|Apo®-Lorazepam; Novo-Lorazepam; Nu-Loraz;
Oral: Management of anxiety disorders or short-term relief of the symptoms of
anxiety or anxiety associated with depressive symptoms
I.V.: Status epilepticus, preanesthesia
Unlabeled uses: Alcohol detoxification; insomnia; psychogenic
catatonia; partial complex seizures; antiemetic adjunct
Clinical effects on the fetus: Crosses the placenta. Respiratory depression
or hypotonia if administered near time of delivery.
Breast-feeding/lactation: Crosses into breast milk and no data on clinical
effects on the infant. American Academy of Pediatrics states MAY BE OF CONCERN.
Hypersensitivity to this drug or any component of its formulation
(cross-sensitivity with other benzodiazepines may exist); acute narrow-angle
glaucoma; sleep apnea (parenteral); intra-arterial injection of parenteral
formulation; severe respiratory insufficiency (except during mechanical
Use with caution in elderly or debilitated patients, patients with hepatic
disease (including alcoholics) or renal impairment. Use with caution in patients
with respiratory disease or impaired gag reflex. Initial doses in elderly or
debilitated patients should not exceed 2 mg. Prolonged lorazepam use may have a
possible relationship to GI disease, including esophageal dilation.
Causes CNS depression (dose-related) resulting in sedation, dizziness,
confusion, or ataxia which may impair physical and mental capabilities. Patients
must be cautioned about performing tasks which require mental alertness (ie,
operating machinery or driving). Use with caution in patients receiving other
CNS depressants or psychoactive agents. Effects with other sedative drugs or
ethanol may be potentiated. Benzodiazepines have been associated with falls and
traumatic injury and should be used with extreme caution in patients who are at
risk of these events (especially the elderly).
Lorazepam may cause anterograde amnesia. Paradoxical reactions, including
hyperactive or aggressive behavior have been reported with benzodiazepines,
particularly in adolescent/pediatric or psychiatric patients. Does not have
analgesic, antidepressant, or antipsychotic properties.
Use caution in patients with depression, particularly if suicidal risk may be
present. Use with caution in patients with a history of drug dependence.
Benzodiazepines have been associated with dependence and acute withdrawal
symptoms on discontinuation or reduction in dose. Acute withdrawal, including
seizures, may be precipitated after administration of flumazenil to patients
receiving long-term benzodiazepine therapy.
As a hypnotic agent, should be used only after evaluation of potential causes
of sleep disturbance. Failure of sleep disturbance to resolve after 7-10 days
may indicate psychiatric or medical illness. A worsening of insomnia or the
emergence of new abnormalities of thought or behavior may represent unrecognized
psychiatric or medical illness and requires immediate and careful evaluation.
Central nervous system: Sedation
Respiratory: Respiratory depression
1% to 10%:
Central nervous system: Confusion, dizziness, akathisia, unsteadiness,
headache, depression, disorientation, amnesia
Dermatologic: Dermatitis, rash
Gastrointestinal: Weight gain or loss, nausea, changes in appetite
Neuromuscular & skeletal: Weakness
Respiratory: Nasal congestion, hyperventilation, apnea
<1%: Menstrual irregularities, increased salivation, blood dyscrasias,
reflex slowing, physical and psychological dependence with prolonged use
Symptoms of overdose include confusion, coma, hypoactive reflexes, dyspnea,
Treatment for benzodiazepine overdose is supportive. Rarely is mechanical
ventilation required. Flumazenil has been shown to selectively block the binding
of benzodiazepines to CNS receptors, resulting in a reversal of
benzodiazepine-induced CNS depression but not respiratory depression. Treatment
requires support of blood pressure and respiration until drug effects subside.
Alcohol and other CNS depressants may increase the CNS effects of lorazepam
Oral contraceptives may increase the clearance of lorazepam
Lorazepam may decrease the antiparkinsonian efficacy of levodopa
Scopolamine in combination with parenteral lorazepam may increase the
incidence of sedation, hallucinations, and irrational behavior
Theophylline and other CNS stimulants may antagonize the sedative effects of
There are rare reports of significant respiratory depression, stupor, and/or
hypotension with concomitant use of loxapine and lorazepam. Use caution if
concomitant administration of loxapine and CNS drugs is required.
Intact vials should be refrigerated, protected from light; do not use
discolored or precipitate containing solutions
May be stored at room temperature for up to 60 days
Stability of parenteral admixture at room temperature
(25°C): 24 hours
Standard diluent: 1 mg/100 mL D5W
I.V. is incompatible when administered in the same line with
foscarnet, ondansetron, sargramostim
Binds to stereospecific benzodiazepine receptors on the postsynaptic GABA
neuron at several sites within the central nervous system, including the limbic
system, reticular formation. Enhancement of the inhibitory effect of GABA on
neuronal excitability results by increased neuronal membrane permeability to
chloride ions. This shift in chloride ions results in hyperpolarization (a less
excitable state) and stabilization.
Onset of hypnosis: I.M.: 20-30 minutes
Onset of sedation, anticonvulsant: I.V.: 5 minutes; oral: 30 minutes to 1
Duration: 6-8 hours
Absorption: Oral, I.M.: Prompt following administration
Distribution: Crosses the placenta; appears in breast milk
Neonates: 0.76 L/kg
Adults: 1.3 L/kg
Protein binding: 85%, free fraction may be significantly higher in elderly
Metabolism: In the liver to inactive compounds
Neonates: 40.2 hours
Older Children: 10.5 hours
Adults: 12.9 hours
Elderly: 15.9 hours
End-stage renal disease: 32-70 hours
Elimination: Urinary excretion and minimal fecal clearance
Children 2-15 years: I.V.: 0.05 mg/kg (up to 2 mg/dose) prior to chemotherapy
Adults: Oral, I.V.: 0.5-2 mg every 4-6 hours as needed
Anxiety and sedation:
Infants and Children: Oral, I.V.: Usual: 0.05 mg/kg/dose (range: 0.02-0.09
mg/kg) every 4-8 hours
Adults: Oral: 1-10 mg/day in 2-3 divided doses; usual dose: 2-6 mg/day in
Elderly: 0.5-4 mg/day
Insomnia: Adults: Oral: 2-4 mg at bedtime
I.M.: 0.05 mg/kg administered 2 hours before surgery; maximum: 4 mg/dose
I.V.: 0.044 mg/kg 15-20 minutes before surgery; usual maximum: 2 mg/dose
Operative amnesia: Adults: I.V.: Up to 0.05 mg/kg; maximum: 4 mg/dose
Status epilepticus: I.V.:
Infants and Children: 0.1 mg/kg slow I.V. over 2-5 minutes, do not exceed 4
mg/single dose; may repeat second dose of 0.05 mg/kg slow I.V. in 10-15 minutes
Adolescents: 0.07 mg/kg slow I.V. over 2-5 minutes; maximum: 4 mg/dose; may
repeat in 10-15 minutes
Adults: 4 mg/dose given slowly over 2-5 minutes; may repeat in 10-15 minutes;
usual maximum dose: 8 mg
Rapid tranquilization of agitated patient (administer every 30-60 minutes):
Oral: 1-2 mg
I.M.: 0.5-1 mg
Average total dose for tranquilization: 4-8 mg
Alcohol: Additive CNS depression has been reported with benzodiazepines;
avoid or limit alcohol
Respiratory and cardiovascular status, blood pressure, heart rate, symptoms
Therapeutic: 50-240 ng/mL (SI: 156-746 nmol/L)
May increase the results of liver function tests
|Dental Health: Local
No information available to require special precautions
Effects on Dental Treatment|
>10% of patients experience dry mouth (normal salivary flow returns with
cessation of drug therapy)
Oral: Take exactly as directed (do not increase dose or frequency); may cause
physical and/or psychological dependence. Do not use excessive alcohol or other
prescription or OTC medications (especially pain medications, sedatives,
antihistamines, or hypnotics) without consulting prescriber. Maintain adequate
hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). You
may experience drowsiness, lightheadedness, impaired coordination, dizziness, or
blurred vision (use caution when driving or engaging in tasks requiring
alertness until response to drug is known); nausea, vomiting, or dry mouth
(small frequent meals, frequent mouth care, chewing gum, or sucking lozenges may
help); constipation (increased exercise, fluids, or dietary fruit and fiber may
help); altered sexual drive or ability (reversible); or photosensitivity (use
sunscreen, wear protective clothing and eyewear, and avoid direct sunlight).
Report persistent CNS effects (eg, confusion, depression, increased sedation,
excitation, headache, agitation, insomnia or nightmares, dizziness, fatigue,
impaired coordination, changes in personality, or changes in cognition); changes
in urinary pattern; chest pain, palpitations, or rapid heartbeat; muscle
cramping, weakness, tremors, or rigidity; ringing in ears or visual
disturbances; excessive perspiration, or excessive GI symptoms (cramping,
constipation, vomiting, anorexia); or worsening of condition.
Pregnancy/breast-feeding precautions: Do not get pregnant while taking this
medication; use appropriate barrier contraceptive measures. Breast-feeding is
Keep injectable form in the refrigerator; inadvertent intra-arterial
injection may produce arteriospasm resulting in gangrene which may require
amputation; emergency resuscitative equipment should be available when
administering by I.V.; prior to I.V. use, lorazepam injection must be diluted
with an equal amount of compatible diluent; injection must be made slowly with
repeated aspiration to make sure the injection is not intra-arterial and that
perivascular extravasation has not occurred; provide safety measures (ie, side
rails, night light, and call button); supervise ambulation
Injection: 2 mg/mL (1 mL, 10 mL); 4 mg/mL (1 mL, 10 mL)
Solution, oral concentrated, alcohol and dye free: 2 mg/mL (30 mL)
Tablet: 0.5 mg, 1 mg, 2 mg
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