Lorazepam: Difference between revisions
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{{MedTemplate | {{MedTemplate | ||
| generic | | generic = Lorazepam | ||
| brand | | brand = Ativan (oral, injectable), Loreev XR | ||
| structure | | structure = | ||
| classes | | classes = [[:Category:Benzodiazepines|Benzodiazepine]], [[:Category:Anxiolytics|Anxiolytic]], [[:Category:Schedule IV controlled substances|Schedule IV controlled substance]] | ||
| | | 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) | ||
| fda_max = | | pill_id = | ||
| routes | | routes = Oral, intramuscular, intravenous | ||
| onset | | onset = 30-60 minutes (oral); 5 minutes (IV); 15-30 minutes (IM) | ||
| duration | | duration = 6-8 hours | ||
| halflife | | 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> | ||
| bioavailability = ~90% (oral)<ref name="ativan-label" /> | |||
| pregnancy = Some signal for cleft lip/palate with first-trimester exposure (debated); neonatal sedation and withdrawal with third-trimester exposure.{{citation needed}} | |||
| 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" /> | |||
| | | 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" />. | ||
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== References == | |||
<references /> | |||
[[Category:Benzodiazepines]] | |||
[[Category:Anxiolytics]] | [[Category:Anxiolytics]] | ||
[[Category:Schedule IV controlled substances]] | |||