Lorazepam: Difference between revisions

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{{MedTemplate

| generic = Lorazepam

| brand = Ativan

| brand = Ativan (oral, injectable), Loreev XR

| structure =

| classes = Benzodiazepine, Anxiolytic

| classes = [[:Category:Benzodiazepines|Benzodiazepine]], [[:Category:Anxiolytics|Anxiolytic]], [[:Category:Schedule IV controlled substances|Schedule IV controlled substance]]

| ~~mechanism = GABAA positive allosteric modulator~~

| uses = <vote slug="anxiety-disorders-broad-use">Anxiety disorders (FDA)</vote>, <vote slug="preoperative-sedation-use">Preoperative sedation (FDA, IV)</vote>, <vote slug="status-epilepticus-use">Status epilepticus (FDA, IV; first-line per current guidelines)</vote>, <vote slug="alcohol-withdrawal-use">Alcohol withdrawal (off-label, often first-line in hepatic impairment)</vote>, <vote slug="agitation-acute-use">Acute agitation (off-label, IM)</vote>, <vote slug="chemotherapy-induced-nausea-use">Chemotherapy-induced nausea (off-label adjunct)</vote>

| uses =

| starting_dose = Anxiety: 0.5-1 mg PO BID-TID. Insomnia: 1-2 mg PO at bedtime. Status epilepticus: 4 mg IV (adult), repeat after 5-10 minutes if needed. Acute agitation: 1-2 mg IM

| starting_dose =

| preparations = Tablets 0.5, 1, 2 mg; oral concentrate 2 mg/mL; injection 2 mg/mL and 4 mg/mL; Loreev XR capsules 1, 2, 3 mg

| preparations =

| fda_max = 10 mg/day (anxiety, oral)

| ~~routes =~~

| pill_id =

~~| onset~~ =

| routes = Oral, intramuscular, intravenous

| ~~duration~~ =

| onset = 30-60 minutes (oral); 5 minutes (IV); 15-30 minutes (IM)

| ~~halflife~~ =

| duration = 6-8 hours

| ~~bioavailability~~ =

| halflife = 12-15 hours (intermediate); '''no active metabolites''' (key clinical feature)<ref name="ativan-label">FDA Prescribing Information, Ativan (lorazepam), Bausch/Pfizer, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/017794s044lbl.pdf</ref>

| ~~pregnancy~~ =

| bioavailability = ~90% (oral)<ref name="ativan-label" />

| ~~legal~~ =

| pregnancy = Some signal for cleft lip/palate with first-trimester exposure (debated); neonatal sedation and withdrawal with third-trimester exposure.{{citation needed}}

~~| intro~~ =

| legal = [[USLegal:Schedule IV|Schedule IV controlled substance]] in US. Carries the benzodiazepine class '''Boxed Warning''' for risk of fatal respiratory depression, coma, and death when combined with opioids<ref name="ativan-label" />

| ~~pharmacokinetics~~ =

| mechanism = <vote slug="lorazepam-mech-claim">Positive allosteric modulator of the GABA-A receptor at the benzodiazepine binding site (α-γ subunit interface), enhancing chloride ion conductance and consequent neuronal inhibition. The intermediate half-life sits between short-acting alprazolam and long-acting diazepam/clonazepam, making lorazepam a clinically versatile choice.</vote> Metabolized by '''glucuronidation rather than CYP''', so unlike alprazolam and diazepam, lorazepam has minimal CYP-mediated interactions, and the lack of active metabolites makes it the preferred benzodiazepine in elderly patients and in hepatic impairment. Tolerance, dependence, and significant withdrawal syndrome on abrupt discontinuation; slow taper essential after extended use<ref name="ativan-label" />.

~~| pharmacodynamics~~ =

| ~~indications~~ =

| ~~dosing~~ =

| ~~effects~~ =

| ~~contraindications =~~

~~| interactions =~~

~~| pregnancy_details =~~

~~| monitoring~~ =

~~| counseling~~ =

~~| anecdotes =~~

~~| seealso =~~

~~| references~~ =

}}

== References ==

[[Category:Benzodiazepines]]

[[Category:Anxiolytics]]

[[Category:Schedule IV controlled substances]]

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