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Lorazepam: Difference between revisions

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{{MedTemplate
{{MedTemplate
| generic           = Lorazepam
| generic           = Lorazepam
| brand             = Ativan
| brand             = Ativan (oral, injectable), Loreev XR
| structure         =  
| 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)
| 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    =
| bioavailability   = ~90% (oral)<ref name="ativan-label" />
| pregnancy         =  
| pregnancy        = Some signal for cleft lip/palate with first-trimester exposure (debated); neonatal sedation and withdrawal with third-trimester exposure.{{citation needed}}
| legal              =  
| 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" />
| intro              =
| 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" />.
| pharmacokinetics   =  
| pharmacodynamics  =  
| indications        =  
| dosing             =  
| effects            =
| interactions      = <pharmaInteractions/>
| pregnancy_details  =
| monitoring         =  
| counseling        =  
| anecdotes          =
| seealso            =
| references        =  
}}
}}


== References ==
<references />


[[Category:Anxiolytics & Sedative-Hypnotics]]
[[Category:Benzodiazepines]]
[[Category:Benzodiazepines]]
[[Category:Anxiolytics]]
[[Category:Anxiolytics]]
[[Category:Schedule IV controlled substances]]

Latest revision as of 06:56, 23 May 2026

Benzodiazepine, Anxiolytic, Schedule IV controlled substance
Lorazepam
Ativan (oral, injectable), Loreev XR

Experience

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Problems

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Titration strategies

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Effects

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Summary
Classes
Benzodiazepine, Anxiolytic, Schedule IV controlled substance
Common uses
Anxiety disorders (FDA)0, Preoperative sedation (FDA, IV)0, Status epilepticus (FDA, IV; first-line per current guidelines)0, Alcohol withdrawal (off-label, often first-line in hepatic impairment)0, Acute agitation (off-label, IM)0, Chemotherapy-induced nausea (off-label adjunct)0
Pharmacy
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
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
US FDA Max
10 mg/day (anxiety, oral)
Pharmacology
Routes
Oral, intramuscular, intravenous
Onset
30-60 minutes (oral); 5 minutes (IV); 15-30 minutes (IM)
Duration
6-8 hours
Half-life
12-15 hours (intermediate); no active metabolites (key clinical feature)[1]
Bioavailability
~90% (oral)[1]
Pregnancy
Some signal for cleft lip/palate with first-trimester exposure (debated); neonatal sedation and withdrawal with third-trimester exposure.[citation needed]
Legal status
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[1]
Purported mechanism
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.0 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[1].

References

  1. ↑ 1.0 1.1 1.2 1.3 FDA Prescribing Information, Ativan (lorazepam), Bausch/Pfizer, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/017794s044lbl.pdf
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