CNS: amnesia, agitation, ataxia, depression, disorientation, dizziness, drowsiness, headache, incoordination, asthenia.
Controlled substance schedule IV.
CV (with too rapid I.V. administration): hypotension, bradycardia, tachycardia, apnea, cardiac arrest, cardiovascular collapse.
CNS depressants (including antidepressants, antihistamines, benzodiazepines, sedative-hypnotics): additive CNS depression. Drug-drug.
Pregnancy risk category D.
☞ Monitor for signs and symptoms of overdose (such as confusion, hypotension, coma, and labored breathing). • Assess liver function tests and CBC.
Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression.
Smoking: increased metabolism and decreased efficacy of lorazepam.
Unknown. Thought to depress CNS at limbic system and disrupt neurotransmission in reticular activating system.
Solution (concentrated): 2 mg/ml.
Tablets: 0.5 mg, 1 mg, 2 mg.
Alcohol use: increased CNS depression. Drug-behaviors.
Injection: 2 mg/ml, 4 mg/ml.
• Hypersensitivity to drug, other benzodiazepines, polyethylene or propylene glycol, or benzyl alcohol • Acute angle-closure glaucoma • Coma or CNS depression • Hepatic or renal failure.
Apo-Lorazepam (CA), Ativan, Dom-Lorazepam (CA), Novo-Lorazem (CA), Nu-Loraz (CA), PHL-Lorazepam (CA), PMS-Lorazepam (CA), Pro-Lorazepam (CA) Pharmacologic class: Benzodiazepine Therapeutic class: Anxiolytic.
Adults: 2 to 4 mg P.O. at bedtime.
injection at least 2 hours before surgery, or 0.044 mg/kg (not to exceed 2 mg) I.V. 15 to 20 minutes before surgery. ➣ Status epilepticus. Adults: 0.05 mg/kg (not to exceed 4 mg) deep I.M. For greater amnestic effect, give up to 0.05 mg/kg (not to exceed 4 mg) I.V. 15 to 20 minutes before surgery.
EENT: blurred vision, diplopia, nystagmus.
☞ Give each 2 mg of I.V. Don't exceed rate of 2 mg/minute. • Don't give parenteral form to children younger than age 18. dose slowly, over 2 to 5 minutes.
Other: increased or decreased appetite.
If seizures continue or recur after 10 to 15 minutes, repeat dose. Adults: 4 mg I.V. given slowly (no faster than 2 mg/minute). If seizure control isn't established after second dose, other measures should be used. Don't exceed 8 mg in 12 hours.
➣ Premedication before surgery (as antianxiety agent, sedative-hypnotic, or amnestic).
Institute safety precautions as needed to prevent injury. • Watch closely for CNS depression. administration, monitor ECG and cardiovascular and respiratory status. • Evaluate for amnesia. • Monitor vital signs closely. ☞ During I.V.
Use cautiously in: • hepatic or renal impairment • history of suicide attempt, drug abuse, depressive disorder, or psychosis • elderly patients • pregnant or breastfeeding patients.
• Elderly or debilitated patients.
Hormonal contraceptives: increased lorazepam clearance.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above. Recommend appropriate safety precautions. • Instruct patient to avoid alcohol, because it increases drowsiness and other CNS effects. • l patient and family about drug's possible CNS effects. • Advise female patient to inform prescriber if she is pregnant or breastfeeding. • Explain that with long-term use, drug must be discontinued slowly (typically over 8 to 12 weeks). • Caution patient to avoid smoking, because it speeds drug breakdown in body.
• Acute alcohol withdrawal syndrome.
• For I.V. use, dilute with equal volume of compatible diluent, such as normal saline solution or dextrose 5% in water. Keep resuscitation equipment and oxygen at hand.
⊘ Indications and dosages ➣ Anxiety.
GI: nausea, abdominal discomfort.
daily in two or three divided doses. ➣ Insomnia. Adults: 2 to 3 mg P.O. Maximum dosage is 10 mg daily.Lorazepam