1. Drug Overview
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Generic Name: Lorazepam
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Brand Name: Ativan®
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Strength: 2mg per tablet
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Drug Class: Benzodiazepine (Anxiolytic/Sedative-Hypnotic)
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Schedule: C-IV Controlled Substance (Risk of Abuse/Dependence)
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Manufacturer: Bausch Health Companies Inc.
2. Therapeutic Indications
✔ Anxiety Disorders: Short-term relief of anxiety symptoms (GAD, panic disorder)
✔ Insomnia: Management of sleep disturbances (short-term use only)
✔ Preoperative Sedation: Anxiolysis before surgery/procedures
✔ Status Epilepticus: IV form used for acute seizures (tablet not for this use)
3. Dosage & Administration
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Adults (Anxiety):
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Initial dose: 2–3 mg/day in divided doses (e.g., 0.5–1mg 2–3x daily)
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Max dose: 10 mg/day (rarely needed)
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Elderly/Debilitated Patients:
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Start with 0.5–1 mg/day (increased sensitivity)
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Administration:
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Take orally with/without food
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Avoid abrupt discontinuation (taper to prevent withdrawal)
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4. Mechanism of Action
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GABA-A Receptor Potentiation: Enhances inhibitory neurotransmitter effects → sedation, anxiolysis, muscle relaxation
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Peak Effect: 2 hours (oral)
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Half-Life: 10–20 hours
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Duration: 6–8 hours (acute dosing)
5. Contraindications
❌ Acute narrow-angle glaucoma
❌ Severe respiratory depression (e.g., COPD, sleep apnea)
❌ Pregnancy (Risk of fetal harm, esp. 1st trimester)
❌ Hypersensitivity to benzodiazepines
❌ Concurrent use with opioids (increased respiratory depression risk)
6. Warnings & Precautions
⚠ Risk of Dependence/Addiction:
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Limit to short-term use (2–4 weeks)
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Taper dose to avoid withdrawal (seizures, rebound anxiety)
⚠ CNS Depression: -
Avoid alcohol, opioids, other sedatives
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Impaired driving/alertness
⚠ Paradoxical Reactions: -
Agitation, aggression, hallucinations (esp. in elderly)
⚠ Suicidal Ideation: Monitor in depression/anxiety patients
7. Adverse Effects
Common (≥1%):
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Sedation, dizziness, weakness
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Ataxia, confusion (elderly)
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Memory impairment (“benzodiazepine amnesia”)
Serious (Seek Medical Help):
❗ Respiratory depression (esp. with opioids)
❗ Severe hypotension
❗ Dependence/withdrawal seizures
❗ Suicidal behavior
8. Drug Interactions
🚫 Opioids (fentanyl, oxycodone): ↑ Respiratory depression (potentially fatal)
🚫 Alcohol: ↑ Sedation/overdose risk
🚫 CNS Depressants (antihistamines, barbiturates): Additive effects
🚫 Probenecid/Valproate: ↑ Lorazepam levels
9. Special Populations
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Hepatic Impairment: Reduce dose (lorazepam is hepatically metabolized)
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Elderly: Start low (0.5mg), ↑ fall risk
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Pregnancy: Category D (avoid; risk of neonatal withdrawal/floppy infant syndrome)
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Breastfeeding: Excreted in milk (avoid or monitor infant for sedation)
10. Overdose Management
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Symptoms: Extreme drowsiness, coma, respiratory arrest
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Treatment:
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Flumazenil (Romazicon®) for reversal (caution in benzo-dependent patients)
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Supportive care (airway management)
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11. Storage & Handling
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Temperature: 20–25°C (68–77°F)
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Packaging: Blister packs or bottles (light-resistant)
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DEA Requirements: Secure storage (C-IV controlled substance)
12. Patient Counseling Points
✔ Do not stop suddenly (taper under medical supervision)
✔ Avoid alcohol
✔ Report worsening anxiety/suicidal thoughts
✔ Do not drive/operate machinery until effects known
Prescribing Reminder: Short-term use only (reevaluate after 2–4 weeks). Consider non-pharmacologic therapies (CBT) for chronic anxiety.
