DESCRIPTION
Lorazepam, a benzodiazepine drug, is an antianxiety drug primarily used to relieve anxiety in affected persons, although your doctor may prescribe this drug for other reasons, such as alcohol withdrawal psychosis or delirium and for tension-type headache. Side effects of lorazepam include drowsiness, dizziness, tiredness, weakness, memory loss, diarrhea, upset stomach, and appetite changes.

Benzodiazepine-type drugs are fast acting and offer a sedative effect; they are considered to be the mainstay treatment for mild-to-moderate alcohol withdrawal. However, long-term use of benzodiapines is associated with dependence and may result in withdrawal when the drug is stopped.

ORIGINAL USES (ON-LABEL)
Management of anxiety disorders or short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms, intravenous lorazepam is used for certain types of seizures, preanesthesia for desired amnesia and in combination therapy to prevent vomiting.

NEWLY DISCOVERED USES (OFF-LABEL)
Acute cisplatin-induced nausea and vomiting, acute schizophrenia, alcohol withdrawal, labyrinthitis, oculogyric crisis, panic attack, tension headache treatment.

POTENTIAL SIDE EFFECTS
Sedation, respiratory depression, low blood pressure, confusion, dizziness, skin reaction, rash, weight gain/loss, nausea, changes in appetite, weakness, nasal congestion, hyperventilation, amnesia, sedation, light headedness, sleepiness, dry mouth, blurred vision, double vision.

CAUTIONS
  • Notify your doctor if you have had an allergic reaction to other benzodiazepines.
  • Not for use if you have acute narrow-angle glaucoma, sleep apnea, or severe respiratory depression.
  • Careful monitoring or reduced doses are needed in elderly or debilitated patients and those with liver or kidney impairment.
  • Inform your doctor if you have a respiratory disease or impaired gag reflux.
  • Prolonged use can result in dependence. Inform your doctor if you have a history of drug dependence.
  • Caution in operating machinery or driving due to sedative properties of lorazepam.
  • Use caution in patients using other central nervous system depressants or psychoactive drugs.
  • This drug may cause amnesia.
  • Paradoxical reactions, including hyperactive or aggressive behavior have been reported with this drug class.
  • Use caution if you have depression, particularly if you have suicidal risk.
  • Do not stop therapy abruptly. Acute withdrawal symptoms on discontinuation or reduction in dose can occur.
  • Lorazepam should only be used as a hypnotic drug only after evaluation of potential causes of sleep disturbance.
DRUG INTERACTIONS
Other central nervous system (CNS) depressants, scopolamine, loxapine, levodopa, oral contraceptives, theophylline, probenecid, rifampin, digoxin, phenytoin, neuromuscular blocking drugs.

FOOD INTERACTIONS
Alcohol

HERBAL INTERACTIONS
Valerian, St. John’s wort, kava kava, gotu kola

PREGNANCY AND BREAST-FEEDING CAUTIONS
FDA Pregnancy Risk Category D. Excreted in the breast milk and is not for use while breast-feeding.

SPECIAL INFORMATION
May result in drowsiness. Avoid driving or other tasks that require alertness. May be taken with food if stomach upset occurs. Do not stop therapy abruptly or change dose without notifying your doctor.

TREATMENT OF ALCOHOL WITHDRAWAL SYNDROME
A clinical trial comparing patient responses to the benzodiazepine drugs lorazepam and carbamazepine was conducted by researchers at the substance abuse clinic at the Medical University of South Carolina. Patients with moderate alcohol withdrawal syndrome received carbamazepine (Tegretol) or Ativan on day one, and then reduced dosages of Tegretol or lorazepam. In this study, both drugs were equally effective at decreasing the symptoms of alcohol withdrawal. In the post-treatment period, 89 patients drank on at least one day. Carbamazepine-treated patients drank less than one drink per drinking day (on average) and lorazepam patients drank almost three drinks per drinking day.

In those patients with multiple previous detoxifications, the carbamazepine group drank less than one drink per day (on average) and the lorazepam group drank about five drinks per day (on average). Lorazepam-treated patients had a significant rebound of alcohol withdrawal symptoms post-treatment, and the risk of having a first drink was three times greater compared with the carbamazepine-treated patients. Researchers concluded that Tegretol was superior to lorazapam in preventing rebound withdrawal symptoms and decreasing post-treatment drinking.

TREATMENT OF TENSION HEADACHE
In general, benzodiazepines cause sedation and are habit forming; therefore, their use requires close monitoring by doctors. They are considered a last resort and not a first choice for the management of tension-type headache. An article in a medical journal noted that two trials found insufficient evidence regarding the effects of benzodiazepine-type drugs compared with placebo and other treatments for tension-type headache. The researcher also emphasized that regular use of benzodiazepine drugs has adverse effects and concluded that they are ineffective or harmful for chronic tension headache. Even though benzodiazepines, such as lorazepam, have been used to treat tension-type headache, controlled trials are quite limited in the medical literature.

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What is Ativan?
Lorazepam is used to manage excitable states in patients. It works by binding to specific benzodiazepine receptors.
BRAND NAME
Lorazepam Intensol, Ativan

GENERIC NAME
Lorazepam

CHEMICAL CLASS
Benzodiazepine

THERAPEUTIC CLASS
Antianxiety, anticonvulsant, sedative (benzodiazepine)
AVAIL FORMS
Tablets — Oral 1 mg, 2 mg.
DOSAGE
Adult
Anxiety: PO 2-6 mg/day in divided doses bid-tid; largest dose at hs; not to exceed 10 mg/day
Insomnia: PO 2-4 mg hs; only minimally effective after 2 wk continuous therapy
Elderly: 1-2 mg/day in divided doses
Child
Not recommended PO <12 yr

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