Lorazepam (Ativan), like alprazolam, is a short-acting benzodiazepine drug.

It is used to treat patients with insomnia, anxiety, and status epilepticus.

Lorazepam (Ativan) Uses:

• Anxiety (oral):

  • It helps with handling anxiety problems or quickly easing anxiety that lasts for a short time, like less than 4 months.

• Procedural anxiety, premedication (injection):

  • Additionally, doctors who specialize in anesthesia use it before procedures in adults to reduce memory and induce forgetfulness, as well as to make them feel sleepy and less anxious.

• Status epilepticus (injection):

  •  

    It plays a crucial part in treating status epilepticus.

  • Moreover, it can be used off-label to treat seizures that haven't progressed to status epilepticus yet.

• Off Label Use of Lorazepam in Adults:

  • Akathisia caused by using antipsychotic medications.
  • Symptoms of alcohol withdrawal.
  • Catatonia, a state of unresponsiveness in movement and thought.
  • Nausea and vomiting induced by chemotherapy.
  • Trouble falling asleep, staying asleep, or insomnia.
  • Management of intoxication from substances like cocaine and methamphetamine.
  • Neuroleptic malignant syndrome, a serious reaction to antipsychotic drugs.
  • Withdrawal symptoms from opioids. Addressing sedation or agitation during critical illness.
  • Serotonin syndrome, a condition of excessive serotonin levels.
  • Treatment for acute episodes of vertigo.

Lorazepam (Ativan) Dose in Adults:

Note:

• It's not recommended for people at risk of substance abuse or addiction.
• However, it can be used in urgent situations, like emergencies such as acute agitation or status epilepticus.

Lorazepam (Ativan) Dose in the treatment of antipsychotic-induced Akathisia (alternative agent) (off-label):

• Start with 0.5 to 1 mg twice a day, either through intravenous (IV) or oral administration.
• Depending on how well it works and how well it is tolerated, the dose can be increased up to 10 mg per day.

Lorazepam (Ativan) Dose in the treatment of Anxiety:

• Anxiety and agitation, acute/severe (monotherapy or adjunctive therapy):

  • For intramuscular (IM), intravenous (IV), or oral administration, you can give up to 10 mg per day as needed, in doses of 0.5 to 2 mg every 4 to 6 hours.

  • Depending on how the patient responds and tolerates the medication, the dose can be adjusted.

  • Some experts suggest doses up to 4 mg, and if patients are highly agitated in a hospital setting, IM or IV doses can be repeated every 10 to 30 minutes.

  • It can be used alone or in combination with antipsychotic medications.

• Anxiety disorder (monotherapy or adjunctive therapy) (alternative agent):

  • It's usually used for a short period, typically less than 12 weeks, to quickly relieve symptoms while other medications take effect.
  • Long-term use is considered only if other treatments aren't effective or are poorly tolerated by the patient.
  • When taken orally, it can start with 0.5 to 1 mg twice or three times a day.
  • The dose can be gradually increased up to 6 mg per day in 2 to 4 divided doses, based on how well the patient responds and tolerates it.
  • In some cases, doses of up to 10 mg per day may be needed for a necessary response.

Lorazepam (Ativan) Dose in the treatment of Advanced cancer and/or palliative care:

• It can be given through intramuscular (IM), intravenous (IV), or oral routes at doses of 0.25 to 2 mg every 3 to 6 hours, depending on the need.
• When other methods are not available, the pill and oral solution can also be placed under the tongue (sublingually) at the same doses.
• The injectable solution may be given rectally or subcutaneously.

Lorazepam (Ativan) Dose in the treatment of Performance- or phobia-related anxiety (monotherapy or adjunctive therapy):

Note: To make sure the drug is well-tolerated, a test dose should be given at the same dosage recommended for the actual therapy.

When taken orally, it can be administered as 0.5 to 2 mg about 30 to 60 minutes before the stimulus.

• Procedural anxiety (premedication) (off-label):

  • Oral, Sublingual:

    • A single dose of 0.5 to 2 mg should be administered 30 to 90 minutes before the surgery.

    • If the response is not enough, another dose can be given after 30 to 60 minutes, but this time at half the dosage of the first one.

  • IV:

    • A single dose of 1 to 4 mg, or 0.02 to 0.04 mg/kg, should be given 5 to 20 minutes before surgery, with a maximum allowed single dose of 4 mg.

    • If needed, the dose can be repeated at half the initial dose after more than 5 minutes if an incomplete reaction and longer procedure time suggest it.

    • It's important to note that dosing not based on weight should be taken into account for obese patients.

Lorazepam (Ativan) Dose in Catatonia (off-label):

• Diagnosis:

  • After the injection, there might be a brief, partial improvement of symptoms, which aligns with the diagnosis.

  • A negative or lack of response does not rule out catatonia.

  • For intravenous (IV) administration, in catatonia, it's recommended to give 1 to 2 mg only once.

  • If there is no response after 5 to 10 minutes, the dose can be repeated only once.

  • For intramuscular (IM), oral, or sublingual administration, a one-time dose of 2 mg can be given.

  • Two additional doses can be administered, each three hours apart, if necessary.

• Treatment:

  • For patients with malignant catatonia, electroconvulsive therapy should be initiated promptly.

  • When administered through intramuscular (IM), intravenous (IV), or oral routes, start with 1 to 2 mg three times daily.

  • Initially, it's best to administer the dosage intravenously and then switch to oral as the patient's condition improves.

  • To achieve the typical dose of 6 to 21 mg per day, the dose can be increased in increments of 3 mg every one to two days based on the patient's response and tolerance.

  • Doses up to 30 mg per day have been reported.

  • Some clinicians suggest starting with a dose of 0.5 mg three times daily if there's a concern about oversedation or respiratory suppression.

  • The duration of treatment can lead to remission within 4 to 10 days.

  • While longer courses may be necessary, maintenance therapy at the effective dose is often continued for 3 to 6 months to sustain recovery.

Lorazepam (Ativan) Dose in Chemotherapy-induced nausea and vomiting for prevention and treatment (as adjunctive therapy) (off-label):

• Anticipatory or breakthrough nausea/vomiting, as an adjunct to conventional antiemetics:

  • When administered orally, intravenously, or sublingually, the medication is given at a dosage of 0.5 to 2 mg every 6 hours, as needed.

Lorazepam (Ativan) Dose in the alternative treatment of Insomnia (for sleep-onset or sleep-maintenance):

• Typically, it is intended for short-term use, ideally in combination with nonpharmacologic treatments, for a period of less than 4 to 8 weeks.

• Chronic use is only recommended when nonpharmacologic treatments are unavailable or ineffective, and the benefits are considered to outweigh the risks.

• Some studies have discouraged the long-term use of midazolam for managing insomnia.

• The oral dosage is 0.5 to 2 mg at bedtime.

Lorazepam (Ativan) Dose in Intoxication:

• Cocaine, methamphetamine, and other sympathomimetics (off-label use):

• Based on limited data:

• Intravenous (IV): Administered as needed for agitation, sedation, seizures, hypertension, and tachycardia, the medication is given as 2 to 4 mg every 3 to 10 minutes until the desired symptom management is achieved.

• In some cases, large repeated doses may be necessary.

• Watch out for respiratory depression and hypotension as they can occur.

• It's important to note that in individuals who are only weakly or moderately inebriated, starting treatment at 1 mg may be sufficient, but dosages should be repeated or increased as necessary.

• If intravenous access is not possible, consider intramuscular (IM) administration. This may delay the onset of the required responses.

Lorazepam (Ativan) Dose in the treatment of Neuroleptic malignant syndrome (adjunctive therapy) (off-label):

• It is used off-label for patients with severe symptoms, such as hyperthermia and evidence of rhabdomyolysis, or for those who do not respond to discontinuing the initial medication and supportive care.

• It is administered intramuscularly (IM) or intravenously (IV) at a dose of 0.5 to 2 mg every 4 to 6 hours until the symptoms subside.

Lorazepam (Ativan) Dose as an alternative agent in the treatment of Sedation/agitation, critical illness (off-label):

• For treating muscular stiffness, it is recommended to use higher doses, such as 1 to 2 mg.

• To achieve a mild level of sedation, titrate the dose of midazolam, for example, using the Richmond Agitation-Sedation Scale from 0 to 2.

• To prevent oversedation, intermittent dosing as needed therapy is advised, while a fixed dose is preferable for obese individuals. Some people use Ideal Body Weight (IBW) for weight-based dosing.

• Avoid using propylene glycol (PG) in infusion form in ICU settings due to potential buildup and related consequences like osmolal gap metabolic acidosis and kidney failure. Monitor PG accumulation using the osmolal gap.

• Continuous infusions of midazolam or nonbenzodiazepines are generally preferred.

• Intermittent (preferred):

  • Fixed-dose:

    • It can be administered intravenously (IV) with an initial dose of 1 to 4 mg, followed by a maintenance dose of 1 to 4 mg every 2 to 6 hours, as needed.

  • Weight-based:

    • For intravenous (IV) administration, a maintenance dose of 0.02 to 0.06 mg/kg can be given every 2 to 6 hours, with a maximum single dose of 4 mg.

    • The initial dose can vary from 0.02 to 0.04 mg/kg, also with a maximum single dose of 4 mg.

  • Continuous:
    • In continuous infusion, it is administered at a rate of 0.01 to 0.1 mg/kg/hour, with a maximum dose of up to 10 mg/hour.

Lorazepam (Ativan) Dose in the Seizures:

Since intramuscular (IM) lorazepam has unpredictable absorption and a long time to reach its peak drug levels, it is not recommended if intravenous (IV) access is not available.

Lorazepam can be administered sublingually, subcutaneously, or intravenously (IM), providing various options for delivery.

• Acute active seizures (non-status epilepticus) (off-label):

  • It is given intravenously (IV) as 4 mg, with a maximum infusion rate of 2 mg per minute, for off-label use in non-status epileptic seizures.

  • If the convulsions persist, the administration can be repeated in 3 to 5 minutes.

• Status epilepticus:

  • It is administered intravenously (IV) at a dose of 4 mg, with a maximum infusion rate of 2 mg per minute.

  • The dose can be repeated in 3 to 5 minutes if seizures persist.

  • Even after seizures have stopped, it is recommended to use a non-benzodiazepine anti-seizure medication to prevent recurrence.

Lorazepam (Ativan) Dose in the treatment of Serotonin syndrome (serotonin toxicity) (off-label):

• Intravenously (IV), the dosage can vary based on the patient's response, with 2 to 4 mg given every 8 to 10 minutes.

Substance withdrawal:

• Lorazepam has various off-label uses, including the treatment of alcohol withdrawal syndrome.

• Fixed-dose regimens are often favored over symptom-triggered regimens, and the specific dose and frequency may vary based on institution-specific protocols.

• However, longer-acting benzodiazepines are generally recommended.

• For patients with liver dysfunction, shorter-acting benzodiazepines like lorazepam may be preferred.

• Due to unpredictable absorption, some professionals advise against using intramuscular (IM) administration in this context.

Symptom-triggered regimen:

• For both oral and intravenous (IV) administration, the recommended dosage is 2 to 4 mg as indicated.
• The dose and frequency are determined based on the severity of withdrawal symptoms, often assessed using a recognized severity assessment scale such as the Clinical Institute Withdrawal Assessment for Alcohol, revised scale (CIWA-Ar).

Fixed-dose regimen:

• For both oral and intravenous (IV) administration, the initial dose is 6 to 8 mg per day, divided into multiple doses, for one day.

• Subsequently, the dose should be gradually tapered off over the following three to four days.

• Depending on withdrawal symptoms and scores on established evaluation scales, further doses may be considered, such as using the Clinical Institute Withdrawal Assessment for Alcohol, revised scale (CIWA-Ar).

Opioid withdrawal (autonomic instability and agitation) (adjunctive therapy) (alternative agent) (off-label use):

• Based on limited studies, it can be given intravenously at a dosage of 1 to 2 mg every 10 minutes until hemodynamic stability and adequate sedation are achieved.

Lorazepam (Ativan) Dose as an alternative agent in the treatment of an acute episode of vertigo (off-label):

• For intramuscular (IM), intravenous (IV), or oral administration, the recommended dosage is 0.5 to 2 mg every 4 to 12 hours, as indicated, for a period of 24 to 48 hours.

Lorazepam (Ativan) Discontinuation of therapy:

• • When discontinuing the medication for patients on extended- or higher-dose benzodiazepine therapy, it's advisable to do so progressively to detect reemerging symptoms and reduce rebound and withdrawal effects, unless safety considerations require a faster withdrawal.

  • Based on response and tolerance, reduce the total daily dose by 10% to 20% every 1 to 2 weeks.

  • Each patient will have a unique taper rate and length, and those receiving higher doses may need up to 6 months.

  • For individuals on high doses, initiate a quicker taper initially and then gradually reduce the dose over time.

  • For example, halve the dose with weekly 25% reductions, then continue to cut back by around 12% every 4 to 7 days.

  • Consider using an equivalent dose of a benzodiazepine with a significantly longer half-life than 24 hours, in place of benzodiazepines like lorazepam, to facilitate a more gradual tapering in drug serum concentrations.

Lorazepam (Ativan) Dose in Childrens:

Lorazepam (Ativan) Dose in the treatment of Chemotherapy-induced nausea and vomiting, anticipatory:

• Infants, Children, and Adolescents:

  • The recommended oral dose is 0.04 to 0.08 mg/kg/dose, with a maximum dose of 2 mg per dose.

  • It is advised to administer one dose the night before chemotherapy and another dose the following morning before the chemotherapy session.

Lorazepam (Ativan) Dose in the treatment of Chemotherapy-associated nausea and vomiting, breakthrough: 

• Children and Adolescents:

  • The recommended intravenous (IV) dose is 0.025 to 0.05 mg/kg/dose every 6 hours as indicated, with the maximum dose set at 2 mg per dose.

Lorazepam (Ativan) Dose in the treatment of acute Anxiety:

• Infants and Children <12 years:

  • The standard regimen for oral and intravenous (IV) administration is 0.05 mg/kg/dose every 4 to 8 hours, with a maximum dose of 2 mg per dose.
  • The recommended range for the dose is 0.02 to 0.1 mg/kg/dose.

• Children ≥12 years and Adolescents:

  • It can be given orally at a dose of 0.25 to 2 mg per dose, two or three times per day.

  • The maximum dose per administration is 2 mg.

Lorazepam (Ativan) Dose for pre-procedural Sedation:

• Children and Adolescents:

  • The typical oral dose is 0.05 mg/kg, falling within a reported range of 0.02 to 0.09 mg/kg according to the literature.
  • For adults, the standard dose is 4 mg.

Lorazepam (Ativan) Dose in the treatment of Status epilepticus:

• Infants, Children, and Adolescents:

  • For intravenous (IV) administration, the recommended dose is 0.05 to 0.1 mg/kg, with a maximum dose of up to 4 mg per dose given slowly over 2 to 5 minutes.

  • It can be repeated in 5 to 15 minutes if necessary, with a usual total maximum dose of 8 mg.

  • IM administration is an option if IV is not possible.

  • Intranasal administration is reserved for patients without IV access, with a dose of 0.1 mg/kg, and a maximum dose of 4 mg per dose.

Dosing adjustment for lorazepam with concomitant medications:

• Children ≥12 years and Adolescents:

  • When administered concomitantly with either probenecid or valproic acid, the lorazepam dose should be reduced by half.

  • This adjustment helps manage potential interactions and ensures appropriate dosing in the presence of these medications.

Lorazepam Pregnancy Risk Category: D

• Lorazepam or its metabolite has the potential to cross the human placenta.

• Some benzodiazepines, including lorazepam, may have teratogenic effects, though additional research is needed to fully understand these effects.

• Maternal exposure to benzodiazepines could be associated with an increased risk of low birth weights and premature births.

• Exposure late in pregnancy may result in respiratory problems and hypoglycemia in neonates.

• Neonates exposed to certain benzodiazepines, such as lorazepam, may also experience withdrawal symptoms.

• It's important to note that the elimination of lorazepam in newborn infants is slow, and in utero exposure can lead to the excretion of lorazepam in term infants for up to 8 days after birth.

• Pregnant individuals or those planning to become pregnant should consult with healthcare professionals to carefully weigh the potential risks and benefits of using lorazepam during pregnancy.

Use Lorazepam while breastfeeding

• Lorazepam is secreted in breast milk, with the relative infant dose (RID) ranging from 2.4% to 4.7%.

• The RID should ideally be less than 10%, and some sources caution against breastfeeding if psychotropic agents have a RID of 5% or more.

• The highest total milk concentration, calculated after maternal administration of oral lorazepam (2.5 mg twice daily for the first five days postpartum), was 7.05 mg/kg/day.

• Adverse effects, such as sedation, lethargy, and irritability, have been reported in breastfed infants exposed to benzodiazepines, although these effects were not observed with lorazepam exposure.

• Breastfeeding mothers prescribed lorazepam should weigh the clinical benefits against potential risks, and exposure to single doses should be limited when possible.

• Lorazepam can cause sedation in breastfed babies, potentially impairing their ability to suckle.

• It is crucial to closely monitor breastfed infants for signs of drowsiness.

• If concerns arise, healthcare professionals should be consulted for personalized guidance.

Lorazepam (Ativan) Dose in Kidney Disease:

• In oral form, no dose adjustments are required.

• Parenteral:

  • In cases of mild to severe impairment, there is generally no need to change the dosage for single doses of lorazepam.

  • However, caution is advised when administering repeated doses, as it may increase the risk of propylene glycol poisoning.

  • Monitoring the osmolal gap closely is recommended when using lorazepam for extended periods or at high doses as an alternative marker for propylene glycol buildup.

  • Regular assessment and supervision by healthcare professionals are crucial in such situations.

Lorazepam (Ativan) Dose in Liver Disease:

• Oral:
  • If you have a little to medium problem:
  • You don't need to change the amount you take.
  • If you have a serious problem or brain disorder:
  • Be careful and take a smaller amount than usual.

• Parenteral:

  • If you have a small to medium problem:
  • Be careful when using it, but you don't need to change the dose.
  • If you have a serious problem or your liver isn't working well:
  • Don't use Midazolam according to the information in the literature.

Common Side Effects of Lorazepam (Ativan):

• Central nervous system:

  • Sedation
  • Drowsiness

• Local:

  • Pain at injection site

• Miscellaneous:

  • Paradoxical reaction

Less Common Side Effects of Lorazepam (Ativan):

• Cardiovascular:

  • Hypotension

• Central nervous system:

  • Restlessness
  • Unsteadiness
  • Excessive crying
  • Coma
  • Hallucinations
  • Confusion
  • Depression
  • Headache
  • Delirium
  • Stupor
  • Dizziness

• Local:

  • Erythema at injection site

• Neuromuscular & skeletal:

  • Asthenia

• Respiratory:

  • Respiratory failure
  • Hypoventilation
  • Apnea

Frequency of Side effects Not Defined:

• Central Nervous System:

  • Vertigo
  • Disorientation
  • Extrapyramidal Reaction
  • Suicidal Ideation
  • Dysarthria
  • Sleep Apnea (Exacerbation)
  • Euphoria
  • Memory Impairment
  • Hypothermia
  • Fatigue
  • Slurred Speech
  • Dysautonomia
  • Suicidal Tendencies
  • Drug Dependence
  • Withdrawal Syndrome
  • Disinhibition

• Dermatologic:

  • Skin Rash
  • Alopecia

• Endocrine & Metabolic:

  • Increased Lactate Dehydrogenase
  • Hyponatremia
  • SIADH
  • Change In Libido

• Gastrointestinal:

  • Constipation
  • Changes In Appetite

• Genitourinary:

  • Orgasm Disturbance
  • Impotence

• Hematologic & Oncologic:

  • Leukopenia
  • Pancytopenia
  • Agranulocytosis

• Hepatic:

  • Increased Serum Transaminases
  • Jaundice
  • Increased Serum Bilirubin

• Hypersensitivity:

  • Anaphylaxis
  • Hypersensitivity Reaction
  • Anaphylactoid Reaction

• Ophthalmic:

  • Visual Disturbance

• Respiratory:

  • Respiratory Depression
  • Exacerbation Of Chronic Obstructive Pulmonary Disease)

Contraindications to Lorazepam (Ativan):

• Injecting into an artery:

• If you have a type of glaucoma with sudden narrow-angle vision, it's not recommended.
• Except when you're on a machine helping you breathe (mechanical ventilation) or if you have serious trouble breathing.
• Using through injection:
• Don't use if you're very sensitive to polyethylene glycol or propylene glycol.
• Avoid if you have sleep apnea, are a premature infant, or have myasthenia gravis (a neuromuscular disorder).
• Also, if you are highly sensitive to lorazepam, any ingredient in it, or other benzodiazepines, it's not suitable.
• In Canada, there may be additional reasons not to use it that aren't mentioned in the US guidelines.

Warnings and precautions

• Anterograde amnesia

  • It can also be used together with benzodiazepines (BDZs).

• Depression in the CNS:

  • It's important to know that using it may cause CNS depression, which can lead to mental or physical limitations.

  • Patients should be informed about activities that require mental alertness, such as operating machinery or driving a vehicle.

• Paradoxical reactions

  • Unexpected effects, like increased activity or aggressive behavior, have been observed with benzodiazepines.

  • People with a history of alcohol abuse disorder, psychiatric disorders, or adolescents may be at a higher risk for these effects.

• Activities that are sleep-related:

  • Benzodiazepines can lead to risky sleep-related activities like driving, cooking, eating, and making phone calls while still asleep.

• Use of drugs:

  • Patients with a history of significant personality disorder or past alcohol/drug use have a higher risk of developing an addiction.
  • However, it's important to be cautious.
  • Using higher doses and taking it for a longer time may result in tolerance, psychological dependence, or physical dependence.
  • To lower the risk, it's recommended to limit treatment to the short term (between 2 and 4 weeks).
  • Before extending therapy, carefully assess whether continued treatment is necessary.

• Hepatic impairment

  • People with encephalopathy, hepatic impairment, or insufficiency should be careful when using it.
  • It's important not to take less than the regular dose, as it may worsen hepatic-encephalopathy.

• Psychiatric disorders

  • The treatment may trigger a return or worsening of pre-existing depression.

  • It's not advisable for use in primary depressive and psychotic disorders.

  • Individuals at a high risk of suicide should avoid using it without proper antidepressant treatment.

• Renal impairment

  • Patients with kidney problems should be careful.

• Respiratory disease

  • Patients with sleep apnea or chronic obstructive pulmonary disease (COPD) should be cautious.
  • Benzodiazepines have the potential to significantly reduce respiratory function.

Lorazepam: Drug Interaction

Monitoring parameters:

• Monitoring is important for various health indicators:

• Heart rate, blood pressure, and respiratory status:

  • Keep an eye on these vital signs.

• Anxiety symptoms:

  • Observe and manage anxiety symptoms.

• For long-term therapy, additional tests are recommended:

• Complete Blood Count (CBC):

  • Assess blood cell levels.

• Liver function tests:

  • Check how well the liver is functioning.

• LDH (Lactate Dehydrogenase):

  • Monitor LDH levels.

• Patients with renal impairment or high-dose IV or continuous IV use:

  • Regularly monitor these individuals.

• For Propylene glycol toxicemia, clinical signs and tests include:

• Serum creatinine, BUN (Blood Urea Nitrogen), serum Lactate, and osmol Gap:

  • Assess these values.

• Osmol gap greater than 10:

  • Indicates high propylene glycol concentrations.

• Values above 12:

  • Suggest propylene glycol toxicity.

• For critically ill patients:

• Use the RAS (Richmond Agitation-Sedation) or Sedation-Agitation Scale:
  • Evaluate and adjust sedation levels.

How to administer Lorazepam (Ativan)?

Intramuscular (IM):

• Inject directly into the muscle mass.

Intravenous (IV) injection:

• Dilute before use (follow the manufacturer's instructions).
• Administer over 2 to 5 minutes, not exceeding 2 mg/minute or 0.05 mg/kg.
• Monitor the IV site during administration.
• Avoid self-administration.

Oral Concentrate:

• Use the provided calibrated dropper for the recommended dose.
• Mix the dose with a liquid (water, juice, soda) or semi-solid meal (applesauce, pudding).
• Administer the mixture immediately.

Subcutaneous (SubQ):

• Use when other routes are not accessible, especially in comfort care settings.

Rectal:

• Administer the injectable solution rectally when other routes are not available, such as in comfort care settings.

Sublingual:

Oral Concentrate:

• Deliver sublingually when other routes (like comfort care settings) are not available.

Oral Tablet:

• Administer sublingually when other routes (like comfort care settings) are not available.

Sublingual Tablet [Canadian product]:

• Place under the tongue.
• The patient should not consume anything for at least two minutes.

Mechanism of action of Lorazepam (Ativan):

• This compound binds to specific GABA receptors in various parts of the central nervous system, such as the limbic and reticular systems.

• This binding increases the permeability of neuronal membranes to chloride ions, enhancing the inhibitory effects of GABA.

• This change in chloride ions leads to stability and hyperpolarization, putting neurons in a less excitable state.

• The GABA-A receptors, associated with the actions of benzodiazepines, are affected by this compound. However, GABA-B receptors are not influenced by benzodiazepines.

  Onset of action:

• Anticonvulsant (IV): Within 10 minutes
• Hypnosis (IM): 20 to 30 minutes
• Sedation (IV): Within 2 to 3 minutes

• Duration:

• Anesthesia premedication (Adults, IM, IV): Approximately 6 to 8 hours

• Absorption:

• IM: Rapid and complete absorption
• Oral: Readily absorbed

• Protein binding:

• Approximately 91%

• Metabolism:

• Hepatic; rapidly conjugated to lorazepam glucuronide (inactive)

• Bioavailability:

• Oral: 90%

• Half-life elimination:

• Full-term neonates (IV): 40.2 ± 16.5 hours; range: 18 to 73 hours
• Pediatric patients (IV):
  • 5 months to <3 years: 15.8 hours (range: 5.9 to 28.4 hours)
  • 3 to <13 years: 16.9 hours (range: 7.5 to 40.6 hours)
  • 13 to <18 years: 17.8 hours (range: 8.2 to 42 hours)
• Adults:
  • Oral: Approximately 12 hours
  • IV: Approximately 14 hours
  • IM: Approximately 13 to 18 hours
  • End-stage renal disease (ESRD): Approximately 18 hours

• Time to peak:

• IM: Up to 3 hours
• Oral: Approximately 2 hours
• Sublingual tablet [Canadian product]: 1 hour

• Excretion:

• Urine (~88%, predominantly as inactive metabolites)
• Feces (~7%)

International Brand Names of Lorazepam:

• Ativan
• LORazepam Intensol
• APO-LORazepam
• Ativan
• DOM-LORazepam
• PMS-LORazepam
• PRO-LORazepam
• TEVALORazepam
• Abinol
• Ansilor
• Anta
• Anxiar
• Anxira
• Anzepam
• Aplacasse
• Aripax
• Ativan
• Bonatranquan
• Control
• Donix
• Emotival
• Larpose
• Laubeel
• Lauracalm
• Lonza
• Lopa
• Lopam
• Lora
• Lora-Pita
• Lorabenz
• Lorafen
• Loram
• Lorans
• Loranxil
• Loravan
• Lorax
• Loraxen
• Lorazep
• Lorazepam-Efeka
• Lorazepam-Eurogenerics
• Lorazin
• Lorenin
• Loridem
• Lorivan
• Lorsilan
• Lozam
• Lozicum
• Merlit
• Merlopam
• Nervistop L
• Neuropam
• Novhepar
• Orfidal
• Renaquil
• Rilex
• Sedatival
• Sidenar
• Silence
• Sinestron
• Stapam
• Tavor
• Temesta
• Titus
• Tranqipam
• Trapax
• Trapex
• Vigiten

Lorazepam Brand Names in Pakistan: