lorazepam

Pronunciation

Generic Name: lorazepam (injection) (lor A ze pam)
Brand Name: Ativan

What is lorazepam injection?

Lorazepam is in a group of drugs called benzodiazepines (ben-zoe-dye-AZE-eh-peens). Lorazepam affects chemicals in the brain that may become unbalanced and cause anxiety.

Lorazepam injection is used to treat a seizure emergency called status epilepticus. This medication is also used as a sedative to help you relax before having surgery.

Lorazepam injection may also be used for purposes not listed in this medication guide.

What is the most important information I should know about lorazepam injection?

If possible, before you receive lorazepam injection, tell your doctor if you have narrow-angle glaucoma, kidney or liver disease, sleep apnea, asthma, COPD, or other breathing problems.

Also tell your doctor if you are allergic to lorazepam or to other benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), or oxazepam (Serax).

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Lorazepam can cause birth defects in an unborn baby, and generally should not be used during pregnancy. However, status epilepticus is a life-threatening emergency and the benefit of receiving lorazepam to treat it may outweigh any risk to the unborn baby.

Do not drink alcohol shortly after receiving lorazepam injection.

Avoid using other medicines that make you sleepy. They can add to sleepiness caused by lorazepam injection.

In an emergency situation it may not be possible before you are treated to tell your caregivers about your health conditions or if you are pregnant or breast feeding. Make sure any doctor caring for you afterward knows that you have received this medication.

After treatment with lorazepam injection, you will be watched to make sure the medication does not cause harmful side effects.

What should I discuss with my healthcare provider before using lorazepam injection?

If possible before you receive lorazepam injection, tell your doctor if you are allergic to any drugs, or if you have:

  • narrow-angle glaucoma;

  • sleep apnea or severe breathing problem;

  • asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing disorders;

  • kidney disease;

  • liver disease; or

  • if you are allergic to lorazepam or to other benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), or oxazepam (Serax).

If you have any of these conditions, you may not be able to receive lorazepam injection, or you may need a dose adjustment or special tests during treatment.

FDA pregnancy category D. Lorazepam can cause birth defects in an unborn baby, and generally should not be used during pregnancy. However, status epilepticus is a life-threatening condition and the benefit of receiving lorazepam to treat it may outweigh any risk to the unborn baby.

In an emergency situation, it may not be possible before you are treated with lorazepam to tell your caregivers if you are pregnant or breast feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medication.

It is not known whether lorazepam injection passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How is lorazepam injection given?

Lorazepam is injected into a vein through an IV. You will receive this injection in an emergency or surgical setting.

After treatment with lorazepam injection, you will be watched to make sure the medication is working and does not cause harmful side effects.

Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while you in surgery.

Lorazepam can make you very drowsy, dizzy, or light-headed. These effects may last longer in older adults. Use caution to avoid falling or accidental injury after you have received lorazepam injection. You may need help getting out of bed for at least the first 8 hours.

What happens if I miss a dose?

Since lorazepam injection is given by a healthcare professional in an emergency setting, you are not likely to miss a dose.

What happens if I overdose?

Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

What should I avoid after receiving lorazepam injection?

Lorazepam injection can cause extreme drowsiness that may last for 24 to 48 hours after you have received the medication. Older adults may feel sleepy for even longer.

Avoid driving or doing anything that requires you to be awake and alert until the effects of lorazepam have worn off completely.

Do not drink alcohol within the first 1 or 2 days after you receive lorazepam injection. This medication can increase the effects of alcohol.

Lorazepam injection side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Tell your caregivers at once if you have any of these serious side effects:

  • weak or shallow breathing;

  • seizure (convulsions);

  • hyperactivity, agitation, hostility;

  • hallucinations;

  • unusual thoughts or behavior; or

  • feeling like you might pass out.

Less serious side effects may include:

  • drowsiness, dizziness;

  • headache;

  • blurred vision;

  • skin rash;

  • nausea, vomiting; or

  • pain or burning where the medicine was injected.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Lorazepam dosing information

Usual Adult Dose for ICU Agitation:

IV, intermittent:
Initial dose: 1 to 4 mg IV every 10 to 20 minutes to control acute agitation.
Maintenance dose: 1 to 4 mg IV every 2 to 6 hours and as needed to maintain desired level of sedation.

IV, continuous infusion:
0.01 to 0.1 mg/kg/hr IV to maintain desired level of sedation.
High-dose infusions (greater than 18 mg/hour for more than 4 weeks, or greater than 25 mg/hour for several hours or days) have been associated with tubular necrosis, lactic acidosis and hyperosmolality states due to the polyethylene glycol and propylene glycol solvents.

Usual Adult Dose for Anxiety:

Oral:
Initial dose: 1 mg orally 2 to 3 times a day.
Maintenance dose: 1 to 2 mg orally 2 to 3 times a day. The daily dosage may vary from 1 to 10 mg/day orally.

IV:
Alternatively, an initial intravenous dose of 2 mg or 0.044 mg/kg, whichever is smaller, may be given.

Usual Adult Dose for Insomnia:

2 to 4 mg orally at bedtime

Usual Adult Dose for Light Anesthesia:

Premedication for Anesthesia:
IM: 0.05 mg/kg up to a maximum of 4 mg.
IV: 2 mg total, or 0.044 mg/kg, whichever is smaller.
This dose should not ordinarily be exceeded in patients over 50 years of age.
Larger doses as high as 0.05 mg/kg up to a total of 4 mg may be administered.

Usual Adult Dose for Nausea/Vomiting:

Oral or IV: 0.5 to 2 mg every 4 to 6 hours as needed

Usual Adult Dose for Status Epilepticus:

4 mg/dose slow IV over 2 to 5 minutes (maximum rate: 2 mg/minute); may repeat in 10 to 15 minutes; usual total maximum dose: 8 mg

Usual Pediatric Dose for Nausea/Vomiting -- Chemotherapy Induced:

Children: IV: Limited information exists, especially for multiple doses:

Single dose: 0.04 to 0.08 mg/kg/dose prior to chemotherapy (maximum dose: 4 mg)

Multiple doses: Some centers use 0.02 to 0.05 mg/kg/dose (maximum dose: 2 mg) every 6 hours as needed

Usual Pediatric Dose for Anxiety:

Infants and Children: Usual: 0.05 mg/kg/dose (maximum dose: 2 mg/dose) every 4 to 8 hours; range: 0.02 to 0.1 mg/kg

Usual Pediatric Dose for Sedation:

Sedation (preprocedure): Infants and Children:

Oral, IM, IV: Usual: 0.05 mg/kg; range: 0.02 to 0.09 mg/kg

IV: May use smaller doses (e.g., 0.01 to 0.03 mg/kg) and repeat every 20 minutes, as needed to titrate to effect

Usual Pediatric Dose for Status Epilepticus:

Infants and Children: 0.05 to 0.1 mg/kg (maximum: 4 mg/dose) slow IV over 2 to 5 minutes (maximum rate: 2 mg/minute); may repeat every 10 to 15 minutes if needed.

Adolescents: 0.07 mg/kg (maximum: 4 mg/dose) slow IV over 2 to 5 minutes (maximum rate: 2 mg/minute); may repeat in 10 to 15 minutes if needed; usual total maximum dose: 8 mg.

What other drugs will affect lorazepam injection?

Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by lorazepam. Tell your doctor if you will need to use any of these other medicines within 48 hours after you receive lorazepam injection.

Tell your doctor about all other medicines you use, especially:

  • birth control pills;

  • probenecid (Benemid);

  • valproate (Depakene);

  • a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Luminal, Solfoton);

  • an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate);

  • medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), clozapine (Clozaril, FazaClo), haloperidol (Haldol), loxapine (Loxitane), mesoridazine (Serentil), pimozide (Orap), or thioridazine (Mellaril);

  • narcotic medications such as butorphanol (Stadol), codeine, hydrocodone (Lortab, Vicodin), levorphanol (Levo-Dromoran), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Kadian, MS Contin, Oramorph), naloxone (Narcan), oxycodone (OxyContin), or propoxyphene (Darvon, Darvocet); or

  • antidepressants such as amitriptyline (Elavil, Vanatrip, Limbitrol), amoxapine (Asendin), citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), paroxetine (Paxil), protriptyline (Vivactil), sertraline (Zoloft), or trimipramine (Surmontil).

This list is not complete and other drugs may interact with lorazepam injection. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about lorazepam injection.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 2.01. Revision Date: 2011-03-10, 10:47:27 AM.

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