Lorazepam , active ingredient lorazepam , is a drug belonging to the category of benzodiazepines used for the treatment of anxiety, tension, and other somatic manifestations associated with the anxious syndrome, insomnia. The drug acts by stimulating the γ-aminobutyric acid system, called GABA, which is the main inhibitory neurotransmitter in mammals. Elimination of the drug occurs mostly through urinary excretion.
Lorazepam administration must be modulated according to the patient's response; it is important that there is a balance between the minimum dose needed to treat symptoms and the duration, which should be as short as possible. Furthermore, the presentation of withdrawal symptoms appears to be a risk in patients who abruptly stop taking the therapy, which is why there is an indication for a gradual decrease in the dosage of the drug; at the same time, any dose increase should take place gradually to avoid adverse reactions.
Thanks to its beneficial effect on mood concomitant with protection against psychic stress, Lorazepam can be administered in combination with antidepressant therapy, strengthening the effect, completing it, and partly accelerating it.
The recommended dose varies according to the type and severity of the disease to be treated; in general, most patients respond to therapy of two / three doses/day of 1 milligram, up to 2.5-milligram tablets in the most severe cases. In the elderly patient, it is recommended not to exceed 2 milligrams/day.
For all patients undergoing therapy, it is recommended to administer a higher dose in the evening to have effective sleep and to optimize the daytime hours by favoring the performance of daily activities.
The plasma concentration of Lorazepam is reached within two to three hours of administration and the half-life of the drug is approximately 14 hours. Lorazepam can be found in solution, tablet or injectable.
Contraindications to the use of Lorazepam
Lorazepam is contraindicated in patients with known hypersensitivity to benzodiazepines, myasthenia gravis, respiratory failure, severe syndrome, sleep apnea, liver failure severe.
The administration of Lorazepam during pregnancy and lactation is not indicated.
Lorazepam can induce an increased sedative effect if its intake is concomitant with that of alcoholic substances. The association with other psychotropic drugs must be carefully evaluated by the prescriber.
It can induce depressive effects on the central nervous system (CNS) when administered concomitantly with opioids, alcohol, or other drugs that act on the CNS such as neuroleptics, hypnotics, antidepressants, antiepileptics.
Lorazepam and side effects
Lorazepam can cause more or less common side effects, such as: drowsiness during the day, altered libido, ataxia, mental confusion, nausea, muscle weakness, fatigue. Rarer: dizziness, hypothermia, urinary retention, liver dysfunction.
It manifests itself in varying degrees of CNS depression ranging from drowsiness, dysarthria, mental confusion to coma states. Overdose problems occur predominantly in combination with alcohol and/or other medications.
Following oral intake of excessive doses, it may be necessary to induce vomiting (within one hour of dosing) in alert patients or to undertake gastric lavage with airway protection in case of an unconscious patient. Activated charcoal should be administered to reduce absorption.
Also commercially available is the antidote, flumazenil, which can be administered in acute poisoning to antagonize the binding of benzodiazepines to the GABA receptor.
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