lorazepam

Pronunciation

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

What is lorazepam?

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 is used to treat anxiety disorders.

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

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

Do not use this medication if you are allergic to lorazepam or to other benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), or oxazepam (Serax).

This medication can cause birth defects in an unborn baby. Do not use lorazepam if you are pregnant.

Before taking lorazepam, tell your doctor if you have any breathing problems, glaucoma, kidney or liver disease, or a history of depression, suicidal thoughts, or addiction to drugs or alcohol.

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Do not drink alcohol while taking lorazepam. This medication can increase the effects of alcohol.

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

Lorazepam may be habit-forming and should be used only by the person it was prescribed for. Lorazepam should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

It is dangerous to try and purchase lorazepam on the Internet or from vendors outside of the United States. Medications distributed from Internet sales may contain dangerous ingredients, or may not be distributed by a licensed pharmacy. Samples of lorazepam purchased on the Internet have been found to contain haloperidol (Haldol), a potent antipsychotic drug with dangerous side effects. For more information, contact the U.S. Food and Drug Administration (FDA) or visit www.fda.gov/buyonlineguide.

What should I discuss with my healthcare provider before taking lorazepam?

It is dangerous to try and purchase lorazepam on the Internet or from vendors outside of the United States. Medications distributed from Internet sales may contain dangerous ingredients, or may not be distributed by a licensed pharmacy. Samples of lorazepam purchased on the Internet have been found to contain haloperidol (Haldol), a potent antipsychotic drug with dangerous side effects. For more information, contact the U.S. Food and Drug Administration (FDA) or visit www.fda.gov/buyonlineguide.

Do not use this medication if you have narrow-angle glaucoma, or if you are allergic to lorazepam or to other benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), or oxazepam (Serax).

Before taking lorazepam, tell your doctor if you are allergic to any drugs, or if you have:

  • glaucoma;

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

  • kidney or liver disease;

  • a history of depression or suicidal thoughts or behavior; or

  • a history of drug or alcohol addiction.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take this medication.

FDA pregnancy category D. Lorazepam can cause birth defects in an unborn baby. Do not use lorazepam without your doctor's consent if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

It is not known whether lorazepam passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

The sedative effects of lorazepam may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking lorazepam.

Do not give this medication to a child younger than 12 years old.

How should I take lorazepam?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Measure the liquid form of lorazepam with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Lorazepam should be used for only a short time. Do not take this medication for longer than 4 months without your doctor's advice.

Lorazepam may be habit-forming and should be used only by the person it was prescribed for. Lorazepam should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

Contact your doctor if this medicine seems to stop working as well in treating your symptoms.

Do not stop using lorazepam suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

Your symptoms may return when you stop using lorazepam after using it over a long period of time. You may also have seizures or withdrawal symptoms when you stop using lorazepam. Withdrawal symptoms may include tremor, sweating, muscle cramps, stomach pain, vomiting, unusual thoughts or behavior, and seizure (convulsions).

To be sure this medication is not causing harmful effects, your doctor may need to check your progress on a regular basis. Do not miss any scheduled visits to your doctor.

Store lorazepam at room temperature away from moisture, heat, and light.

Store the liquid form of lorazepam in the refrigerator.

Keep track of how many pills have been used from each new bottle of this medicine. Benzodiazepines are drugs of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of lorazepam can be fatal.

Overdose symptoms may include extreme drowsiness, confusion, muscle weakness, fainting, or coma.

What should I avoid while taking lorazepam?

Do not drink alcohol while taking lorazepam. This medication can increase the effects of alcohol.

Lorazepam can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

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 regularly use any of these other medicines.

Lorazepam 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.

Call your doctor at once if you have any of these serious side effects:

  • confusion, depressed mood, thoughts of suicide or hurting yourself;

  • hyperactivity, agitation, hostility;

  • hallucinations; or

  • feeling light-headed, fainting.

Less serious side effects may include:

  • drowsiness, dizziness, tiredness;

  • blurred vision;

  • sleep problems (insomnia);

  • muscle weakness, lack of balance or coordination;

  • amnesia or forgetfulness, trouble concentrating;

  • nausea, vomiting, constipation;

  • appetite changes; or

  • skin rash.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. 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?

Before taking lorazepam, tell your doctor if you are using any of the following drugs:

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

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

  • medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), haloperidol (Haldol), 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), propoxyphene (Darvon, Darvocet); or

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

This list is not complete and there may be other drugs that can interact with lorazepam. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about lorazepam.
  • 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: 7.07. Revision Date: 2010-12-15, 5:01:39 PM.

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