Benzodiazepines (Systemic)

Antianxiety agent, Sedative-hypnotic, Antipanic agent, Skeletal muscle relaxant adjunct, Antitremor agent

lorazepam indicated for adjunctive management of anxiety associated with mental depression, also used for relief of acute alcohol withdrawal symptoms and for treatment of tension headache.

FDA Pregnancy Category D

Lorazepam is assumed to cross the placenta because of their similarity to the other benzodiazepines.

Breast-feeding

Lorazepam is assumed to be distributed into breast milk because of their similarity to the other benzodiazepines.

Patients sensitive to one of the benzodiazepines may be sensitive to the other benzodiazepines also.

Contraindications

Except under special circumstances, this medication should not be used when following medical problem exist:

Glaucoma, acute narrow angle, Hypersensitivity to the benzodiazepine prescribed or to any other benzodiazepine or any component of the product.

Risk-benefit should be considered when the following medical problems exist:

Alcohol intoxication, acute, with depressed vital signs, Coma, Shock, Drug abuse or dependence history of, Glaucoma, open angle, Hepatic function impairment

 (elimination half-life may be prolonged; minimal effect with lorazepam), Hyperkinesis, Mental depression, severe, Myasthenia gravis, Organic brain disorders, Psychoses, Pulmonary disease, severe chronic obstructive, Renal function impairment, Sleep apnea, established or suspected.

Drug Interaction

Alcohol or CNS depression-producing medications, (when a benzodiazepine is used with an opioid analgesic, the dosage of the opioid analgesic should be reduced by at least one third and administered in small increments),Cimetidine, oral estrogen-containing contraceptives, diltiazem, disulfiram, erythromycin, fluoxetine, fluvoxamine, grapefruit juice, itraconazole, ketoconazole, nefazodone, propoxyphene, ranitidine, and verapamil, which inhibit the oxidative metabolism of benzodiazepines, are less likely to affect lorazepam, which undergoes glucuronide conjugation.

Fentanyl derivatives (Premedication with lorazepam may decrease dose of a fentanyl derivative required for induction of anesthesia and reduce time to loss of consciousness with induction doses.)

Probenecid may impair glucuronide conjugation of lorazepam, resulting in increased effects and possibly excessive sedation.

Antianxiety agent-

Oral, 1 to 3 mg two or three times a day.

Note: Debilitated patients- Oral, initially 0.5 to 2 mg per day in divided doses, the dosage being increased gradually as needed and tolerated.

Sedative-hypnotic -

Oral, 2 to 4 mg as a single dose at bedtime.

Note:  Elderly and debilitated patients may require a lower dose.

Antianxiety agent or Sedative-hypnotic -

Children younger than 12 years of age: Safety and efficacy have not been established.

Incidence less frequent:

Anterograde amnesia, anxiety, confusion, mental depression, tachycardia/palpitation

Incidence rare:

Abnormal thinking; including delusions, depersonalization, or disorientation; allergic reaction, behavior changes; including bizarre behavior; or decreased inhibition; blood dyscrasias, including agranulocytosis, anemia, leukopenia, neutropenia, thrombocytopenia,  extrapyramidal effects, dystonic, hepatic dysfunction, hypotension, muscle weakness; paradoxical reactions; Benzodiazepine treatment should be discontinued if a paradoxical reaction occurs, including agitation, aggressive behavior; hallucinations, hostility or rage; insomnia; unusual excitement, irritability, or nervousness; phlebitis or venous thrombosis.

Store below 30°C (86°F).

Protect from light and keep the medicine in the box.

Boxes of 100 Lorazepam Scored Tablets 1 & 2 mg