Dr. C P Ravi Kumar
Dr. C. P. Ravi Kumar Lead & Senior Consultant – Paediatric Neurology, The Krishna Institute of Medical Sciences (KIMS), Mahadevapura, Bangalore
What is Lorazepam
Lorazepam belongs to a class of medications called benzodiazepines which is used to reduce the frequency of seizures. In addition, it is used in many other conditions.
What is Lorazepam used for?
- Seizures
- Akathisia, antipsychotic induced
- Anxiety
- Catatonia
- To prevent / treat Chemotherapy induced nausea and vomiting
- In side effects from drug abuse
- for sedation mechanically ventilated patients in the ICU
- Neuroleptic malignant syndrome
- Serotonin syndrome
- Substance withdrawal
What is Lorazepam available as?
- Immediate release and extended-release tablets.
- Oral solution/liquid syrup (not widely available in India)
- Injectable solution.
How does Lorazepam act (mechanism of action)?
Lorazepam enhances the effect of GABA, the brain’s main inhibitory neurotransmitter, by binding to GABA-A receptors. This increases the flow of chloride ions into neurons, making them less likely to fire. The result is sedation, reduced anxiety, muscle relaxation, and seizure control.
LORAZEPAM VS CLONAZEPAM
- Lorazepam: Shorter-acting, often used for short-term anxiety, sedation, and seizures. It has a quicker onset and a shorter duration (8-12 hours).
- Clonazepam: Longer-acting, used for long-term anxiety, panic disorders, and seizures. It has a longer duration (18-50 hours) and is more potent per milligram.
Both are benzodiazepines, but Clonazepam tends to stay in the system longer, while Lorazepam is better for acute use.
How much time does Lorazepam take to act?
Lorazepam is well absorbed after oral administration. Peak blood levels are reached in 2 hours after taking medicine. Depending on the dosage and individual response, the drug may last anywhere from six to eight hours.
Is Lorazepam important for you/your child’s treatment?
YES, it is important that you/your child takes lorazepam regularly to relive anxiety disorders.
Do not stop using Lorazepam without asking your doctor. If you abruptly stop taking the medication after using it for a long time, you can have withdrawal symptoms.
What is the ideal time to take Lorazepam?
The best time to consume Lorazepam depends on the underlying medical issue. For anxiety, it’s usually taken during the day when symptoms are most noticeable, while for insomnia, it is best taken at night, about 30 minutes before bedtime. Always follow your doctor’s instructions for timing and dosage.
NEVER GIVE A DOUBLE DOSE OF LORAZEPAM.
You can give the medication dosage again if your child throws up within 30 minutes of taking it, but if they throw up after 30 minutes, you should just leave it alone and not give them the medication again.
How should I give Lorazepam?
Oral solution/ syrup: Oral solution/syrup: Use the provided measuring tool (not a kitchen spoon) to measure the oral concentration (liquid). Combine the liquid with juices, water, or semi-solid meals like custard or apple sauce.
Swallow this mixture right away. Store syrup in the refrigerator. Any syrup that isn’t utilised within 90 days should be thrown out.
Tablets: Swallow the extended-release tablets whole and do not crush, chew, break, or open it.
Injection: Injections are given in the hospital sector as directed by your doctor.
When Should I take Lorazepam?
Lorazepam can be taken either before or after food, as it does not significantly affect how the body absorbs the medication. However, if you experience any stomach discomfort when taking it on an empty stomach, you can take it after food to help reduce this. Always follow your doctor’s instructions for the best use based on your specific situation.
Could this medication have any side effects?
Every medicine can have potential side effects, even though it does not happen to everyone. Knowing possible side effects helps in taking quick action if needed. Rarely, serious reactions can occur—seek medical help right away if you notice any unusual or severe symptoms.
Adverse reactions (Side effects) of Lorazepam:
- Injection site: Pain or redness at site of Intramuscular injection (uncommon route of use)
- Nervous system: Drowsiness, feeling sedated, Dizziness, confusion, delirium, hallucinations, Seizures, abnormal gait, or memory problems
- Heart related: Low or high blood pressure
- Muscle related: Weakness or unsteadiness
- Respiratory: Breathing problems like slow breathing or apnea (rare)
- Gastrointestinal: Nausea, vomiting, or drooling
- Blood related: Low blood platelets
- Liver related: Liver issues or abnormal liver tests
- Hypersensitivity: Allergic reactions like anaphylaxis (serious)
Very Rare or Uncommon:
- Mental health: Agitation, confusion, disorientation, or even suicidal thoughts
- Ear related: Hearing loss
- Miscellaneous: Paradoxical Reactions (opposite of what is expected)
If you/your child start developing skin Rash, Stop Medications right there and SEEK IMMEDIATE MEDICAL ADVICE from your DOCTOR.
Sometimes you/your child may experience other side-effects that are not listed above. If you notice any abnormalities with your child’s body or behaviour, do not hesitate and immediately contact your doctor.
Can I take any other common or regular medicines during the course of Lorazepam?
You can take some common medicines, like paracetamol or vitamins, while on lorazepam, but you need to be careful because it can interact with other drugs. Medicines that cause drowsiness, such as sedatives, sleeping medicine, opioids, or certain antidepressants, can increase lorazepam’s sedative effects, and alcohol should be avoided completely. Some drugs can also affect how lorazepam is broken down in the body, so it’s important to tell your doctor or pharmacist about all medications or supplements you are taking.
Lorazepam contraindications
- Hypersensitivity (Allergy)
- Severe Respiratory Insufficiency
- Severe Hepatic Impairment
- Acute Narrow-Angle Glaucoma
- Myasthenia Gravis
- Pregnancy (especially in the first trimester)
- Breastfeeding
It is important to consult with a doctor before taking lorazepam, especially if there are any underlying health conditions or if other medications are being taken.
What foods should I avoid while taking Lorazepam?
- Alcohol: Must avoid alcohol as it may increase the risk of dizziness and drowsiness.
- Caffeine: Caffeine can counteract the sedative effects of lorazepam, making it less effective.
- Fatty foods: Fatty foods can slow down the absorption of Lorazepam, leading to delayed effects. Avoid consuming fatty foods like fried foods, processed meats, and high-fat dairy products.
- Tyramine-rich foods: Tyramine is an amino acid found in certain foods that can interact with Lorazepam. Avoid consuming tyramine-rich foods like fermented meats (salami, parmesan), red wine, marinated or pickled foods.
PREGNANCY AND LACTATION:
In general, taking lorazepam while pregnant is not advised, particularly in the first several months. For breastfeeding mothers, it’s best to talk to your doctor before taking lorazepam to ensure it’s the right choice for you.
If I get pregnant while using Lorazepam, is there any risk?
If you conceive while taking Lorazepam, there may be some risks, especially during the early stages of pregnancy. your doctor can assess the situation and help you decide whether to continue the medication or check for safer alternatives. Always consult your healthcare provider if you’re planning to conceive or if you find out you’re pregnant while on lorazepam.
MONITORING PARAMETERS:
- Respiratory rate
- cardiovascular status namely, BP, heart rate,
- Symptoms of anxiety
- Mental alertness.
- Long-term therapy: CBC, Lactate Dehydrogenase, liver function tests
How can one manage Lorazepam side effects?
- Dizziness: To prevent falls, utilise furniture or a wall for support. Avoid machinery works and driving.
- Fatigue: Engaging in physical activity, even a brief walk, can help increase your energy levels. Additionally, taking short naps during the day can be effective.
- Heart rhythm changes and severe allergic reactions: If you experience changes in your heartbeat, along with chest pain, difficulty breathing, or light-headedness, get medical attention immediately.
- Suicidal thoughts: If you experience any changes in your mood or thoughts while on Lorazepam, contact your healthcare provider.
SUMMARY:
Lorazepam is a medicine that calms the brain and is used to treat anxiety, sleep problems, and seizures; it can make you feel sleepy, relaxed, or less anxious, but may also cause dizziness, tiredness, or mild memory issues, and should be avoided by people with breathing problems, severe liver disease, or those who are pregnant or breastfeeding; it is safe for short-term use, but long-term use can lead to dependence, so it should only be started or stopped after consulting a doctor.
Let us know if this information was useful!
REFERENCE:
Author:
- Dr. Likitha B S, Pharm. D, Clinical Pharmacologist, Aster Hospitals, Bengaluru
- Dr Praveen Kumar, B. Pharm, Pharm D(PB), Lead Clinical Pharmacologist, REGIONAL HEAD KIMS Hospitals, Bengaluru
- Dr. C. P. Ravi Kumar Lead & Senior Consultant – Paediatric Neurology KIMS HOSPITALS BENGALURU
