly.