Lorazepam

Brand names of lorazepam

• Alzapam
• Apo-Lorazepam
• Ativan
• Loraz
• Lorazepam Intensol
• Novo-Lorazem
• Novo-Lorazepam
• Nu-Loraz
• Riva-Lorazepam

Usage

To treat anxiety. The injection form of lorazepam, administered in a hospital setting, is used to treat a type of seizure disorder (status epilepticus) and is used before surgery to sedate patients prior to the administration of anesthesia.

How it works

In general, lorazepam produces mild sedation by depressing activity in the central nervous system. In particular, lorazepam appears to enhance the effect of gamma aminobutyric acid (GABA), a natural chemical that inhibits the firing of neurons and dampens the transmission of nerve signals, thus decreasing nervous excitation.

Side effects

Serious

• bleeding
• bruising
• confusion
• depression
• difficulty concentrating
• faintness
• fatigue
• fever and chills
• hallucinations
• itching
• low blood pressure
• memory impairment
• muscle weakness
• outbursts of anger
• skin rash
• sore throat
• ulcers in mouth or throat
• yellowish tinge to eyes or skin

Common

• dizziness
• drowsiness
• lightheadedness
• loss of coordination
• slurred speech
• unsteady gait

Less common

• Change in sexual desire or ability
• constipation
• false sense of well-being
• fatigue
• nausea and vomiting
• urinary problems

Possible interactions

Other medicaments:

Lorazepam taken concurrently with:

• clozapine (Clozaril) may result in marked sedation and muscular incoordination.
• heparin may result in increased effects of lorazepam (increased free fraction).
• lithium (Lithobid, others) may result in a lowering of body temperature (hypothermic reaction).
• oxycodone (Percocet, others) and other central nervous system depressants may result in additive CNS or respiratory depression.
• phenytoin (Dilantin) or fosphenytoin (Cerebyx) may result in altered phenytoin or lorazepam levels.
• quetiapine (Seroquel) may increase lorazepam levels. Watch for increased drowsiness, dizziness or movement trouble.

The following medicaments may increase the effects of lorazepam:

• macrolide antibiotics.
• probenecid (Benemid)-may result in a 50% increased lorazepam level; decreased lorazepam doses or an increased time between doses are indicated.
• valproic acid (Depakene); decreased doses or an increased time between doses may be needed.

The following medicaments may decrease the effects of lorazepam:

• birth control pills (oral contraceptives).
• caffeine, amphetamines or other stimulants.
• theophylline (Theo-Dur, others).

Herbal medicines or minerals:

Kava and valerian may exacerbate central nervous system depression (avoid this combination). Kola nut, Siberian ginseng, mate, ephedra, hawthorn may blunt the benefits of this medicine. While St. John's wort is indicated for anxiety, it is also thought to increase (induce) cytochrome P450 enzymes and will tend to blunt lorazepam effectiveness. St. John's wort may also worsen sun sensitivity.

Beverages:

Avoid excessive caffeine-containing beverages: coffee, tea and cola.

Alcohol:

Alcohol increases depression of mental function, further worsens coordination and causes increased lorazepam levels.

Tobacco smoking:

Heavy smoking may reduce the calming action of this medicament.

Marijuana smoking:

Additive drowsiness and impaired physical performance.

Discontinuation:

Do not stop this medicament suddenly if it has been taken for over 4 weeks.

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