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Back to Psychiatry Drug Index
Name: Lorazepam
Pregnancy Category D
C-IV controlled substance
Drug classes
- Benzodiazepine
- Antianxiety drug
- Sedative/hypnotic
Therapeutic actions
Exact mechanisms of action are not understood; acts mainly at subcortical
levels of the CNS, leaving the cortex relatively unaffected. Main sites
of action may be the limbic system and reticular formation; benzodiazepines
potentiate the effects of GABA, an inhibitory neurotransmitter; anxiolytic
effects occur at doses well below those necessary to cause sedation
and ataxia.
Indications
Management of anxiety disorders or for short-term relief of symptoms
of anxiety or anxiety associated with depression (oral)
Preanesthetic medication in adults to produce sedation, relieve anxiety,
and decrease recall of events related to surgery (parenteral)
Unlabeled parenteral use-management of status epilepticus, chemotherapy
induced nausea and vomiting, acute alcohol withdrawal
Contraindications/cautions
Contraindicated in the presence of hypersensitivity to benzodiazepines,
propylene glycol, polyethylene glycol or benzyl alcohol (parenteral lorazepam);
psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication
with depression of vital signs; pregnancy (crosses the placenta; risk
of congenital malformations and neonatal withdrawal syndrome); labor and
delivery ("floppy infant" syndrome reported when mothers were given benzodiazepines
during labor); and lactation.
Use caution in the presence of impaired liver or kidney function or
debilitation.
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Adverse effects
- CNS: Transient, mild drowsiness initially; sedation, depression,
lethargy, apathy, fatigue, lightheadedness, disorientation, anger, hostility,
episodes of mania and hypomania, restlessness, confusion, crying, delirium,
headache, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia,
vertigo, euphoria, nervousness, difficulty concentrating, vivid dreams,
psychomotor retardation, extrapyramidal symptoms; mild paradoxical excitatory
reactions during first 2 wk of
treatment
- GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia,
vomiting, difficulty in swallowing, gastric disorders, hepatic dysfunction
- CV: Bradycardia, tachycardia, cardiovascular collapse, hypertension
and hypotension, palpitations, edema
- Hematologic: Elevations of blood enzymes: LDH, alkaline phosphatase,
SGOT, SGPT; blood dyscrasias: agranulocytosis, leukopenia
- GU: Incontinence, urinary retention, changes in libido, menstrual
irregularities
- EENT: Visual and auditory disturbances, diplopia, nystagmus, depressed
hearing, nasal congestion
- Dermatologic: Urticaria, pruritus, skin rash, dermatitis
- Other: Hiccups, fever, diaphoresis, paresthesias, muscular disturbances,
gynecomastia. Drug dependence with withdrawal syndrome when drug is
discontinued; more common with abrupt discontinuation of higher dosage
used for longer than 4 mo.
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